Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background: Studies suggest that casino proximity may influence gambling behavior in adults and college students (Adams, Sullivan, Horton, Menna, & Guilmette, 2007; Sévigny, Ladouceur, Jacques, & Cantinotti, 2008). Casinos may play a role in adolescent gambling because they may provide opportunities for adolescents to illegally gamble and to be exposed to a pro-gambling environment (Welte, Barnes, Tidwell, & Hoffman 2009; Fabiansson, 2006). Exposure to a pro-gambling environment may influence gambling initiation, because peer and family approval may be predictors of gambling among youth (Moore and Ohtsuka, 1999; Larimer and Neighbors, 2003). Additionally, casinos may promote gambling among youth through advertisements; youth and young adults view casino ads as favorable and enticing (McMullen & Miller, 2010; McMullan, Miller, & Perrier, 2012). No studies have examined the association between casino proximity and gambling among high school and middle school youth. It is possible that casino proximity may be associated with lifetime gambling and gambling frequency in youth because those near a casino may be exposed more frequently to a pro-gambling environment and to casino advertisements. Objectives: To determine 1) the prevalence of gambling and gambling by frequency; 2) if casino proximity is associated with lifetime gambling; (3) if casino proximity is associated with gambling frequency. Casino proximity was measured by living in a zip-code that is in a town that has at least one casino. Methods: The 2012 Arizona Youth Survey (AYS) was used (n=62,603) to collect data on gambling behaviors, zip-codes, and important confounders. Data were collected from all 15 counties in Arizona and 349 schools between January and April 2012 (Harrison, 2012). The dataset consisted of eighth, tenth, and twelfth graders.

Analyses: Prevalence were calculated by dividing the number of students in a particular frequency category by the total number of students with data for gambling behaviors (n=60,891). Logistic regression was used to determine if proximity was a predictor of lifetime gambling. Multinomial logistic regression was used to determine if proximity was a predictor of gambling frequency (with “never” as the base level). Gambling frequencies were: never, before but not in the past 12 months, in the past year, once or twice a month, once or twice a week, and almost every day. Results: Proximity was a predictor of lifetime gambling, with grade level serving as an effect modifier. Proximity was only a significant predictor among eighth graders, although the increase in odds was only marginal. Eighth graders who lived near a casino were approximately 10% more likely to report ever gambled (OR=1.1; 95% CI =1.02 – 1.2, p=.01). Proximity was also a predictor of gambling frequency, with grade level serving as an effect modifier. Eighth graders near a casino were 14% more likely to have gambled at least once in the past year compared to eighth graders far from a casino (RRR=1.14, 95%=1.01 – 1.29). Tenth graders near a casino were 22% more likely to have gambled at least once in the past year (RRR=1.22, 95% CI=1.06 - 1.40). Twelfth graders near a casino were 45% less likely to have gambled weekly (RRR=.55, 95% CI=.36 - .82). Lastly, twelfth graders near a casino were 41% less likely to have gambled daily (RRR=.59, 95% CI= .35 - 1.00). Being in the twelfth grade may be a protective factor against higher gambling frequencies. Conclusions: The findings of this study may provide some comfort because proximity was not positively associated with higher gambling frequencies. Those who gamble at higher frequencies may be more of a concern compared to those who gamble at low frequencies because frequency may be associated with gambling severity (Shinogle, Norris, Park, Volberg, Haynes, & Stokan, 2011). However, those who gamble a few times a year may still be at risk for developing gambling problems. Just because one does not gamble frequently does not mean that one is in control of one’s gambling. Some individuals in the population gamble less frequently and yet more heavily (Abbott, 2001; Abbott, Volberg, & Rönnberg, 2004). Thus, we should be concerned that casino proximity was positively associated with prior-year gambling (among eighth and tenth graders) and lifetime gambling (among eighth graders), although the association was minor. Interventions should be implemented that discourage gambling and target adolescents living near a casino. Adams et al. (2007) suggests that casinos provide money and other resources to local schools for prevention and treatment programs for gambling problems that may materialize due to exposure or accessibility effects. Additionally, casinos may take care to practice socially responsible advertising. Casinos may be responsible by using ads that show gambling as a pleasurable experience, meanwhile showing that it is possible to have fun, win money, have social status, and experience excitement without gambling (McMullan et al., 2012).




School of Medicine



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