Faculty of Health and Environmental Sciences

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The research carried out at AUT's Faculty of Health and Environmental Sciences can be broadly defined in three themes:

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30-year trends in stroke rates and outcome in Auckland, New Zealand (1981-2012): a multi-ethnic population-based series of studies
(PLoS One, 2015) Feigin, VL; Krishnamurthi, RV; Barker-Collo, S; McPherson, KM; Barber, PA; Parag, V; Arroll, B; Bennett, DA; Tobias, M; Jones, A; Witt, E; Brown, P; Abbott, M; Bhattacharjee, R; Rush, E; Suh, FM; Theadom, A; Rathnasabapathy, Y; Te Ao, B; Parmar, PG; Anderson, C; Bonita, R; ARCOS IV Group
Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.
Comparing an Additional High-risk Gambler Cohort With National Gambling Study High-risk Gamblers. NGS Series Report Number 7
(Gambling and Addictions Research Centre, Auckland University of Technology, 2018-07-03) Bellringer, M; Prah, P; Garrett, N; Abbott, M
Background The New Zealand National Gambling Study (NGS) is a nationally representative longitudinal survey of adults aged 18 years and older. The purpose of the NGS is to provide information on the prevalence, incidence, nature and effects of gambling in New Zealand. Participants in the NGS were recruited in 2012 (Wave 1), and then re-interviewed annually in 2013 to 2015 (Waves 2 to 4). It is important to note that in 2013 (Wave 2), due to budgetary constraints, attempts were only made to re-contact 5,266 (84%) of the original 6,251 participants meaning that 985 participants (16%) were lost to the study because no re-contact attempt was made. In 2012, there were 1481 moderate-risk and problem gamblers amongst the 6,251 participants. Subsequently, the number was 75, 55 and 57 in 2013, 2014 and 2015 respectively. As the number of moderate-risk and problem gamblers in the NGS is relatively small (about two percent of participants), this limits the extent of statistical analyses that can be performed, especially when sub-group analyses are required. Therefore, an additional cohort of 1062 adult (aged 18 years and older) moderate-risk and problem gamblers was recruited from gambling venues and via advertisements in 2014/15, and re-assessed in 2015/16. The cohort was a self-selected convenience sample recruited in Auckland, Christchurch, Hamilton and Wellington from August 2014 to July 2015. From September 2015 to July 2016, 70 participants were re-contacted and re-interviewed (66% response rate). Participants were sought via advertisements placed in the jobs section of a national auction and classifieds website, advertisements on a national employment website (in the volunteer section) and via gambling venues (casino and Class 43 venues). The four cities were selected as they are the major cities in New Zealand with a range of available gambling opportunities. The questionnaires used for the additional cohort were the same as those used in Wave 1 (2012) and Wave 2 (2013) of the NGS, so that additional cohort data could be used to supplement NGS data. The questionnaire incorporated a range of measures on gambling participation, gambling strategies and cognitions, gambling attitudes, problem gambling, health and well-being, psychological status, substance use/misuse, life events, social capital/support and demographic information. Findings from the NGS study to date have been published in a series of six reports. The Wave 1 results are presented in three reports covering an overview of gambling and gambling participation findings (Abbott, Bellringer, Garrett, & Mundy-McPherson, 2014a), gambling harm and problem gambling (Abbott et al., 2014b), and attitudes towards gambling (Abbott et al., 2015a). The Wave 2, Wave 3 and Wave 4 results are detailed in three further reports (Abbott et al., 2015b; Abbott et al., 2016, Abbott et al., 2018). This report is the seventh in the series. As the results from the additional cohort are compared with data from NGS Wave 1 and Wave 2 data, this report should be read in conjunction with those reports, in particular, report number 1 (Abbott et al, 2014a), report number 2 (Abbott et al., 2014b) and report number 4 (Abbott et al., 2015b).
Effectiveness of Problem Gambling Brief Telephone Interventions: A Randomised Controlled Trial
(Ministry of Health – Manatū Hauora, New Zealand Government, 2012-12-13) Abbott, M; Bellringer, M; Vandal, A; Hodgins, D; Palmer Du Preez, K; Landon, J; Sullivan, S; Feigin, V
Summary of project/aims AUT was contracted by the Ministry of Health in January 2009 to deliver a study of the effectiveness of interventions for problem gambling. Five key aims were agreed for this project, which were to: - generate reliable findings on the effectiveness of intervention services in producing positive outcomes on a range of measures and impact on others - increase the body of evidence available on the clinical effectiveness of common problem gambling intervention practices in New Zealand and inform future clinical practice - compare the effectiveness (on a range of outcomes) of common problem gambling interventions in New Zealand with common problem gambling intervention practices that have been validated internationally, including pharmaceutical interventions - identify client characteristics that mitigate the effectiveness of validated interventions, with particular attention to client ethnicity and primary gambling mode - develop a potential two stage research proposal that builds upon this project to provide additional evidence on the long-term effectiveness and outcomes of the treatment under trial.
