Skip to main content
Erschienen in: Journal of Gambling Studies 1/2012

01.03.2012 | Original Paper

Gambling-Related Cognitive Biases and Pathological Gambling Among Youths, Young Adults, and Mature Adults in Chinese Societies

verfasst von: Catherine So-kum Tang, Anise M. S. Wu

Erschienen in: Journal of Gambling Studies | Ausgabe 1/2012

Einloggen, um Zugang zu erhalten

Abstract

This study investigated the extent to which gambling-related cognitive biases would associate with various levels of gambling pathology among 2,835 youths, 934 young adults, and 162 mature adults in Chinese societies. Results showed that gambling cognitive biases, especially biases in perceived inability to stop gambling and positive gambling expectancy, were salient correlates of pathological gambling across the three age cohorts. Analyses of variances on total cognitive biases also showed a gambling pathology main effect and an age cohort × gambling pathology 2-way interaction effect. It was noted that the probable pathological gambling group had greater cognitive biases than the probable problem gambling group, which in turn had greater cognitive biases than the non-problem gambling group. In the non-problem gambling group, mature adults had greater cognitive biases than youths and young adults, but this pattern was reversed in the probable problem gambling group. In the probable pathological gambling group, youths had greater cognitive biases than young and mature adults. Specific categories of cognitive biases also varied according to gender and gambling pathology. While men as compared to women in the non-problem and probable problem gambling groups reported a greater bias in their perceived inability to stop gambling, no significant gender difference in this bias was found in the probable pathological gambling group. Men generally had greater perceived gambling expectancy bias than women.
Literatur
Zurück zum Zitat American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders—Fourth edition. Washington, DC: Author. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders—Fourth edition. Washington, DC: Author.
Zurück zum Zitat Baboushkin, H., Hardoon, K., Derevensky, J., & Gupta, R. (2001). Underlying cognitions in gambling behavior among university students. Journal of Applied Social Psychology, 31, 1409–1430.CrossRef Baboushkin, H., Hardoon, K., Derevensky, J., & Gupta, R. (2001). Underlying cognitions in gambling behavior among university students. Journal of Applied Social Psychology, 31, 1409–1430.CrossRef
Zurück zum Zitat Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman and Co. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman and Co.
Zurück zum Zitat Blaszczynski, A., & Nower, L. (2002). A pathway model of problem and pathological gambling. Addiction, 97, 487–499.PubMedCrossRef Blaszczynski, A., & Nower, L. (2002). A pathway model of problem and pathological gambling. Addiction, 97, 487–499.PubMedCrossRef
Zurück zum Zitat Casey, L. M., Oei, T. P. S., Melville, K. M., Bourke, E., & Newcombe, P. A. (2008). Measuring self-efficacy in gambling: The Gambling Refusal Self-Efficacy Questionnaire. Journal of Gambling Studies, 24, 229–246.PubMedCrossRef Casey, L. M., Oei, T. P. S., Melville, K. M., Bourke, E., & Newcombe, P. A. (2008). Measuring self-efficacy in gambling: The Gambling Refusal Self-Efficacy Questionnaire. Journal of Gambling Studies, 24, 229–246.PubMedCrossRef
Zurück zum Zitat Cosgrove, K., Mazure, C., & Staley, J. (2007). Evolving knowledge of sex differences in brain structure, functions, and chemistry. Biological Psychiatry, 62, 847–855.PubMedCrossRef Cosgrove, K., Mazure, C., & Staley, J. (2007). Evolving knowledge of sex differences in brain structure, functions, and chemistry. Biological Psychiatry, 62, 847–855.PubMedCrossRef
