Transcript Acculturation and Gambling Among Hispanics

Hispanic Gamblers and the
CPGTSP Outpatient Program
Michael Campos, Ph.D.
UCLA Gambling Studies Program
Phone: 310.825.6427
E-mail: [email protected]
 2010 Census Data (Ennis et al., 2011)
 2006 California Problem Gambling Prevalence
Survey Data (Volberg et al., 2006)
 2012 Outpatient CPGTSP Program Demographic
and Utilization Data (UGSP 2013)
Definition of Hispanic
2010 Census:
“Hispanic or Latino” refers to a person of Cuban,
Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin regardless of race.
Diversity of the Hispanic Population
 Country of origin
 Racial background
 Reasons for immigration
 Length of time in U.S.
 Generational Status
 Language Preference
 Acculturation
U.S. Demographic Trends
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308.7 million people resided in the U.S. in 2010.
50.5 million (16%) were of Hispanic origin.
Increase from 35.3 million (13%) in 2000
Represents the majority of growth in the total
population.
Between 2000 and 2010 the Hispanic population grew by
43% which was 4 times the national growth rate.
U.S. Demographic Trends
 Three quarters of Hispanics reported being of
Mexican, Puerto Rican, or Cuban origin.
 Mexican origin = 63%
 Puerto Rican = 9%
 Cuban = 4%
U.S. Demographic Trends
 Population Increases among other Hispanic groups:
 Salvadoran = 152%
 Guatemalan = 180%
 South Americans = 105%
 Dominicans = 85%
California Demographics
 CA population = 37,253,956
 CA Hispanic population = 14,013,719
 37.6% of CA residents were Hispanic
 Majority (81%) were Mexican origin or heritage
 CA ranks first in population for 4 of 7 Hispanic groups
Hispanic Population by County
Key Points
 Hispanics are a large and growing segment of the
population.
 The majority of Hispanics in the US are of Mexican
origin or heritage, but trends show increasing diversity
within the Hispanic population.
 In California, Hispanics comprise over 1/3 of the total
population, with the large majority being of Mexican
origin or heritage.
Culture and Mental Health
 A patient’s cultural background may influence
 Description of symptoms
 Meaning imparted to illness
 Causation and prevalence for some disorders, but not others
 Coping styles
 Treatment seeking
 Stigma
 A clinician’s cultural background may influence
 Communication
 Diagnosis
 Conceptions of Mental Illness
 Assumptions about what a clinician is (and is not) supposed to do
Source: Mental Health: Culture, Race, and Ethnicity, SAMHSA, 2001
Gambling Among U.S. Hispanics
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Few nationally representative samples
Others sampled from Texas, New Mexico, Florida, Minnesota
All cross-sectional surveys or interviews
General areas of studies:
 Epidemiology
 Help Line Usage
 Co-morbidities
Prevalence of Gambling Problems
 Studies show elevated prevalence rates for problem or
pathological gambling among Hispanics relative to
Non-Hispanic Caucasians (Stinchfield, 1997; Welte et
al., 2001; Westermeyer et al., 2005)
Help Seeking for Gambling
Problems
Source: Caudrado, 1999
Key Points
 Few studies have examined gambling among
Hispanics and for the most part they have focused on
epidemiology.
 Most studies show increased prevalence of gambling
problems among Hispanics relative to Non-Hispanic
Caucasians.
 Help seeking for gambling problems among Hispanics
is lower than that of Non-Hispanic Caucasians.
CA Prevalence Survey Data
Gambling Problem Grouping
 Assessed using the NODS (Gerstein et al., 1999).
 Used the same four groups as in the CA Problem
Gambling Prevalence Survey Final Report:
 Non-Gambler/Non-Problem Gambler
 At-Risk (1 to 2 NODS items endorsed)
 Problem (3 to 4 NODS items endorsed)
 Pathological Gambler (5 or more NODS items endorsed)
Prevalence of Gambling
Problems
** p < 0.01
Preferred Games for Past Year
Gamblers
**
**
**
*
* p < 0.05; ** p < 0.01
Key Points
 Problem, but not pathological gambling, is higher among Hispanics
relative to Non-Hispanics, particularly among males.
 Past year gambling is lower among Hispanic females relative to Non-
Hispanic females.
