Reliability of instruments measuring at-risk and problem gambling among young individuals: A protocol of a systematic review covering years 2009-2015

1Internationl Gambling Conference 2016_Auckland_Castren12.2.2016

Reliability of instruments measuring at-risk and problem gambling

among young individuals:

A protocol of a systematic review covering years 2009-2015

Castrén S, Edgren R, Alho H, Salonen AH

Internationl Gambling Conference 2016_Auckland_Castren 2

Gambling scene in FinlandAvailability, accessibility and acceptability

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• Tripartite monopoly system• Expenditure on gambling one of the

highest in Europe• Approximately 20 000 slot machines

in kiosks, shops, bars, restaurants, gas stations, shopping centres

• Young age, male gender, high net income and risky alcohol consumption, associated with favorable gambling attitudes

• Advertising and marketing are perceptible

Salonen AH, Castrén S, Raisamo S, Orford J, Alho H, Lahti T. Attitudes towards gambling in Finland: A cross sectional population study. BMC Public Health 2014; 14, 982-. Castren S, Murto A, Salonen AH. Rahapelimarkkinointi yhä aggressiivisempaa – unohtuivatko hyvät periaatteet? YP. Gambling advertising in Finland. Yhteiskuntapolitiikka, YP 2014; 79 (4):438-443.


Finland in World gambling map

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N. Irela

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Singap

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Standardized Problem Gambling Prevalence RatesPe

rcen

tage

s %

Source: Williams et al. 2012. The Population Prevalence of Problem Gambling: Methodological Influences, Standardized Rates, Jurisdictional Differences, and Worldwide Trends 2012. Report prepared for the Ontario Problem Gambling Research Centre and The Ontario Ministry of Health and Long Term Care.

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Finnish gambling 2015

• Past-year population prevalence, Finns aged 15-74 yrs– Any gambling 80% – At-risk and problem gambling (SOGS = 1+) 18.3%– Problem gambling (SOGS = 3+) 3.3%– Probable PGs (SOGS =5+) 1.3%

• Gambling in 2011 and 2015– Gambling increased among 18-24 & 65-74-year-olds– Problem gambling among women increased– ARPG increased

Salonen A. & Raisamo S. (2015) Suomalaisten rahapelaaminen 2015. Rahapelaaminen, rahapeliongelmat ja rahapelaamiseen liittyvät asenteet ja mielipiteet 15–74-vuotiailla. [Finnish gambling 2015. Gambling, gambling problems, and attitudes and opinions on gambling among Finns aged 15–74.] National Institute for Health and Welfare (THL). Report 16/2015.

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At-risk and problem gambling (ARPG) among Finnish youth

Measurement of youth ARPG– Single questions– SOGS-RA– DSM-IV-MR-J– SOGS & PGSI – instruments

developed for adults

No validated scales/measures in Finland for any context

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Background for the systematic review

• Continuing the existing reviews stating: There is a lack of valid/reliable instruments to assess ARPG among youth– Stichfield R. A critical review of adolescent problem gambling

assessment instruments. Int J Adolesc Med Health 2010;22:77-93.– Blinn-Pike A, Worthy SL, Jonkman JN. Adolescent gambling: A review of

an emerging field of research. J Adolesc Health 2010: 47:223-236.

• Preliminary plan: a population study for Finnish youth– to measure ARPG with the most reliable and valid instrument(s)– utilize register data and longitudinal design

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Aims of the study

• to clarify which instruments measuring ARPG among youth are the most reliable and valid for both population-based and clinical studies in light of reported estimates of internal consistency, classification accuracy and psychometric properties.

• to identify the most suitable instruments presently available and provide insight on what brances of the field require further investigation.

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The team involved in the process• Researchers (5) with expertise in

– Youth gambling– Population studies and clinical studies– Reliability and validity of gambling instruments– Systematic reviews– Academic writing

• Informatician (1)– Data bases and searches

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Search strategy

• The data search was categorized using Cochraine handbook guidelines (PICOS) for formulating review questions and inclusion criteria.– P = Patient, i.e. population– I = Intervention, i.e. instrument– C = Comparator, i.e. reference instrument– O = Outcome, i.e. reliability.

• A structured electronic search was conducted Nov 2014 according to methods recommended in the PRISMA statement in Medline, Pub Med, PsycInfo databases covering articles between 2009-2014.

• Database searches were updated in November 2015.