Zurück zum Zitat Derevensky, J., & Gupta, R. (2005). Gambling problems in youth: Theoretical and applied perspective. New York: Kluwer Academic/Plenum Publishers. Derevensky, J., & Gupta, R. (2005). Gambling problems in youth: Theoretical and applied perspective. New York: Kluwer Academic/Plenum Publishers.
Zurück zum Zitat Derevensky, J., Gupta, R., & Della-Cioippa, G. (1996). A developmental perspective of gambling behavior in children and adolescents. Journal of Gambling Studies, 12, 49–66.CrossRef Derevensky, J., Gupta, R., & Della-Cioippa, G. (1996). A developmental perspective of gambling behavior in children and adolescents. Journal of Gambling Studies, 12, 49–66.CrossRef
Zurück zum Zitat Friedland, N., Keinan, G., & Regev, Y. (1992). Controlling the uncontrollable: Effects of stress on illusory perceptions of controllability. Journal of Personality and Social Psychology, 63, 923–931.PubMedCrossRef Friedland, N., Keinan, G., & Regev, Y. (1992). Controlling the uncontrollable: Effects of stress on illusory perceptions of controllability. Journal of Personality and Social Psychology, 63, 923–931.PubMedCrossRef
Zurück zum Zitat Griffins, M., & Woods, R. (2005). Youth and technology: The case of gambling, video-game playing and the internet. In J. Derevensky & R. Gupta (Eds.), Gambling problems in youth: Theoretical and applied perspectives (pp. 101–120). New York: Springer.CrossRef Griffins, M., & Woods, R. (2005). Youth and technology: The case of gambling, video-game playing and the internet. In J. Derevensky & R. Gupta (Eds.), Gambling problems in youth: Theoretical and applied perspectives (pp. 101–120). New York: Springer.CrossRef
Zurück zum Zitat Gupta, R., & Derevensky, J. (1998). Adolescent gambling behavior: A prevalence study and examination of the correlates associated with problem gambling. Journal of Gambling Studies, 14, 319–345.PubMedCrossRef Gupta, R., & Derevensky, J. (1998). Adolescent gambling behavior: A prevalence study and examination of the correlates associated with problem gambling. Journal of Gambling Studies, 14, 319–345.PubMedCrossRef
Zurück zum Zitat Herman, J., Gupta, R., & Derevensky, J. (1998). Children’s cognitive perceptions of 6/49 lottery tickets. Journal of Gambling Studies, 14, 227–244.CrossRef Herman, J., Gupta, R., & Derevensky, J. (1998). Children’s cognitive perceptions of 6/49 lottery tickets. Journal of Gambling Studies, 14, 227–244.CrossRef
Zurück zum Zitat Hong, Y. Y., & Chiu, C. Y. (1988). Sex, locus of control, and illusion of control in Hong Kong as correlates of gambling involvement. Journal of Social Psychology, 128, 667–673.PubMedCrossRef Hong, Y. Y., & Chiu, C. Y. (1988). Sex, locus of control, and illusion of control in Hong Kong as correlates of gambling involvement. Journal of Social Psychology, 128, 667–673.PubMedCrossRef
Zurück zum Zitat Ibanez, A., Blanco, C., Moreryra, P., & Saiz-Ruiz, J. (2003). Gender differences in pathological gambling. Journal of Clinical Psychiatry, 64, 295–301.PubMedCrossRef Ibanez, A., Blanco, C., Moreryra, P., & Saiz-Ruiz, J. (2003). Gender differences in pathological gambling. Journal of Clinical Psychiatry, 64, 295–301.PubMedCrossRef
Zurück zum Zitat Ladd, G. T., & Petry, N. M. (2002). Disordered gambling among university-based medical and dental patients: A focus on Internet gambling. Psychology of Addictive Behaviors, 16, 76–79.PubMedCrossRef Ladd, G. T., & Petry, N. M. (2002). Disordered gambling among university-based medical and dental patients: A focus on Internet gambling. Psychology of Addictive Behaviors, 16, 76–79.PubMedCrossRef
