Abby L. Goldstein, Ph.D. OISE, University of Toronto

1. Promoting Resilience in the Context of Risk: Applications of Resilience Theory to Gambling in Two Samples of Youth Abby L. Goldstein, Ph.D. OISE, University of Toronto

2. Adolescent Gambling • Rates of gambling among youth rival those of alcohol use • US survey of 14-21 year olds (Welte, Barnes, Tidwell, & Hoffman, 2008) • 68% gambled in past year • 11% more than twice per week

3. Adolescent Gambling • Higher prevalence of pathological gambling among adolescents than adults • Early initiation of gambling associated with problems in young adulthood, increased likelihood of mental health concerns (Burge, Pietrzak, Molina, & Petry, 2004)

4. Adolescent Gambling • Significant research on risk correlates of gambling • Alcohol use • Tobacco use • Other drug use • Delinquency • Peer violence • Dating violence

5. Resilience Theory • Framework for understanding how adolescents adapt well, even with exposure to multiple risk factors • Accumulation of risk  increased likelihood of unhealthy behaviours • Promotive factors  reduce likelihood of negative outcomes despite exposure to risk

6. Resilience Theory • Promotive factors exert their effects in one of two ways (Fergus & Zimmerman, 2005) • Compensatory – exert a direct effect in the context of risk • Interactive – moderate or weaken the impact of risk factors • Few studies have examined how risk and promotive factors contribute to gambling in adolescents (see Lussier, Derevensky, Gupta, Bergevin, & Ellenbogen, 2007 for an exception)

7. Application of Resilience Theory to Gambling – Youth in an Inner City ED • Study explored the application of resilience theory to gambling in a sample of adolescents presenting to an inner city ED • ED important context for screening and intervention • Use of Latent Class Analysis (LCA) to identify subgroups of gamblers

8. Study of Youth in ED • Part of larger RCT of an alcohol and violence intervention in the ED in Flint, MI • Baseline sample consisted of 726 adolescents and 34.3% had gambled in the past year (N = 249) • Among those who gambled • 30.1% were female • 59.4% were African American, 30.9% Caucasian

9. Measures • Gambling items adapted from the OSDUS (Adlaf, Paglia-Boak, Beitchman, & Wolfe, 2006) • Frequency of gambling in past 12 months • Largest amount gambled in past 12 months • Subset of items from the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA; Winters, Stinchfield, & Fulkerson, 1993) • How often gone back to win $ lost? • Gambled more than planned? • Felt bad about gambling? • Argued with family/friends? • Borrowed money and not paid it back?

10. Measures Risk Factors • Alcohol use - Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) • Drug Use – Add Health items (Harris et al., 2003) • Peer violence – Add Health and CTS2 items (Sieving et al., 2001; Strauss et al., 1996) • Dating violence – CADRI items (Wolfe et al., 2001) • Community violence (Richters & Martinez, 1993) • Delinquency (Zimmerman et al., 2000) • Peer influence (negative) (Ostaszewski & Zimmerman, 2006)

11. Measures Promotive Factors • Adult mentors (Zimmerman et al., 2002) • School, religious, community involvement (Doljanac & Zimmerman, 1998) • Parental monitoring (Arthur et al., 2002) • Peer influence (positive) (Ostaszewski & Zimmerman, 2006)

12. Measures • Index scores • Risk and promotive factor index scores • All items standardized • Upper 15.9% of the distribution high levels of risk or promotive factor (score of 2), middle 68.2% average levels (score of 1), and lower 15.9% low or no promotion or risk (score of 0) • Combine from all measures

13. Goldstein, A. L., Walton, M. A., Cunningham, R., Chermack, S., & Blow, F. (in press). A latent class analysis of adolescent gambling: Application of resilience theory. International Journal of Mental Health and Addiction.

14. Bivariate associations between gambling groups, demographics and risk factors Goldstein, A. L., Walton, M. A., Cunningham, R., Chermack, S., & Blow, F. (in press). A latent class analysis of adolescent gambling: Application of resilience theory. International Journal of Mental Health and Addiction.