Effectiveness of Problem Gambling Interventions in a Service Setting: A Protocol for a Pragmatic Randomised Controlled Clinical Trial
(BMJ Publishing Group Ltd., 2017-03-01) Abbott, M; Bellringer, M; Vandal, AC; Hodgins, DC; Battersby, M; Rodda, SN
Introduction: The primary purpose of this study is to evaluate the relative effectiveness of 2 of the best developed and most promising forms of therapy for problem gambling, namely face-to-face motivational interviewing (MI) combined with a self-instruction booklet (W) and follow-up telephone booster sessions (B; MI+W+B) and face-to-face cognitive-behavioural therapy (CBT). Methods and analysis: This project is a single-blind pragmatic randomised clinical trial of 2 interventions, with and without the addition of relapse-prevention text messages. Trial assessments take place pretreatment, at 3 and 12 months. A total of 300 participants will be recruited through a community treatment agency that provides services across New Zealand and randomised to up to 10 face-to-face sessions of CBT or 1 face-toface session of MI+W+up to 5 B. Participants will also be randomised to 9 months of postcare text messaging. Eligibility criteria include a self-perception of having a current gambling problem and a willingness to participate in all components of the study (eg, read workbook). The statistical analysis will use an intent-to-treat approach. Primary outcome measures are days spent gambling and amount of money spent per day gambling in the prior month. Secondary outcome measures include problem gambling severity, gambling urges, gambling cognitions, mood, alcohol, drug use, tobacco, psychological distress, quality of life, health status and direct and indirect costs associated with treatment. Ethics and dissemination: The research methods to be used in this study have been approved by the Ministry of Health, Health and Disability Ethics Committees (HDEC) 15/CEN/99. The investigators will provide annual reports to the HDEC and report any adverse events to this committee. Amendments will also be submitted to this committee. The results of this trial will be submitted for publication in peerreviewed journals and as a report to the funding body. Additionally, the results will be presented at national and international conferences.
Epidemiology of Stroke Long-term Trends in Stroke Incidence in New Zealand: 1981-2012
(John Wiley & Sons, 2014) Abbott, M; Feigin, VL; Krishnamurthi, R; Barker-Collo, S; McPherson, K; Parag, V; Bonita, R; Tobias, M; Arroll, B; Bennett, D; Witt, E; Jones, A; Bhattarcharjee, R; Parmar, P; Barber, AP
Background: In the context of declining stroke mortality rates, reliable data on long-term trends of stroke incidence and case fatality is required to understand reasons for the decline and to plan long-term health care stroke services and to monitor the effects of stroke prevention in the community.
Evaluation and Clinical Audit of Problem Gambling Intervention and Public Health Services
(Auckland University of Technology, 2015-09-25) Kolandai-Matchett, K; Landon, J; Bellringer, M; Garrett, N; Mundy-McPherson, S; Abbott, M; Haapu, B; Cumming, S
No abstract.
