Research Report: Health Risks of Casino Employees
What began as a casino company's1 survey of health risks of its employees has developed into ground-breaking research by Howard Shaffer, Ph.D., and colleagues at the Division on Addictions at Harvard Medical School. Casino employees represent a unique and important segment of the population, with full access and exposure to gambling compared to the general public. The studies, funded by Casino, Inc., and the National Center for Responsible Gaming and now published in three scientific journals, address the question that most often arises in debates about the expansion of legalized gambling: Does increased exposure to gambling opportunities necessarily lead to increased cases of pathological gambling? The Harvard investigation offers insights into this issue but also reveals patterns that might have implications for the general public and our understanding of the disorder.
The first publication reported on "Gambling, Drinking, Smoking and Other Health Risk Activities Among Casino Employees," in the American Journal of Industrial Medicinein 1999. This study of a sample of 3,841 full-time employees representing four geographic sites established that casino employees have a higher prevalence of past-year pathological gambling than the adult general population but a lower prevalence of past-year Level 2 gambling. (Level 2 refers to gamblers who are experiencing some problems because of their gambling but not enough to qualify for a diagnosis of pathological gambling according to the American Psychiatric Association.) The authors hypothesized that the lower rate of Level 2 gambling might be an example of the process of adaptation demonstrated in the study of other addictive behaviors. Individuals immersed in an environment of addictive behaviors may adapt to the environment and develop some immunity toward addictive behavior (Zinberg, 1984). Casino employees may learn from direct observation the downside of gambling, and this might serve as a protective factor against developing problems with gambling. However, the authors point out, this social adaptation may provide insufficient immunity to protect workers who are already vulnerable – perhaps because of other co-occurring psychiatric disorders – to the development of the more serious level of disordered gambling (Shaffer, Vander Bilt & Hall, 1999).
The second publication addressed the question of the truthfulness of the self-reports by the employees in the study. In other words, can the data collected in this study – focusing on behaviors that may be seen as less than socially acceptable – be trusted? As explained in the second published article in Addictive Behaviors, "concerns about the integrity of self-reported data escalate when the population from which the sample is drawn is popularly considered less than honest and forthright. Population credibility deficits, real or imagined, can lead to serious doubts about the validity of the data." The investigators used blood tests to determine if the casino employees were reporting accurate information about their smoking behaviors. As smoking has become less socially acceptable, it is reasonable to expect that people will tend to underreport their tobacco use. However, the findings indicate that casino employees were truthful about their smoking and, therefore, demonstrate the ability of this group to provide accurate self-reports of a possibly undesirable behavior (Shaffer, Eber, Hall & Vander Bilt, 2000).
The third and most recent study, published in The Journal of Social Psychology, gathered data from 1,176 casino employees at three observation points approximately 12 months apart. Observing the same population over time affords the opportunity to address questions about the natural history or course of the disorder and, in particular, the conventional wisdom that has portrayed pathological gambling as a progressive and chronic disorder – i.e., once symptoms emerge, the gambler always gets progressively worse, moving to Level 3, the most severe form of the disorder (e.g., American Psychiatric Association, 1994). The findings of this study, however, challenge this notion of disordered gambling. The data suggest that there is more movement among the various levels of disordered gambling, not only toward more severe states but also toward healthier levels, than is recognized by the more traditional understanding of pathological gambling. In this study, the majority of Level 3 gamblers tended to become Level 2 gamblers. The authors conclude that the conventional wisdom about disordered gambling as "always progressive" needs reconsideration (Shaffer & Hall, 2002).
For copies of the three journal articles on casino employees, contact Christine Reilly at the Institute for Research on Pathological Gambling and Related Disorders.
1 To maintain the anonymity of the casino company and its employees, the authors referred to this company as Casino, Inc.
REFERENCES
American Psychiatric Association. (1994). DSM-IV: Diagnostic and statistical manual of mental disorders (Fourth ed.). Washington, D.C.: American Psychiatric Association.
Shaffer, H. J., Eber, G., Hall, M. N., & Vander Bilt, J. (2000). Smoking Behavior among Casino Employees: Self-Report Validation Using Plasma Cotinine. Addictive Behaviors, 25(5), 693-704.
Shaffer, H. J., & Hall, M. N. (2002). The Natural History of Gambling and Drinking Problems Among Casino Employees.Journal of Social Psychology, 142(4), 405-424.
Shaffer, H. J., Vander Bilt, J., & Hall, M. N. (1999). Gambling, drinking, smoking and other health risk activities among casino employees. American Journal of Industrial Medicine, 36(3), 365-378.
Zinberg, N. E. (1984). Drug, set, and setting: the basis for controlled intoxicant use. New Haven: Yale University Press.