15. Bivariate associations between gambling groups, promotive factors, and index scores Goldstein, A. L., Walton, M. A., Cunningham, R., Chermack, S., & Blow, F. (in press). A latent class analysis of adolescent gambling: Application of resilience theory. International Journal of Mental Health and Addiction.

16. Application of Resilience Theory to Predicting Classification in High Consequence Group Goldstein, A. L., Walton, M. A., Cunningham, R., Chermack, S., & Blow, F. (in press). A latent class analysis of adolescent gambling: Application of resilience theory. International Journal of Mental Health and Addiction.

17. Predicted value for gambling consequence group as a function of high vs. low promotive factor Goldstein, A. L., Walton, M. A., Cunningham, R., Chermack, S., & Blow, F. (in press). A latent class analysis of adolescent gambling: Application of resilience theory. International Journal of Mental Health and Addiction.

18. Conclusions • Promotive factors attenuate risk for gambling • The driving promotive factor is parental monitoring • Consistent with literature on substance use in adolescence • Important role of parents, over and above other factors

19. Child Maltreatment & Gambling • Child maltreatment identified as a significant risk factor for the development of gambling problems • Theoretical models highlight gambling as a way of coping with early trauma (Blaszczynski & Nower, 2002; Jacobs, 1986; Lesieur & Blume, 1991)

20. Child Maltreatment & Gambling • Pathological gamblers have higher rates of CM than general population and increased severity of CM associated with lower age of gambling onset (Petry & Steinberg, 2005) • In a community sample, individuals with gambling problems have higher rates of CM than those without (Hodgins et al., 2010) • Similar findings emerged for a sample of adolescents and young adults (Felsher et al., 2010)

21. Parental Monitoring in a Child Welfare Sample? • Examine the role of parental/caregiver monitoring in promoting resilience in a sample of emerging adults transitioning out of child welfare • Do promotive factors compensate or moderate the relationship between CM and gambling?

22. Study of Emerging Adults in CW • Recruited emerging adults on “cheque day” • 97 emerging adults participated (76.0% female) • Majority was currently attending school (56.7%) and 36.1% were employed • Had been involved with child welfare for an average of 9 years (SD = 4.13)

23. Measures • Child maltreatment – Childhood Trauma Questionnaire – Short Form (Bernstein et al., 2003) • Number of types of moderate to severe maltreatment • Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003) • Measures salient features of resilience (patience, self-efficacy, tolerance of negative affect, optimism) • Measure of internal resilience • Caregiver monitoring (Barnes et al., 1999)

24. Results • Maltreatment scores ranged from 0 to 5 • 33.6% experienced 1-2 types • 28.6% experienced 3-4 types • 15.3% experienced all 5 types • Overall, 29.6% of the sample reported lifetime gambling • 21.4% reported spending between $1 to $9 on gambling and only 7.1% had spend more than $50 at one time • 12.2% of participants had experienced problems related to their gambling

25. Bivariate relationships between background variables, maltreatment and promotive factors

26. Conclusions • Preliminary findings – child maltreatment did not increase risk for gambling frequency or consequences • However, caregiver monitoring was significantly associated with fewer gambling consequences • Further evidence that parental monitoring plays a significant and important role in reducing problem gambling behaviours in youth and young adults

27. Thank You! • Funding for research • Social Sciences and Humanities Research Council • National Institute on Alcohol Abuse and Alcoholism (M. Walton, PI) • Ministry of Research and Innovation – Early Researcher Award • Collaborators • Christine Wekerle, Ph.D. (McMaster University) • Deborah Goodman, Ph.D. (Children’s Aid Society of Toronto) • Bruce Leslie, M.S.W (Toronto Catholic Children’s Aid Society) • Maureen Walton, Ph.D. (University of Michigan) • Rebecca Cunningham, M.D. (University of Michigan) • Marc Zimmerman, Ph.D. (University of Michigan) • Stephen Chermack, PhD. (University of Michigan) • Fred Blow, Ph.D. (University of Michigan)