 Counter to expectations, we did not see a preference for action oriented
games among Hispanic males.
Spanish Speaking Gambling
Treatment Providers
Gambling Problem Prevalence by
CA Region
 Red = 4.5%
 Yellow = 4.3% to 4.5%
 Green = 3.7% to 4.3%
 Blue = 2.0% to 3.7%
Spanish Speaking CPGTSP
Providers
CPGTSP Outpatient Data
Sample Used
 The sample was limited to
English Speaking, US Born,
Non-Hispanic Caucasians
and Hispanics
 62.1% of Hispanics spoke a
language other than English
at home and 39.8% of
Hispanics were born outside
the US
 All data comes from Intake
and In Treatment Forms
Non-Hispanic Caucasian
60.0%
50.0%
53.5%
40.0%
30.0%
20.0%
10.0%
15.3%
0.0%
Ethnicity
Hispanic
Top Referral Sources
Non-Hispanic
Caucasian
Hispanic
Helpline (1-800GAMBLER)
220 (39.1)
102 (63.4)
GA or Gam-Anon
69 (12.3)
8 (5.0)
California Council on
Problem Gambling
40 (7.1)
14 (8.7)
Family/Friend
48 (8.5)
7 (4.3)
Healthcare Professional
49 (8.7)
5 (3.1)
Former Client
39 (6.9)
6 (3.7)
Demographics
Key Points
 Relative to Non-Hispanic Caucasians, Hispanics were
 Younger
 More likely to be male
 Less educated
 Trended towards being more likely to be married
 No statistical differences for income or employment.
Age, Gender, Marital Status
Non-Hispanic
Caucasian
Hispanic
t-value or X2
p-value
Mean (SD) Age
49.5 (13.3)
44.5 (13.4)
4.17
0.000
N (%) Male
341 (56.6)
105 (65.2)
3.84
0.050
Divorced
150 (24.9)
23 (14.3)
9.79
0.081
Separated
38 (6.3)
15 (9.3)
Widowed
28 (4.7)
7 (4.3)
Cohabitation
33 (5.5)
8 (5.0)
Now Married
207 (34.4)
66 (41.0)
Single/Never
Married
146 (24.3)
42 (26.1)
N (%) Marital
Status
Education
Non-Hispanic
Caucasian
Hispanic
X2
p-value
< High School
48 (8.0)
36 (22.4)
44.60
0.000
High School
77 (12.8)
39 (24.2)
Some College
288 (47.8)
63 (39.1)
Bachelor’s
Degree
127 (21.1)
16 (9.9)
Grad/Prof
Degree
62 (10.3)
7 (4.3)
Employment
Non-Hispanic
Caucasian
Hispanic
X2
p-value
Full Time
295 (49.0)
96 (59.6)
6.08
0.108
Part Time
87 (14.5)
18 (11.2)
Unemployed
(SW)
83 (13.8)
20 (12.4)
Unemployed
(NSW)
137 (22.8)
27 (16.8)
Income
Non-Hispanic
Caucasian
Hispanic
X2
p-value
< $9,999
50 (8.3)
13 (8.1)
2.41
0.121
$10,000 to $14,999
37 (6.2)
14 (8.7)
$15,000 to $24,999
75 (12.5)
15 (9.3)
$25,000 to $34,999
74 (12.4)
24 (14.9)
$35,000 to $49,999
74 (12.4)
29 (18.0)
$50,000 to $74,999
132 (22.0)
36 (22.4)
$75,000 to $99,999
56 (9.3)
17 (10.6)
$100,000 to $149,999
64 (10.7)
10 (6.2)
$150,000 to $199,999
17 (2.8)
1 (0.6)
$200,000 and Above
20 (3.3)
2 (1.2)
Gambling Behavior
Gambling Activities
Non-Hispanic White
Hispanic
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Poker
Black
Jack*
Video
Poker**
Craps
Slots
Roulette
Other
Gambling Locations
 Most frequently cited location for gambling was at a
casino.
 Relative to Non-Hispanic Caucasians, Hispanics
 Were more likely to gamble at a casino
 Equally likely to report gambling at other locations (e.g.,
track, OTB, Friend’s/Family Home, Internet, etc.)