Evaluation of Problem Gambling Intervention Services: Stage Three Final Report
(Auckland University of Technology (AUT), 2010-07-01) Bellringer, M; Coombes, R; Pulford, J; Garrett, N; Abbott, M
The Ministry of Health is responsible for the funding and coordination of problem gambling services and activities in New Zealand. This includes the funding of a national telephone helpline, two national face-to-face counselling services and several regional treatment providers which include Maori and Pacific specific services (Asian specific services are provided as a division of one of the national face-to-face treatment providers) (Ministry of Health, 2008a). From 2008, the Ministry of Health funded face-to-face problem gambling treatment providers have received specific training around the Ministry of Health expectations for service practice requirements (e.g. the types of intervention that will be funded and the processes expected within those interventions as well as for referrals for co-existing issues), and expectations around data collection, management and information submission to the Ministry of Health. The Ministry of Health has also identified specific sets of screening instruments to be used with clients, which vary depending on whether the client is receiving a Brief or Full-length intervention, or is a problem gambler or family/whanau member („significant other‟) of a gambler. These screening instruments came into use in 2008, with different sets of instruments having been used previously. At the present time, the effectiveness of the current problem gambling treatment services is largely unknown, as is the optimal intervention process for different types of client. Whilst this sort of information can ultimately only be ascertained through rigorously conducted effectiveness studies (randomised controlled trials) (Westphal & Abbott, 2006), an evaluation (process, impact and outcome) of services could provide indications as to optimal treatment pathways and approaches for problem gamblers and affected others, as well as identifying successful strategies currently in existence nationally and internationally and areas for improvement in current service provision. In September 2008, the Gambling and Addictions Research Centre at Auckland University of Technology was commissioned by the Ministry of Health to conduct the research project Evaluation of problem gambling intervention services. This project was to focus on four priority areas: 1.) Review and analysis of national service statistics and client data to inform workforce development, evaluation of the Ministry of Health systems and processes, and other related aspects 2.) Process and outcome1 evaluation of the effect of different pathways to problem gambling services on client outcomes and delivery 3.) Process and outcome1 evaluation of distinct intervention services 4.) Process and outcome1 evaluation of the roll-out and implementation of Facilitation Services2
Evaluation of Problem Gambling Intervention Services: Stages One and Two Final Report
(Auckland University of Technology (AUT), 2009-03-01) Bellringer, M; Coombes, R; Garrett, N; Nahi, P; Pulford, J; Abbott, M
Background The Ministry of Health is responsible for the funding and coordination of problem gambling services and activities in New Zealand. This includes the funding of a national telephone helpline, two national face-to-face counselling services and several regional treatment providers which include Maori and Pacific specific services (Asian specific services are provided as a division of one of the national face-to-face treatment providers) (Ministry of Health, 2008a). From 2008, Ministry funded face-to-face problem gambling treatment providers have received specific training around Ministry expectations for service practice requirements (e.g. the types of intervention that will be funded and the processes expected within those interventions as well as for referrals for co-existing issues), and expectations around data collection, management and information submission to the Ministry. The Ministry has also identified specific sets of screening instruments to be used with clients, which vary depending on whether the client is receiving a brief or full-length intervention, or is a problem gambler or family/whanau member (‘significant other’) of a gambler. These screening instruments came into use in 2008, with different sets of instruments having been used previously. At the present time, the effectiveness of the current problem gambling treatment services is largely unknown, as is the optimal intervention process for different types of client. Whilst this sort of information can ultimately only be ascertained through rigorously conducted effectiveness studies (randomised controlled trials) (Westphal & Abbott, 2006), an evaluation (process, impact and outcome) of services could provide indications as to optimal treatment pathways and approaches for problem gamblers and affected others, as well as identifying successful strategies currently in existence and areas for improvement in current service provision. In September 2008, the Gambling and Addictions Research Centre at Auckland University of Technology was commissioned by the Ministry of Health to conduct the research project Problem gambling: Evaluation of problem gambling intervention services. This project focused on four priority areas: 1.) Review and analysis of national service statistics and client data to inform workforce development, evaluation of Ministry systems and processes, and other related aspects 2.) Process and outcome evaluation of the effect of different pathways to problem gambling services on client outcomes and delivery 3.) Process and outcome evaluation of distinct intervention services 4.) Process and outcome evaluation of the roll-out and implementation of Facilitation Services
Evaluation of the Partners for Change Outcome Management System (PCOMS) in a Gambling Treatment Setting
(Auckland University of Technology, Gambling and Addictions Research Centre, 2019-06-21) Bellringer, M; Kolandai-Matchett, K; Janicot, S; Michie, E; Garrett, N; Van Kessel, K; Abbott, M
No abstract.
Exploration of the Impact of Gambling and Problem Gambling on Pacific Families and Communities in New Zealand
(Gambling and Addictions Research Centre, AUT University, 2013-01-09) Bellringer, M; Fa'amatuainu, B; Taylor, S; Coombes, R; Poon, Z; Abbott, M
No abstract.
