Problem gambling through the lens of population health

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Résumé (français)

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Résumé (anglais)

The purpose of this thesis is to examine problem gambling from a population health perspective. In particular, this research determines the extent to which the household income, regional income inequality, and income insecurity are associated with problem gambling. This thesis consists of four essays. The first essay uses the 2013-2014 Canadian Community Health Survey (CCHS) to construct the III by using three variables, namely employment status, current job status, and multiple job status. We used polychoric Principal Component Analysis (polychoric PCA) to construct an III and the constructed III passes a reliability test and validity tests. The second essay estimates the distinct impact of the III on health status, controlling for level of household income and income inequality. The ordered logit (OLOGIT) regression results reveal that the III measures different aspects of income than the material deprivation and income inequality, thus serving to predict health status. The third essay stands as the core of the thesis. It examines the association between problem gambling and household income, regional income inequality and income insecurity. The OLOGIT regression results suggest that individuals with high income insecurity have greater odds of developing gambling problems independent of the roles played by material deprivation and income inequality. To the extent that problem gambling is associated with income insecurity, there is a role for general social policy to play aiming at better addressing income insecurity faced by particular population groups such as the working poor and insecurely employed. The fourth essay quantifies the losses of Health-Related Quality of Life (HRQL) associated with problem gambling in Canada. Using the 2013-2014 CCHS, I ran an Ordinary Least Squares (OLS) regression to estimate the association between the Health Utility Index (HUI) and problem gambling. The results illustrate that problem gamblers have significantly lower HRQL compared to non-problem gamblers. Using standard metrics for the value of a Quality-Adjusted Life Year (QALY), the annual cost associated with the losses of HRQL is $4,950 per problem gambler per year, and 95% confidence interval suggests that they may range from $300 to $9,450.