Zurück zum Zitat Ladouceur, R. (2004a). Gambling: The hidden addiction. Canadian Journal of Psychiatry, 49, 501–503. Ladouceur, R. (2004a). Gambling: The hidden addiction. Canadian Journal of Psychiatry, 49, 501–503.
Zurück zum Zitat Ladouceur, R. (2004b). Perceptions among pathological and nonpathological gamblers. Addictive Behaviors, 29, 555–565.PubMedCrossRef Ladouceur, R. (2004b). Perceptions among pathological and nonpathological gamblers. Addictive Behaviors, 29, 555–565.PubMedCrossRef
Zurück zum Zitat Ladouceur, R., Ferland, F., Poulin, C., Vitaro, F., & Wiebe, J. (2005). Concordance between the SOGS-RA and the DSM-IV criteria for pathological gambling among youths. Psychology of Addictive Behaviors, 19, 271–276.PubMedCrossRef Ladouceur, R., Ferland, F., Poulin, C., Vitaro, F., & Wiebe, J. (2005). Concordance between the SOGS-RA and the DSM-IV criteria for pathological gambling among youths. Psychology of Addictive Behaviors, 19, 271–276.PubMedCrossRef
Zurück zum Zitat Ladouceur, R., Gaboury, A., Dumont, M., & Rochette, P. (1988). Gambling: Relationship between frequency of wins and irrational thinking. Journal of Psychology, 122, 409–414.CrossRef Ladouceur, R., Gaboury, A., Dumont, M., & Rochette, P. (1988). Gambling: Relationship between frequency of wins and irrational thinking. Journal of Psychology, 122, 409–414.CrossRef
Zurück zum Zitat Ladouceur, R., & Walker, M. (1996). A cognitive perspective on gambling. In P. M. Salkoskvis (Ed.), Trends in cognitive and behavioral therapies (pp. 89–110). New York: Wiley. Ladouceur, R., & Walker, M. (1996). A cognitive perspective on gambling. In P. M. Salkoskvis (Ed.), Trends in cognitive and behavioral therapies (pp. 89–110). New York: Wiley.
Zurück zum Zitat Langer, E. J. (1975). The illusion of control. Journal of Personality and Social Psychology, 32, 311–328.CrossRef Langer, E. J. (1975). The illusion of control. Journal of Personality and Social Psychology, 32, 311–328.CrossRef
Zurück zum Zitat Lau, L., & Ranyard, R. (2005). Chinese and English probabilistic thinking and risk taking in gambling. Journal of Cross-Cultural Psychology, 36, 621–627.CrossRef Lau, L., & Ranyard, R. (2005). Chinese and English probabilistic thinking and risk taking in gambling. Journal of Cross-Cultural Psychology, 36, 621–627.CrossRef
Zurück zum Zitat Loo, J. M. Y., Raylu, N., & Oei, T. P. S. (2008). Gambling among the Chinese: A comprehensive review. Clinical Psychology Review, 28, 1152–1166.PubMedCrossRef Loo, J. M. Y., Raylu, N., & Oei, T. P. S. (2008). Gambling among the Chinese: A comprehensive review. Clinical Psychology Review, 28, 1152–1166.PubMedCrossRef
Zurück zum Zitat May, R., Whelan, J., Steenbergh, T. A., & Meyers, A. (2003). The Gambling Self-Efficacy Questionnaire: An initial psychometric evaluation. The Journal of Gambling Studies, 19, 339–357.CrossRef May, R., Whelan, J., Steenbergh, T. A., & Meyers, A. (2003). The Gambling Self-Efficacy Questionnaire: An initial psychometric evaluation. The Journal of Gambling Studies, 19, 339–357.CrossRef
Zurück zum Zitat Messerlain, C., Byrne, A., & Derevensky, J. (2004). Gambling, youth and the Internet: Should we be concerned? The Canadian Child and Adolescent Psychiatry Review, 13, 12–15. Messerlain, C., Byrne, A., & Derevensky, J. (2004). Gambling, youth and the Internet: Should we be concerned? The Canadian Child and Adolescent Psychiatry Review, 13, 12–15.
Zurück zum Zitat Miller, N., & Currie, S. (2008). A Canadian population level analysis of the roles of irrational gambling cognitions and risky gambling practices as correlates of gambling intensity and pathological gambling. Journal of Gambling Studies, 24, 257–274.PubMedCrossRef Miller, N., & Currie, S. (2008). A Canadian population level analysis of the roles of irrational gambling cognitions and risky gambling practices as correlates of gambling intensity and pathological gambling. Journal of Gambling Studies, 24, 257–274.PubMedCrossRef