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Eligibility criteria• Articles written in English.• Publications in peer/reviewed journals (also doctoral theses -

if the quality reached the standards).• Population-based samples and clinical samples.

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Assessment of the articles • Two researcher independently assessed all articles.

– Inclusion/exclusion criteria– Quality assessment

• The joint probability of agreement between the researchers were counted

• Disagreement in evaluation was resolved by discussion and a third independent researcher were consulted when needed.

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PHASE IExclusion criteria for the abstracts (n = 822)

1. Non-gambling related reseach topic2. Sample age over 28 years of age3. No gambling instrument employed4. Case study, commentary, editorial or letter5. Other (specification required)

The joint probability of agreement between the researchers were 90% for the exclusion of based on the abstracts.

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PHASE IIInclusion criteria for the full texts (n = 445)

P = Patient– Less than 29 years of age

I = Intervention– Instrument designed to evaluate youth gambling

C = Comparator (only used as additional information !)– Reference instrument, measurement etc.

O= Outcome– Instrument reliability reported

The joint probability of agreement between the researchers were 92% for the inclusion based on full-text evaluation.

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Presentation of the article selection process

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Articles included(n = 50)

Full texts read(n = 445)

Articles included(n = 42)

Excluded (n = 403)• Inclusion/exclusion criteria• P - No Findings for ˂29-year-olds (n =

151) • I - No screening instrument (n = 187)• O - No reliability assessment (n = 49)• Other (n = 16)

Excluded (n = 377)• No gambling (n = 294)• No ˂29-year-olds (n = 6)• No screen/instrument (n = 47)• Other (n = 30)

Abstracts read(n = 882)

Literature search (2009-2015)• Medline (OVID) (n = 605)• Pubmed (n = 554)• PsycInfo (n = 65)• Duplicates removed (n = 404)

Reference list search• Potential articles (n =

20)• Included (n = 8)


Quality assessment of included articles (n = 50)• The revised Quality Assessment of Diagnostic Accuracy

Studies tool (QUADAS-2)– The risk of bias of articles.– The applicability of articles.

• QUADAS-2 was tailored for our review, tested on a subsample of articles and modified to ensure unambiguous assessment between researchers.

• An important change was omitting the evaluation of risk of bias regarding reference standard, because both the index test and reference standard (if measured) were applied identically within a gambling context.

• Information pertaining to the reference standard was inferred from the applicability assessment.

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Quality assessment: the revised QUADAS-2

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Risk of bias Applicability

Patient selection

Index test Flow and timing

Patient selection

Index test Reference test

•Were participants selected randomly?•Was the sample representative of the general population?•Were inappropriate exclusions avoided?

Did the conduct of the test avoid introducing bias?(e.g.time restirictions, instructions, order of test completion)

Were all participants included in the analysis?(e.g. were all participants included in the analysis; attrition rate, drop outs, inadequate responses)

Does the sample match the review question?(e.g. is the measure developed for youth)

Is the validity of the index test a research question of the study?(e.g. main focus in reliability or something else)

Is the reference standard used to make judgements about the validity or reliability of the index test? (e.g. money/time spent on gambling)


RESULTSReliability estimates will be reported (Forthcoming)

• SOGS-RA (the South Oaks Gambling Screen Revised for Adolescents)

• DSM-IV-J (the Diagnostic Statistical Manual IV adapted for Juveniles)

• DSM-IV-MR-J (the Diagnostic Statistical Manual IV (Multiple Response format) adapted for Juveniles)

• MAGS (the Massachusetts Gambling Screen)• CAGI (the Canadian Adolescent Gambling Screen)¹• GABSA (the Gambling Addictive Behaviour Scale for

Adolescents)Both GAGI and MAGS were included to complement the reviews by Stichfield (2010) and Blinn-Pike et al. (2010)¹GAGI - Unpublished report- not an article ²MAGS – not strictly an adolescent instrument

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Research group

Edgren R. BA PsychCastren S. Ph.D.Mäkelä M. MD, Ph.D.Pörtfors P. M.Sc.Alho H. MD, Ph.D.Salonen AH. Ph.D.

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Thank you

Sari Castrén Ph.D.Senior ResearcherClinical psychologistNational Institute for Health and Welfare, Tobacco, Gambling and AddictionClinicum, Internal Medicine, University of Helsinki and Helsinki University Hospital Finland

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Government & Nonprofit

Reliability of instruments measuring at-risk and problem gambling among young individuals: A protocol of a systematic review covering years 2009-2015