Spatial distribution of gambling exposure and vulnerability: an ecological tool to support health inequality reduction.

OBJECTIVES

Recent research by Public Health has redefined harmful gambling, shifting the focus from problematic people with irresponsible behaviour to 'gamblogenic' environments. The aim of this research was to support this alternative perspective with concrete ecological tools for characterizing harmful environments. Studies that analyse the spatial distribution of gambling show that people living in the most disadvantaged areas have greater access to gambling and are more affected by the harms of gambling. Despite their quality methodology and usefulness, the scope of geographic access measures has been partially limited. These measures have been mostly structured around a single form of gambling, focus on only one dimension of accessibility (density or proximity) and few of them take into account the risks associated with each type of the game. The main goal of our research was to propose an innovative method to characterize gambling environments in Quebec and address social inequality with respect to gambling exposure. This article more specifically describes the method we used to address the aforementioned shortcomings by developing the gambling exposure index (GEI), a more comprehensive ecological index of all games-weighted by their relative level of risk-to which populations are exposed.

STUDY DESIGN

The study design is a cross-sectional ecological study.

METHODS

The methodological approach was carried out in three stages. A GEI was operationalized and is composed of three dimensions: A dimension of spatial accessibility to gambling sites, a dimension of density of gambling places and a dimension of relative risk associated with different types of game. The two-step floating catchment area (2SFCA) method was used to combine these three dimensions into an overall GEI index. Data were retrieved from a geocoded directory of all gambling sites from Loto-Québec and other commercial databases. The relative risk of each type of game has been expressed by prevalence rates for those specific games in a Quebec population prevalence survey. A vulnerability to gambling index (VGI) was produced based on 6 socio-economic proxies of problem gambling from the 2016 Canadian census. The six variables were weighted and aggregated at the dissemination area (DA) level. Spatial and descriptive statistical analyses were conducted to explore the relationship between VGI and GEI and to identify areas that are highly vulnerable and have a high gambling exposure.

RESULTS

The findings of our analysis reveal widespread geographic exposure to gambling and a significant positive linear relationship between the GEI and the VGI. In many areas, increased accessibility to gambling is significantly associated with a higher vulnerability to gambling. Our findings demonstrate that in 1328 DAs in Quebec, there is a particularly unequal and potentially harmful geographical distribution of gambling, exposing 9% of the population which are theoretically vulnerable to gambling to an increased presence of gambling.

CONCLUSION

This research applied a spatial analytical approach to assess the association between environments, gambling and vulnerability. The GEI and VGI at the DA level can serve as a monitoring tool for policy-makers regarding gambling exposure in the most vulnerable sectors and contribute to prevention and intervention strategies better adapted to the population. The general findings raise the ethical implications of increased marketing development in vulnerable neighbourhoods. As the GEI takes into account both the environmental determinants and the relative risk of games, it is in contributing to the shift in public and scientific discourse, redefining the subject from problematic people to problematic games and environments.