Zurück zum Zitat Myrseth, H., Brunborg, G., & Eidem, M. (2010). Differences in cognitive distortions between pathological and non-pathological gamblers with preferences for chance or skill games. Journal of Gambling Studies, 26(4), 561–569. Myrseth, H., Brunborg, G., & Eidem, M. (2010). Differences in cognitive distortions between pathological and non-pathological gamblers with preferences for chance or skill games. Journal of Gambling Studies, 26(4), 561–569.
Zurück zum Zitat Oei, T. P. S., Fergusson, S., & Lee, N. K. (1998). The differential role of alcohol expectancies and drinking refusal self-efficacy in problem and non-problem drinkers. Journal of Studies on Alcohol, 59, 704–711.PubMed Oei, T. P. S., Fergusson, S., & Lee, N. K. (1998). The differential role of alcohol expectancies and drinking refusal self-efficacy in problem and non-problem drinkers. Journal of Studies on Alcohol, 59, 704–711.PubMed
Zurück zum Zitat Oei, T. P. S., Lin, J., & Raylu, N. (2007). Validation of the Chinese version of the Gambling Related Cognitions Scale (GRCS-C). Journal of Gambling Studies, 23, 309–322.PubMedCrossRef Oei, T. P. S., Lin, J., & Raylu, N. (2007). Validation of the Chinese version of the Gambling Related Cognitions Scale (GRCS-C). Journal of Gambling Studies, 23, 309–322.PubMedCrossRef
Zurück zum Zitat Oei, T. P. S., Lin, J., & Raylu, N. (2008). Relationship between gambling cognitions, psychological states, and gambling: A cross-cultural study of Chinese and Caucasians in Australia. Journal of Cross-cultural Psychology, 39, 147–161.CrossRef Oei, T. P. S., Lin, J., & Raylu, N. (2008). Relationship between gambling cognitions, psychological states, and gambling: A cross-cultural study of Chinese and Caucasians in Australia. Journal of Cross-cultural Psychology, 39, 147–161.CrossRef
Zurück zum Zitat Oei, T. P. S., Raylu, N., & Casey, L. (2010). Effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment program for problem gamblers: A randomized controlled trial. Behavioral and Cognitive Psychotherapy, 38, 233–238.CrossRef Oei, T. P. S., Raylu, N., & Casey, L. (2010). Effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment program for problem gamblers: A randomized controlled trial. Behavioral and Cognitive Psychotherapy, 38, 233–238.CrossRef
Zurück zum Zitat Papineau, E. (2005). Pathological gambling in Montreal’s Chinese community: An anthropological perspective. Journal of Gambling Studies, 21, 157–178.PubMedCrossRef Papineau, E. (2005). Pathological gambling in Montreal’s Chinese community: An anthropological perspective. Journal of Gambling Studies, 21, 157–178.PubMedCrossRef
Zurück zum Zitat Piaget, J. (1950). The psychology of intelligence. London: Routledge & Kegan Paul. Piaget, J. (1950). The psychology of intelligence. London: Routledge & Kegan Paul.
Zurück zum Zitat Pogun, S. (2001). Sex differences, in brain and behavior: Emphasis on nicotine, nitric oxide and place learning. International Journal of Psychophysiology, 42, 195–208.PubMedCrossRef Pogun, S. (2001). Sex differences, in brain and behavior: Emphasis on nicotine, nitric oxide and place learning. International Journal of Psychophysiology, 42, 195–208.PubMedCrossRef
Zurück zum Zitat Preston, S. D., Buchanan, T. W., Stansfield, R. B., & Bechara, A. (2007). Effects of anticipatory stress on decision making in a gambling task. Behavioral Neuroscience, 121, 257–263.PubMedCrossRef Preston, S. D., Buchanan, T. W., Stansfield, R. B., & Bechara, A. (2007). Effects of anticipatory stress on decision making in a gambling task. Behavioral Neuroscience, 121, 257–263.PubMedCrossRef
