Gambling expenditure predicts harm: Evidence from a venue-level study

Background and Aims: The Total Consumption Theory of gambling suggests that gambling expenditure is positively associated with gambling-related harm. We test the hypothesis that electronic gaming machine (EGM) expenditure predicts gambling-related harm at the level of the EGM venue. Design: Cross-sectional analysis of survey and administrative data. Setting: General urban adult population of the Northern Territory of Australia. Participants: The sample consisted of 7049 respondents to a mail-survey about venue visitation and gambling behaviour across 62 EGM venues. Measurements: Gambling-related harm was defined as the endorsement of two or more items on the Problem Gambling Severity Index. We obtained venue-level EGM expenditure data from the local licensing authority for all venues in the study area. We compared the prevalence of gambling-related harm among patrons aggregated at the venue level with the estimated mean EGM expenditure for each adult resident in the venue's service area using a Huff model, correlation analysis and multivariate binomial regression. Findings: Aggregated to the venue level (n=62), per-capita EGM expenditure was correlated significantly with rates of gambling-related harm (r=0.27, n=62, P=0.03). After adjusting for venue type and number of EGMs, an increase in mean per-capita monthly EGM expenditure from $AU10 to $AU150 was associated with a doubling in the prevalence of gambling-related harm from 9% (95% CI=6-12%) to 18% (95% CI=13-23%). Conclusions: As suggested by the Total Consumption Theory of gambling, aggregate patron electronic gaming machine expenditure predicts the prevalence of gambling-related harm at the venue level.