Gambling Problem Severity
Key Points
 Relative to Non-Hispanic Caucasians, Hispanics
 Trended towards slightly higher NODS scores
 Experienced problems sooner after starting to gamble
 Entered treatment sooner after experiencing a problem
 Trended towards being more likely to owe money to family or
friends
 Multivariate analysis indicated that ethnicity was not associated
with problem severity, rather, current age, age of first gambling
experience, time to first problem after initiating gambling, and
having an Axis I disorder were.
Duration and NODS scores
Mean (SD)
Non-Hispanic
Caucasian
Hispanic
t-value
p-value
Age First
Gambled
25.8 (12.3)
27.1 (12.2)
-1.13
0.257
Years to First
Problems
17.3 (13.8)
13.6 (12.2)
3.01
0.003
Years to
Treatment
12.9 (13.5)
9.5 (11.6)
3.11
0.002
Mean NODS
score
8.08 (1.8)
8.38 (1.7)
-1.87
0.062
Legal Problems Due to Gambling
Non-Hispanic Caucasian
Hispanic
12
10
11.8
8
6
7.3
4
2
0
% with Legal Problems
Gambling Debt
Non-Hispanic
Caucasian
Hispanic
t-value or X2
p-value
Mean (SD)
Log of Total
Debt
9.29 (1.9)
9.02 (1.5)
1.46
0.104
Any Casino
Debt
62 (10.3)
15 (9.3)
0.13
0.713
Any Credit
Card Debt
186 (30.9)
56 (34.8)
0.89
0.347
Any
Family/Friend
Debt
156 (25.9)
54 (33.5)
3.70
0.054
Any Other
Debt
112 (18.6)
39 (24.2)
2.53
0.112
Substance Use
Non-Hispanic Caucasian
Hispanic
Non-Hispanic Caucasian
Hispanic
10.0%
20.00%
5.0%
10.00%
0.0%
0.00%
Smoking*
Alcohol*
Tranquilizers
30.00%
Narcotics*
15.0%
Stimulants
40.00%
Meth
20.0%
Cocaine
50.00%
Marijuana*
25.0%
60.00%
Psychiatric Comorbidity
Non-Hispanic
Caucasian
Hispanic
X2
p-value
Mood
181 (33.5)
30 (18.6)
12.97
0.000
Anxiety
105 (19.4)
19 (11.8)
4.94
0.026
ADHD
20 (3.7)
1 (0.6)
4.05
0.044
Psychotic
18 (3.3)
1 (0.6)
3.45
0.063
Personality
6 (1.1)
2 (1.2)
0.02
0.889
Any Axis I
Disorder
233 (43.0)
41 (25.5)
16.03
0.000
Significant Predictors of Problem
Severity
Variable
Beta
t-value
p-value
Age
0.21
3.10
0.000
Age First
Gambled
-0.36
-4.79
0.000
Time to First
Problem
-0.12
-2.11
0.036
Any Axis I
Disorder
0.131
3.08
0.002
F [16, 540] = 16.75, p < 0.000; R2 = 0.16
Treatment
Key Points
 Relative to Non-Hispanic Caucasians, Hispanics
 Are more often entering treatment for the first time
 Waited about the same time to enter treatment
 Spent a bit more time in treatment, but had slightly
fewer sessions
 Multivariate analysis suggested that ethnicity was not
related to number of visits, rather, age and intake
NODS scores were.
Prior Treatment Experience
Non-Hispanic Caucasian
Hispanic
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
None
One Prior Therapist
Chi-Square = 12.21, p < 0.01
2 or More Prior
Therapists
Wait for Treatment
Non-Hispanic Caucasian
Hispanic
12
10
11.1
8
6
8.7
4
2
0
Days from First Contact to Intake
Time in Treatment and Number of
Sessions
Non-Hispanic Caucasian
90
80
70
60
50
40
30
20
10
0
Non-Hispanic Caucasian
Hispanic
Hispanic
6
84.2*
5
72.9
5.5*
5.1
4
3
2
1
0
Days from Intake to Discharge
Total Number of Visits
Predictors of Number of Visits
Variable
Beta
t-value
p-value
Age
0.14
2.54
0.011
Intake NODS
Score
0.11
2.60
0.010
F [16, 668] = 9.12, p < 0.013; R2 = 0.045