Zurück zum Zitat Raylu, N., & Oei, T. P. S. (2002). Pathological gambling: A comprehensive review. Clinical Psychology Review, 22, 1009–1061.PubMedCrossRef Raylu, N., & Oei, T. P. S. (2002). Pathological gambling: A comprehensive review. Clinical Psychology Review, 22, 1009–1061.PubMedCrossRef
Zurück zum Zitat Raylu, N., & Oei, T. P. S. (2004a). The Gambling Related Cognitions Scale (GRCS): Development, confirmatory factor validation and psychometric properties. Addiction, 99, 757–769.PubMedCrossRef Raylu, N., & Oei, T. P. S. (2004a). The Gambling Related Cognitions Scale (GRCS): Development, confirmatory factor validation and psychometric properties. Addiction, 99, 757–769.PubMedCrossRef
Zurück zum Zitat Raylu, N., & Oei, T. P. S. (2004b). Role of culture in gambling and problem gambling. Clinical Psychology Review, 23, 1087–1114.PubMedCrossRef Raylu, N., & Oei, T. P. S. (2004b). Role of culture in gambling and problem gambling. Clinical Psychology Review, 23, 1087–1114.PubMedCrossRef
Zurück zum Zitat Shaffer, H., & Hall, M. (1996). Estimating the prevalence of adolescent gambling disorders: A quantitative synthesis and guide toward standard gambling nomenclature. Journal of Gambling Studies, 12, 193–214.CrossRef Shaffer, H., & Hall, M. (1996). Estimating the prevalence of adolescent gambling disorders: A quantitative synthesis and guide toward standard gambling nomenclature. Journal of Gambling Studies, 12, 193–214.CrossRef
Zurück zum Zitat Sharpe, L. (2002). A reformulated cognitive-behavioral model of problem gambling: A biopsychosocial perspective. Clinical Psychology Review, 22, 1–25.PubMedCrossRef Sharpe, L. (2002). A reformulated cognitive-behavioral model of problem gambling: A biopsychosocial perspective. Clinical Psychology Review, 22, 1–25.PubMedCrossRef
Zurück zum Zitat Sharpe, L., & Tarrier, N. (1993). Towards a cognitive-behavioral theory of problem gambling. British Journal of Psychiatry, 162, 407–412.PubMedCrossRef Sharpe, L., & Tarrier, N. (1993). Towards a cognitive-behavioral theory of problem gambling. British Journal of Psychiatry, 162, 407–412.PubMedCrossRef
Zurück zum Zitat Steenbergh, T., Meyers, A., May, R., & Whelan, J. (2002). Development and validation of the Gamblers’ Beliefs Questionnaire. Psychology of Addictive Behaviors, 16, 143–149.PubMedCrossRef Steenbergh, T., Meyers, A., May, R., & Whelan, J. (2002). Development and validation of the Gamblers’ Beliefs Questionnaire. Psychology of Addictive Behaviors, 16, 143–149.PubMedCrossRef
Zurück zum Zitat Stinchfield, R., Govoni, R., & Frisch, G. R. (2005). DSM-IV diagnostic criteria for pathological gambling: Reliability, validity, and classification accuracy. The American Journal on Addictions, 14, 73–82.PubMedCrossRef Stinchfield, R., Govoni, R., & Frisch, G. R. (2005). DSM-IV diagnostic criteria for pathological gambling: Reliability, validity, and classification accuracy. The American Journal on Addictions, 14, 73–82.PubMedCrossRef
Zurück zum Zitat Tang, C., Wu, A., & Tang, J. (2007). Gender differences in characteristics of Chinese treatment-seeking problem gamblers. Journal of Gambling Studies, 23, 145–156.PubMedCrossRef Tang, C., Wu, A., & Tang, J. (2007). Gender differences in characteristics of Chinese treatment-seeking problem gamblers. Journal of Gambling Studies, 23, 145–156.PubMedCrossRef
Zurück zum Zitat Toneatto, T. (1999). Cognitive psychopathology of problem gambling. Substance Use and Misuse, 34, 1593–1604.PubMedCrossRef Toneatto, T. (1999). Cognitive psychopathology of problem gambling. Substance Use and Misuse, 34, 1593–1604.PubMedCrossRef
