Online Gambling's Associations With Gambling Disorder and Related Problems in a Representative Sample of Young Swiss Men.

Internet gambling has recently grown in popularity, but relatively little is known about how online and the combination of online and offline (mixed) gambling are associated with gambling disorder (GD) and related problems. The present research examined in a cohort study sample of young Swiss men how their gambling activities and gambling-related problems differed across the spectrum from offline to online gambling. A general-population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF), consisting of 5,352 young Swiss men (mean age 28.26 years old). The spectrum from exclusively offline to almost exclusively online (>90% of gambling money spent online) gambling was measured using one question about the proportion of gambling money spent online. Total money gambled and time spent on gambling were also assessed. GD severity (range 0-9) was measured using items reflecting the nine DSM-5 GD criteria. The number of gambling-related problems (e.g., financial difficulties, range 0-10), other addictive disorders and mental health problems were also inquired about. We estimated a generalised linear model using a count model (negative binomial link function) for GD severity and gambling-related problems associated with the amounts and proportions of money gambled online and offline. The number of GD criteria were associated with money gambled online (IRR [95%CI] = 2.81 [2.43, 3.24]) and offline (IRR = 2.68 [2.40, 3.00]). This was also found for the number of gambling-related problems (IRR = 2.43 [2.13, 2.79] and IRR = 2.89 [2.59, 3.23]). Compared with exclusively-offline gamblers, mixed gamblers (26-90% of money gambled online) showed the highest levels of GD symptoms and gambling-related problems, followed by the almost-exclusively-online gamblers (≥91% money gambled online) and, overall, these associations were still significant after adjustment for overall involvement in gambling (time spent and money gambled). Levels of other addictive disorders and mental health problems were higher among mixed gamblers than among offline-only gamblers, but levels among almost-exclusively-online gamblers were not. Symptoms of gambling disorder and gambling related problems are highest among gamblers engaging in both offline and online gambling. Prevention efforts need to target the combination of offline and online gambling.