Family Violence Among Help-seeking Gamblers: The Effect of Having Dependent Children
(Springer, 2017) Bellringer, M; Pearson, J; Koziol-McLain, J; Abbott, M
This study investigated the effect of problem gambler gender on the relationship between the gambler having dependent children (younger than 18 years) living at home and the gambler perpetrating or being a victim of family violence. The sample comprised 164 help-seeking gamblers (43% female; 37% with dependent child/ren) recruited from three national gambling treatment services in New Zealand. Family violence was measured using a modified version of the HITS scale covering physical, psychological, verbal, emotional and sexual violence. Forty-nine percent of participants reported being a victim of violence and 43% had perpetrated violence. Multivariable logistic regression modelling was conducted, adjusting in sequence for significant socio-demographic, psychosocial and gambling factors. The relationship between having dependent children and being a victim of family violence was gender-related. Female gamblers living with dependent children reported more family violence perpetration and victimisation than male gamblers living with dependent children. Female gamblers with dependent children living at home had greater odds of being a victim of family violence than male gamblers without dependent children living at home. This relationship remained when adjusted for contextual factors of being a victim (ethnicity, income support status, and feelings of inadequacy) in this sample. A similar gender effect of having dependent children living at home on violence perpetration disappeared when known psychosocial contextual factors of violence perpetration (aggression, difficulties in emotion regulation, drug issue in the family, and interpersonal support) were taken into account. These findings suggest the value of coordinated approaches between gambling treatment services and programmes supporting vulnerable families in order to identify vulnerable families and put support mechanisms in place.
Formative Investigation Into the Effectiveness of Gambling Venue Exclusion Processes in New Zealand
(Auckland University of Technology (AUT), 2010-06-01) Bellringer, M; Coombes, R; Pulford, J; Abbott, M
Exclusion of patrons from gambling venues is potentially an effective early intervention for minimising harm from excessive gambling since it may contribute to the treatment and/or recovery of people with developing and established gambling problems. Internationally, some jurisdictional regulations mandate „imposed exclusion‟ programmes, where gamblers with problems are identified by venue staff (usually casinos) and barred from gambling at those venues. In other jurisdictions, „self-exclusion‟ programmes are in place, where gamblers may request that they be banned from the venue, removed from its mailing list and potentially face legal consequences if they re-enter the premises. Traditionally, such self-exclusion programmes have been operated by casinos but increasingly are being required for clubs and pubs where electronic gaming machines are located. In New Zealand, The Gambling Act 2003 stipulates that both imposed- and self- exclusion measures should be operated. The Act refers to these exclusion measures as an "order‟ but colloquial use of the term "contract‟ has been used throughout this report due to the word usage amongst participants in this research and in the literature. However, there is a paucity of research regarding the effectiveness of gambling venue exclusion processes per se and even less information outside the casino environment. In addition, the effectiveness of the particular processes in force in New Zealand has not been evaluated. Currently, different processes are operated by different venues, for example with variations in minimum and maximum exclusion periods, and different requirements for re-entering the gambling venue when an exclusion contract comes to an end. Given that exclusion programmes consume private and public resources and are a legislated requirement, it is important that their effectiveness be ascertained. This will have substantial implications in terms of the potential to improve existing processes to ensure maximum minimisation of harms from gambling. In August 2008, the Gambling and Addictions Research Centre at Auckland University of Technology was commissioned by the Ministry of Health to conduct the research project Formative investigation into the effectiveness of gambling venue exclusion processes in New Zealand. The purpose of this project was two-fold: a) to ascertain the most suitable methodology and processes for researching venue excluders in order to robustly evaluate the effectiveness of current venue exclusion processes, and b) to gain some initial insight into the effectiveness of gambling (particularly electronic gaming machine and casino) venue exclusion processes in New Zealand.
Formative Investigation of the Links Between Gambling (Including Problem Gambling) and Crime in New Zealand
(Auckland University of Technology (AUT), 2009-02-09) Bellringer, M; Abbott, M; Coombes, R; Brown, R; McKenna, B; Dyall, L; Rossen, F
Crime (illegal behaviours) constitutes a continuum ranging from undetected, unreported, and unprosecuted crimes through to prosecuted, convicted and sentenced crimes; any of these may be associated with gambling/problem gambling. There may also be behaviours considered marginally illegal, for example welfare beneficiaries obtaining additional benefit and not disclosing that benefit money has been used for gambling, or business owners using business cash for gambling and not declaring cash as income for tax purposes. These behaviours are difficult to detect and even if detected may be considered morally socially unacceptable but not necessarily criminal and thus not reported to police. There may also be other behaviours, for example embezzlement of employer funds or stealing from family that are clearly criminal and may be detected, but are not likely to be reported to save embarrassment of either the victim or the perpetrator, or even to protect the perpetrator. In some instances, these crimes are not readily linked to gambling. Additionally, there are financial crimes to support gambling, situational crimes associated with gambling venues, violence associated with gambling and family/whanau crime associated with gambling. In November 2006, the Gambling and Addictions Research Centre at Auckland University of Technology, in collaboration with the Centre for Gambling Studies at the University of Auckland, was commissioned by the Ministry of Health to conduct the research project Problem gambling – Formative investigation of the links between gambling (including problem gambling) and crime in New Zealand. The purpose of this project was to develop a better understanding of the nature of the links between gambling and crime, with particular reference to unreported crime and the nature of the resulting harms experienced by individuals, families/whanau and communities.
