Spatial and sociodemographic correlates of gambling participation and disorder among female Filipino migrant workers in Macao, People's Republic of China
Introduction
Prevalence and correlates of gambling disorder among vulnerable or transient populations are under-studied. Within migrant populations, associations between sociodemographic risk factors, spatial accessibility of gambling venues, and gambling disorders remain unexplored. Previous research identified the Macao Special Administrative Region (SAR), of the People's Republic of China, as a region of interest wherein to study sociodemographic and spatial correlates of gambling disorder given its high density of gambling venues (Davis & Ozorio, 2005; Tong & Chim, 2013).
Colloquially known as Las Vegas of the East, Macao contains 40 casinos within its 30.4 km2 area as of 2017 (38 at the time of study). Macao is also home to ~182,000 migrant workers who comprise nearly 25% of the population (Public Security Police Force of Macau, 2018). Migrants leave their home countries in pursuit of economic opportunity and regularly send remittances home to financial dependents (Garabiles, Ofreneo, & Hall, 2017). Filipino domestic workers, among the largest groups of migrant workers in Macao, number over 14,200 as of 2018 (Public Security Police Force of Macau, 2018). Domestic workers typically work for private households, either residing in their employer's household (stay-in) or their own residence (stay-out). Women comprise 44.3% of ~150 million global migrant workers but disproportionately represent 73.4% of the migrant domestic workforce (International Labour Office (ILO), 2015).
Participation in gambling activities (i.e. gambling participation) has been associated with increased availability of urban casinos and electronic gaming machines, as well as with sociodemographic characteristics such as older age (25 years or older), male gender, lower educational attainment, married or cohabiting marital status, lower quality of life, and higher income levels (Abbott, Romild, & Volberg, 2014; Chen & Dong, 2015). Previous epidemiological and clinical research has identified strong associations between regular gambling participation and gambling disorder, defined as “behavior related to gambling which can cause harm to the gambler and those around them” (Abbott, 2017; Abbott et al., 2014; Fong & Ozorio, 2005; Volberg, 2000).
Increased risk of gambling disorder among vulnerable populations is a public health concern. Multiple studies reported that ethnic minorities may be at higher risk of developing gambling disorders (Clarke, Abbott, Tse, et al., 2006; Marshall, Elliott, & Schell, 2009; Petry, Armentano, Kuoch, et al., 2003; Potenza, Steinberg, McLaughlin, et al., 2001; Volberg, Abbott, Rönnberg, et al., 2001; Welte, Barnes, Wieczorek, et al., 2004). Previous studies among Cambodian refugees,(Marshall et al., 2009) veterans in Australia,(Biddle, Hawthorne, Forbes, et al., 2005) and prison inmates in the US(Templer, Kaiser, & Siscoe, 1993) identified stress, substance abuse, and poor mental health to be associated with gambling disorders. Collectively, these studies provide evidence that gambling disorders may be comorbid with other psychosocial burdens, particularly among marginalized populations (Biddle et al., 2005; Currie, Wild, Schopflocher, et al., 2013; Jacques & Ladouceur, 2006; Pearce, Mason, Hiscock, & Day, 2008; Templer et al., 1993; van der Maas, 2016). Due to high living costs, minority stress, and isolation from support networks, migrant workers in Macao encounter substantial psychosocial and financial challenges. The density and ease of access to gambling venues in the region may increase their risk of developing gambling disorder.
Gambling disorder is related to venue proximity (Jacques & Ladouceur, 2006; Pearce et al., 2008; Welte, Wieczorek, Barnes, et al., 2004). Individuals living with increased proximity to gambling venues are more likely to report gambling disorder symptoms (Gerstein, Volberg, Toce, et al., 1999; Jacques & Ladouceur, 2006; Pearce et al., 2008; Welte, Wieczorek, et al., 2004). A New Zealand study found that individuals living <0.7 km from a gambling venue were twice as likely to report symptoms of gambling disorder compared to those living >3.1 km away (Pearce et al., 2008). A national US survey found that living within 10 miles of a venue was associated with a 90% increase in odds of reporting gambling disorders (Welte, Wieczorek, et al., 2004). Possible associations between proximity to venues and gambling disorders in Macao are particularly salient considering the high density of gambling venues.
To the best of our knowledge, no studies in Asian contexts have measured the relationship between sociodemographic correlates, proximity to venues, and gambling disorder, and this study is the first to explore this association among female migrant workers in any context. Given the high density of gambling venues in Macao and a significant migrant worker population under financial and psychosocial stress, a more nuanced understanding of this relationship is crucial to identify key contextual factors that may inform efforts to improve migrant workers' health.
The current study estimated the prevalence of gambling disorder among a representative sample of female domestic workers compared to that of the larger Macao population. It also aimed to characterize and measure the strength of associations between sociodemographic and spatial-level risk factors for gambling participation and disorder.
Section snippets
Study design
The design was cross-sectional. A representative sample of domestic workers was recruited through respondent-driven sampling (RDS) (Heckathorn, 1997) from November 2016 to August 2017. The first set of recruits was trained as ‘seeds’ and asked to refer up to five eligible peers to the study. Seeds were selected for having well-connected social networks and were diversified based on age, geographical residence in Macao, and stay-in or stay-out status. Subsequent recruits could recruit up to five
Results
The study population consisted of 1022 participants: 159 (15.6%) who reported one or more symptoms of gambling disorder and 862 (84.4%) who reported no symptoms. Within the sample, 52 (5.1%) reported four or more symptoms and thus met DSM-5 criteria for gambling disorder. Univariable comparisons indicated that symptoms of gambling disorder did not differ by age, living apart from an employer, monthly salary, total loans, number of dependents upon remittances, or number of months worked as a
Discussion
Among the sample of 1022 Filipino female domestic workers, 160 (15.7%) reported one or more symptoms of gambling disorder and the prevalence of gambling disorder was 5.1%, ~2.4 times greater than that of the total Macao population (2.1%) last measured in 2014 (Wu, Lai, & Tong, 2014). Markedly higher gambling disorder within the sample may indicate that domestic workers in Macao are disproportionately susceptible to developing gambling disorders that likely contribute to psychosocial and
Declarations of interest
None.
Acknowledgments
The authors thank Ms. Julia Lam, Ms. Kitty Tam, and Mr. Pun Chi Ming from Macau-Caritas for their considerable support of this work. We also thank the Center for Teaching and Learning Excellence at The University of Macau for support in using iPads, and in particular, Spencer Benson, PhD, Katrine Wong, PhD, and Chris Fulton, PhD. We also wish to thank the Global and Community Mentsal Health Research Group team, for assistance with data collection and translation efforts. We especially thank our
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