Gambling in Brazil: Lifetime prevalences and socio-demographic correlates
Introduction
Gambling has been part of human behavior since prehistory. However, commercial gambling and its explosive growth is a recent phenomenon (Blume and Tavares, 2004). Indeed, gambling has been legalized over almost all of North America (Shaffer and Hall, 2001) and Europe, from East (Bondolfi et al., 2008) to West (Skokauskas and Satkeviciute, 2007). Because gambling is potentially addictive, there is a general concern that this broader access may cause an increase in problematic forms of gambling.
Shaffer proposed a classification of gambling behavior divided into three categories: Level 1 encompasses gamblers who gamble without experiencing adverse consequences; Level 2 gamblers are those who have experienced some adverse symptoms; Level 3 includes those who fulfill criteria for pathological gamblers as defined by the American Psychiatric Association's (APA's) diagnostic criteria (APA, 1994). Recently a subgroup has been spun off from Level 3; a Level 4 that comprises gamblers who, while having met Level 3 criteria, have also sought treatment for gambling-related problems (Shaffer et al., 2002). The emergence of gambling-related problems, and particularly financial ones, is a hallmark of pathological gambling (PG) as defined in previous and current classifications (American Psychiatric Association, 1987, American Psychiatric Association, 2000). However, no specific limits for gambling expenditures have been proposed and tested in order to establish cutoff points to indicate risk of problem or pathological gambling.
Population-based gambling surveys are likely to cover all levels of gambling behavior, while studies based on clinical samples are restricted to the subgroup of pathological gamblers who are under treatment. Studying the profile of all three levels is important in order to establish factors related to disordered gambling. For instance, in previous reports, gender, age and several demographic variables have been deemed to play an important role in differentiating social gamblers from problematic ones. The gender ratio for PG has been reported as around 3:1 to 2:1 in different studies (Weinstock et al., 2008). Problem and pathological gambling have been associated with low socio-economic status (SES), represented by low educational standards, low income, loneliness and unemployment (Cunningham-Williams and Cottler, 2001). Also, a disproportionate percentage of PG has been reported among ethnic and religious minorities, although such an association has been contested in recent studies. Gambling behavior seems to be significantly affected by environmental factors like social insertion and cultural background. Thus, regional variations are expected (Petry et al., 2005). Nonetheless, while prevalence studies on problem and pathological gambling have proliferated in the last few years in the northern hemisphere, few studies have been conducted south of the equator, and — to our knowledge — no data based on national surveys have been published regarding gambling in Latin countries.
In Brazil commercial gambling remains a grey area as regards the law. Brazil is the only Portuguese-speaking country in South America. Despite its continental dimensions and the fifth largest population in the world (roughly 188 million people), the country retains its linguistic unity. Conversely, Brazil presents strong contrasts as a result of its colonization processes. For administrative purposes, the country is divided into five regions according to geographical, historical and cultural criteria: South, Southeast, Northeast, Central-West and North. The Northeast is the oldest region, from which large numbers have immigrated to the North and Southeast regions over the last few decades (Santos and Silveira, 2001).
Gambling is deeply rooted in Brazilian culture, even though it was partially prohibited in the late 1940s by a presidential decree that banned casinos but kept lotteries and betting on horse races. In the early 1990s electronic gambling machines (EGMs) were introduced through a loophole in a law that allowed bingo games for sports fundraising. A diverse array of electronic devices offered in venues of various sizes (from 20 machines up to 400) was swiftly made available for the population. Because of political scandals involving undeclared funds for electoral campaigns, gambling has undergone alternate legalization and bans over the last six years. However, it seems that Pandora's Box has been opened, and even during periods of prohibition EGM venues are busy operating underground (Tavares and Spritzer, 2007).
The goals of the current study were to investigate in a nationally representative sample the lifetime prevalence of four gambling categories (non-gamblers, social gamblers, problem and pathological gamblers), contrasting gambling expenditures among these categories; and to compare the demographic profiles of the gambling categories. Additionally, on an exploratory basis, we intended to tap into cultural issues regarding religious practices and cultural background. In this survey, both region of origin and current living region, besides different measures of migration and living environment, were registered in order to account for influences of past and current cultural background.
Should gambling behavior in Brazil follow patterns previously reported, then problem and pathological gambling would be more frequent among men, youth, and low SES individuals from ethnic and religious minorities (Alegria et al., 2009). However, such associations are likely to vary according to time and community (Abbott et al., 2004), and some of these factors probably interact in complex ways. For instance, while men represent the majority of pathological gamblers, the gender imbalance decreases as one moves to older age brackets, since onset of gambling presents later in women (Petry et al., 2005). Likewise, the international trend has been of juvenalization of gambling (Derevensky et al., 2003). But age may have a bi-directional effect over gambling, while young individuals are naturally curious and action prone (Ernst et al., 2006), older adults are emotionally less vulnerable to monetary losses (Samanez-Larkin et al., 2007), thus both age extremes could be at higher risk for harmful gambling.
Finally, the contribution of SES to gambling behavior may not fall into a simple linear logic (i.e. the lower the SES, the higher the commitment to gambling). Indeed, Welte et al. (2002) reported that gambling participation increased with SES, but lower SES individuals were more likely to be pathological gamblers than higher SES individuals. This apparent paradox may be solved if one's gambling participation is adjusted to his/her income, since low absolute expenditures may represent a higher proportion of the income for low SES individuals. Besides, SES may not be a factor in itself, but rather a partial indicator of social insertion, modulated by other aspects such as ethnicity, religion and other factors related to one's cultural background.
Our hypotheses were that problematic gambling behavior in Brazil would be associated with higher betting expenditures in relation to the family income, male gender, lower age, poorer social insertion, past and present culture background, and affiliation to minority groups, either ethnic or religious ones.
Section snippets
Sampling
The Pesquisa Nacional Brasileira sobre Padrões de Consumo de Álcool (Brazilian National Survey on Alcohol Consumption Patterns: Laranjeira et al., 2007) was carried out between November 2005 and April 2006. It was a household survey that visited 143 cities, making in total 325 census sectors as defined by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística — IBGE, 2000). The sample was designed to represent the Brazilian population aged 14 years
Results
The sample demographics were presented in a previous communication (Laranjeira et al., 2007); the profile was considered compatible with the last national census (IBGE, 2008), and representative of the Brazilian population.
Out of 3007 respondents, 88.3% were classified as non-gamblers, 9.4% were social gamblers, 1.3% problem gamblers, and 1.0% pathological gamblers. Among current regular gamblers (those who declared a monthly gambling expenditure above zero, N = 309), 17.9% reported an average
Discussion
To our knowledge, this is the first epidemiological study to investigate the prevalence of gambling and its socio-demographic predictors in a national Latin–American sample, and possibly the first one of its kind among developing countries.
Approximately 12% of the sample declared that they gambled on a monthly basis, indicating that regular gambling is not an uncommon behavior in Brazil. The overall lifetime prevalences of 1% of pathological gamblers and an additional 1.3% of problem gamblers
Acknowledgment
This study was partially funded by the National Anti-Drug Secretariat (SENAD), grant# 017/2003.
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