Gambling Behaviours and Associated Risk Factors for 17 Year Old Pacific Youth
(Auckland University of Technology, 2019-03-27) Bellringer, M; Prah, P; Iusitini, L; Abbott, M
Summary This study is a component of the Pacific Islands Families Study, which is a longitudinal cohort study of a birth cohort of 1,398 Pacific infants who were recruited into the study from a South Auckland hospital in 2000. In 2017, the cohort children were 17 years old and an extensive set of gambling-related questions was included in their survey. Six hundred and thirty-two youth were surveyed. Research has shown that Pacific adults are less likely to participate in gambling activities than European adults but that those who do gamble have a higher risk of developing levels of harmful gambling. The reasons for the increased risk are not well understood and the gambling behaviours of Pacific youth, which could lead to adult gambling behaviours, are even less researched. This research report begins to address this gap in knowledge.
Holding a Mirror to Society? Sociodemographic Diversity Within Clinical Psychology Training Programmes Across Aotearoa
(New Zealand Medical Association, 2019) Scarf, D; Waitoki, W; Chan, J; Britt, E; Nikora, LW; Neha, T; Schimanski, I; Macfarlane, AH; Macfarlane, S; Bennett, ST; Hunter, JA; Arahanga-Doyle, HG; Abbott, M
No abstract.
Including Gaming Disorder in the ICD-11: The Need to Do so From a Clinical and Public Health Perspective
(Akadémiai Kiadó Zrt, 2018) Rumpf, H-J; Achab, S; Billieux, J; Bowden-Jones, H; Carragher, N; Demetrovics, Z; Higuchi, S; King, DL; Mann, K; Potenza, M; Saunders, JB; Abbott, M; Ambekar, A; Aricak, OT; Assanangkornchai, S; Bahar, N; Borges, G; Brand, M; Chan, EM-L; Chung, T; Derevensky, J; Kashef, AE; Farrell, M; Fineberg, NA; Gandin, C; Gentile, DA; Griffiths, MD; Goudriaan, AE; Grall-Bronnec, M; Hao, W; Hodgins, DC; Ip, P; Király, O; Lee, HK; Kuss, D; Lemmens, JS; Long, J; Lopez-Fernandez, O; Mihara, S; Petry, NM; Pontes, HM; Rahimi-Movaghar, A; Rehbein, F; Rehm, J; Scafato, E; Sharma, M; Spritzer, D; Stein, DJ; Tam, P; Weinstein, A; Wittchen, H-U; Wölfling, K; Zullino, D; Poznyak, V
The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.
Lotteries Literature Review: Final Report
(AUT University, 2008) Bellringer, M; Abbott, M
This report provides an overview of available literature relating to lotteries products, based on five specific question areas of focus: • To what extent do lotteries products in general and New Zealand lotteries products in particular appeal to problem and under-age gamblers? Do someproducts appeal more than others and, if so, can this be described? • What policies, programmes, codes of practice and corporate social responsibility guidelines have other lotteries adopted and is there any evidence about the impact these have had on problem and under-age gamblers? • What other lotteries have made existing or new products available on the internet or via electronic media and what impact, if any, have these had on problem and under-age gambling? • What is the role of lotteries marketing in shaping people’s views on participating in lotteries and about gambling in general? • What education programmes or materials have been developed to educate gamblers about responsible gambling and are there examples of ‘good practice’ in this area? The review was commissioned by the New Zealand Lotteries Commission in order that research gaps could be identified and recommendations made for research that the New Zealand Lotteries Commission could potentially contract. The review consisted of an extensive search of library and other electronic databases, personal specialist collections and grey literature. Professional and personal networks were also drawn on to locate unpublished reports and more especially, organisational documents relating to social responsibility and/or educational programmes and materials that might otherwise not have been easily accessible via the public domain. Relevant documentation was accessed and critically reviewed. Background and contextual information is provided in Chapter 1. Chapter 2 outlines the methodology used. The literature review (Chapter 3) comprises the main body of the report and is followed by the conclusion (Chapter 4), identified research gaps (Chapter 5) and recommendations for research (Chapter 6). Key points from the review follow, grouped under the five questions areas of focus.
