title: The relationship between player losses and gambling-related harm: evidence from nationally representative cross-sectional surveys in four countries.
abstract: OBJECTIVE
  Flaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity.
  
  
  METHODS
  Four cross-sectional surveys.
  
  
  METHODS
  Nationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002).
  
  
  METHODS
  A total of 10 632 Australian adults, 3120 Canadian adults, 4484 people aged 15-74 years in Finland and 5235 people aged 15-74 years in Norway.
  
  
  METHODS
  Problem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index.
  
  
  RESULTS
  Risk curves for total gambling losses were estimated to be r-shaped in Australia {β losses = 4.7 [95% confidence interval (CI) = 3.8, 6.5], β losses(2 =)  -7.6 (95% CI = -17.5, -4.5)}, Canada [β losses = 2.0 (95% CI = 1.3, 3.9), β losses(2 =)  -3.9 (95% CI = -15.4, -2.2)] and Finland [β losses = 3.6 (95% CI = 2.5, 7.5), β losses(2 =)  -4.4 (95% CI = -34.9, -2.4)] and linear in Norway [β losses = 1.6 (95% CI = 0.6, 3.1), β losses(2 =)  -2.6 (95% CI = -12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships.
  
  
  CONCLUSIONS
  Player loss-risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm.
authors.affiliation: Fenner School of Environment and Society, The Australian National University, Acton, Australia.
authors.forename: Francis
authors.identifier: http://orcid.org/0000-0002-4266-2569
authors.initials: F
authors.lastname: Markham
authors.affiliation: School of Business and Tourism, Southern Cross University, Coffs Harbour, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Young
authors.affiliation: Fenner School of Environment and Society, The Australian National University, Acton, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Doran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003617:Dangerous Behavior; D005260:Female; D005387:Finland / Q000453:epidemiology; D005715:Gambling / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
keywords: Electronic gaming machines; dose-response; gambling; gambling expenditure; gambling losses; gambling-related harm; problem gambling; public health; risk curves