Inserm UMR1246 SPHERE

Aims. To estimate whether the use of wagering inducements has a significant impact on the gambling behaviors of online gamblers and describe this temporal relation under naturalistic conditions. Design. This longitudinal observational study is part of the second stage of the Screening for Excessive Gambling Behaviors on the Internet (EDEIN) research program. Setting. Gambling tracking data from the French national online gambling authority (poker, horse race betting and sports betting) and from the French national lottery operator (lotteries and scratch games). Participants. A total of 9306 gamblers who played poker, horse race or sports betting and 5682 gamblers who played lotteries and scratch games completed an online survey. The gender ratio was largely male (around 90% for poker, horse race betting and sports betting and 65% for lotteries). Median age ranged from 35 (sports betting) to 53 (horse race betting and lotteries). Measurements. The survey used the Problem Gambling Severity Index (PGSI) to determine the status of the gamblers (at-risk or not). Gambling tracking data included weekly gambling intensity (wagers, deposits), gambling frequency (number of gambling days), proxies of at-risk gambling behaviors (chasing and breadth of involvement), and use of wagering inducements. Findings Use of wagering inducements was associated with an increase of gambling intensity (β between -0.06 [-0.08;-0.05] and 0.57 [0.54;0.60]), gambling frequency (β between 0.12 [0.10;0.18] and 0.29 [0.28;0.31]), and at-risk gambling behaviors (odds ratio between 1.32 [1.16;1.50] and 4.82 [4.61;5.05]) at the same week of their use. This effect was stronger for at-risk gambling behaviors and at-risk gamblers. Conclusions. Wagering inducements may represent a risk factor for developing or exacerbating gambling problems.

In cluster randomised trials, a measure of intracluster correlation such as the intraclass correlation coefficient (ICC) should be reported for each primary outcome. Providing intracluster correlation estimates may help in calculating sample size of future cluster randomised trials and also in interpreting the results of the trial from which they are derived. For a binary outcome, the ICC is known to be associated with its prevalence, which raises at least two issues. First, it questions the use of ICC estimates obtained on a binary outcome in a trial for sample size calculations in a subsequent trial in which the same binary outcome is expected to have a different prevalence. Second, it challenges the interpretation of ICC estimates because they do not solely depend on clustering level. Other intracluster correlation measures proposed for clustered binary data settings include the variance partition coefficient, the median odds ratio and the tetrachoric correlation coefficient. Under certain assumptions, the theoretical maximum possible value for an ICC associated with a binary outcome can be derived, and we proposed the relative deviation of an ICC estimate to this maximum value as another measure of the intracluster correlation. We conducted a simulation study to explore the dependence of these intracluster correlation measures on outcome prevalence and found that all are associated with prevalence. Even if all depend on prevalence, the tetrachoric correlation coefficient computed with Kirk’s approach was less dependent on the outcome prevalence than the other measures when the intracluster correlation was about 0.05. We also observed that for lower values, such as 0.01, the analysis of variance estimator of the ICC is preferred.

Both in France and Sweden, global changes in online gambling activities due to the COVID-19 pandemic, and their potential for gambling problems, are a source of concerns for public health authorities. The CONGA project aims to measuring the impact of the COVID-19 pandemic on the online gambling activity, both in France and Sweden. The use of gambling tracking data, widely acclaimed in recent years in research on online gambling given its ecological nature, could allow observing longitudinally changes in online gambling activities due to the pandemic. Moreover, the combination of French and Swedish data will allow comparing two countries with very distinct politics regarding the pandemics, i.e. a lockdown in France compared to no lockdown in Sweden. The CONGA study will provide a better understanding of the impact of restriction measures in the context of the health crisis on online gambling activities. Moreover, the identification of sub-populations particularly at risk of increasing their gambling activity in response to the health crisis will have both clinical and epidemiological perspectives, even beyond the current period of crisis.

Principal investigator: Gaëlle Challet-Bouju