Maternal Gambling Associated With Families' Food, Shelter and Safety Needs: Findings From the Pacific Island Families Study
(Centre for Addiction and Mental Health (Toronto), 2007) Schluter, PJ; Bellringer, M; Abbott, M
From a cohort study of Pacific families with children resident in Auckland (n = 983) we examine the association between maternal gambling over the previous 12 months and families' food, shelter, and safety needs. Overall, 666 (68%) mothers reported no gambling, 267 (27%) reported gambling but receiving no criticism, and 50 (5%) reported both gambling and receiving criticism. Compared to those with nongambling mothers, households with gambling mothers were more likely to have both food and housing issues related to a lack of money but no excess in physical intimate partner violence.
Measuring the Burden of Gambling Harm in New Zealand
(New Zealand Ministry of Health, 2017) Browne, M; Bellringer, M; Greer, N; Kolandai-Matchett, K.; Langham, E; Rockloff, M; Du Preez, K.P.; Abbott, M
Project overview The Ministry of Health engaged Central Queensland University’s (CQU) Experimental Gambling Research Laboratory and Auckland University of Technology’s (AUT) Gambling and Addictions Research Centre to develop a framework and a methodology for understanding and measuring gambling-related harm in the New Zealand population. The aim of the project was to systematically investigate gambling-related harm in New Zealand, and assess the aggregate ‘Burden of Harm’ caused by gambling with reference to different levels of problem gambling, and other comparable conditions. This improved understanding of the quality and quantity of harm will help to better target efforts to prevent or reduce the potential negative consequences of problematic gambling.
A Mixed Methods Analysis of Gambling Harm for Women in New Zealand
(Gambling and Addictions Research Centre (GARC), Auckland University of Technology (AUT) for the Ministry of Health, 2019-08-02) Palmer Du Preez, K; Mauchline, L; Paavonen, A; Thurlow, R; Garrett, N; Bellringer, M; Landon, J; Abbott, M
The World Health Organization (WHO) supports multiple layers of gender analysis in health research and policy, accounting for personal and community-level impacts of gender, and investigation of the interactions between sex and gender and their dual impact on health. Gender informed analyses have rarely been conducted in gambling studies, where insufficient attention has been given to gender as an analytical category and/or theoretical construct. Gambling studies have looked at the impacts of gambling on women, however little research has explored gambling harm in New Zealand as a gendered, multifaceted phenomenon involving the interplay of environmental, social and individual level factors. Mixed methods studies are useful for studying dynamic and complex inter-relationships, and understanding multi-layered issues, yet are used relatively rarely in gambling research. Accordingly, gaps in our current understanding of how women are affected by gambling, as both gamblers and as affected others, are likely to constrain harm prevention reduction efforts. Two overarching research questions were posed: How do gender related issues, notions and practices influence women’s gambling related harm in New Zealand What are the implications for women’s gambling harm reduction? A mixed methods approach was selected to enable a multifaceted exploration of the context, issues and factors influencing women’s gambling related harm in New Zealand, and suggest pathways for harm reduction. Three different methods of data analysis were employed across four datasets, to produce a polyvalent understanding. The three methods were: discourse analysis, thematic analysis and factor analysis with multivariate modelling. The research design comprised four components: poststructural analysis of literature positioning women in relation to gambling practices and harm, analysis of women’s experiences of gambling harm in New Zealand, gender analysis of population data related to gambling behaviour and gambling problems in New Zealand and finally, synthesis of findings in relation to harm prevention and reduction. This research demonstrated that women’s gambling and harm in New Zealand are multifaceted phenomena. Gambling studies have shaped and arguably constrained responses to preventing and minimising women’s gambling harm: tending to focus attention narrowly on individual women’s psychological wellbeing. Gender issues and ideology infuse gambling practices and experiences of harm. Women’s socio-cultural positioning as primary caregivers for families contributes to gambling harm by placing unrealistic expectations on women, while simultaneously constraining their ability to prioritise their own wellbeing, and access rest, relaxation and support. Gambling venues in local communities appear to offer women respite, distraction, comfort, time-out and/or connection – while placing them at heightened risk of experiencing problems and harm. Promising avenues for addressing gambling harm for women in New Zealand include reducing EGM gambling opportunities in community settings, promoting gender equality and women’s community connectedness in gambling harm prevention and reduction activities, and explicit and ongoing commitment to gender-aware gambling harm reduction research, policy and practice.

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