Zurück zum Zitat Toneatto, T., Blitz-Miller, T., Calderwood, K., Dragonetti, R., & Tsanos, A. (1997). Cognitive distortions in heavy gambling. Journal of Gambling Studies, 13, 253–266.PubMedCrossRef Toneatto, T., Blitz-Miller, T., Calderwood, K., Dragonetti, R., & Tsanos, A. (1997). Cognitive distortions in heavy gambling. Journal of Gambling Studies, 13, 253–266.PubMedCrossRef
Zurück zum Zitat Toneatto, T., & Ladouceur, R. (2003). Treatment of pathological gambling: A critical review of the literature. Psychology of Addictive Behaviors, 42, 92–99. Toneatto, T., & Ladouceur, R. (2003). Treatment of pathological gambling: A critical review of the literature. Psychology of Addictive Behaviors, 42, 92–99.
Zurück zum Zitat Toneatto, T., & Millar, G. (2004). The assessment and treatment of problem gambling: Empirical status and promising trends. Canadian Journal of Psychiatry, 49, 173–181. Toneatto, T., & Millar, G. (2004). The assessment and treatment of problem gambling: Empirical status and promising trends. Canadian Journal of Psychiatry, 49, 173–181.
Zurück zum Zitat Tsang, E. (2004). Toward a scientific inquiry into superstitious business decision-making. Organizational Studies, 25, 923–946.CrossRef Tsang, E. (2004). Toward a scientific inquiry into superstitious business decision-making. Organizational Studies, 25, 923–946.CrossRef
Zurück zum Zitat Wagenaar, W. (1988). Paradoxes of gambling behavior. London, UK: Lawrence Erlbaum. Wagenaar, W. (1988). Paradoxes of gambling behavior. London, UK: Lawrence Erlbaum.
Zurück zum Zitat Walker, M. B. (1992). The psychology of gambling. Oxford, England: Pergamon Press. Walker, M. B. (1992). The psychology of gambling. Oxford, England: Pergamon Press.
Zurück zum Zitat Wohl, M., Young, M., & Hart, E. (2007). Self-perceptions of dispositional luck: Relationship to DSM gambling symptoms, subjective enjoyment of gambling and treatment readiness. Substance Use and Misuse, 42, 43–63.PubMedCrossRef Wohl, M., Young, M., & Hart, E. (2007). Self-perceptions of dispositional luck: Relationship to DSM gambling symptoms, subjective enjoyment of gambling and treatment readiness. Substance Use and Misuse, 42, 43–63.PubMedCrossRef
Zurück zum Zitat Wong, L. K., & So, M. T. (2003). Prevalence estimates of problem and pathological gambling in Hong Kong. American Journal of Psychiatry, 160, 1353–1354.PubMedCrossRef Wong, L. K., & So, M. T. (2003). Prevalence estimates of problem and pathological gambling in Hong Kong. American Journal of Psychiatry, 160, 1353–1354.PubMedCrossRef
Metadaten
Titel
Gambling-Related Cognitive Biases and Pathological Gambling Among Youths, Young Adults, and Mature Adults in Chinese Societies
verfasst von
Catherine So-kum Tang
Anise M. S. Wu
Publikationsdatum
01.03.2012
Verlag
Springer US
Erschienen in
Journal of Gambling Studies / Ausgabe 1/2012
Elektronische ISSN: 1573-3602
DOI
https://doi.org/10.1007/s10899-011-9249-x

Weitere Artikel der Ausgabe 1/2012

Journal of Gambling Studies 1/2012 Zur Ausgabe

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bislang gibt es kein Medikament zur Prävention von Wochenbettdepressionen. Das Injektionsanästhetikum Esketamin könnte womöglich diese Lücke füllen.

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

22.04.2024 DGIM 2024 Kongressbericht

Die Kombination aus Medikamenten und Psychotherapie gilt als effektivster Ansatz bei Depressionen. Das ist bei betagten Menschen nicht anders, trotz Besonderheiten.

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

22.04.2024 DGIM 2024 Nachrichten

Um Menschen nach der Flucht aus einem Krisengebiet bestmöglich medizinisch betreuen zu können, ist es gut zu wissen, welche Erkrankungen im jeweiligen Herkunftsland häufig sind. Dabei hilft eine Internetseite der CDC (Centers for Disease Control and Prevention).