This is the first national study to examine the prevalence and characteristics of disordered gambling across racial and ethnic groups. We found that: 1) the prevalence of disordered gambling varies by racial and ethnic group; 2) differences exist across racial and ethnic groups with respect to sociodemographic characteristics and psychiatric and medical comorbidities in disordered gamblers, but these differences parallel those of the racial and ethnic groups in the general population; 3) there are no racial and ethnic differences in onset/course of the disorder, number or pattern of criteria or treatment rates of pathological gamblers of different racial and ethnic groups.
The study found that Blacks and Native American/Asians had significantly higher prevalence of disordered gambling than Whites. Our findings are consistent with those of geographically localized clinical and community samples.8, 15, 62
Several reasons may contribute to the racial and ethnic differences in prevalence. Although we found a large number of differences in demographic variables between Black, Hispanic and White disordered gamblers in the present study, those differences are generally consistent with previously documented racial and ethnic differences in characteristics of individuals in the US general population,63
including income, level of education and geographic distribution. Differences in nicotine dependence, alcohol use, drug use, mood, anxiety and personality disorders and general medical health condition in racial and ethnic groups of disordered gamblers are generally consistent with the race and ethnic-related differences in physical and mental health of individuals in the United States found in previous studies. 64–70
Several of the sociodemographic characteristics (e.g., socioeconomic status) and comorbidity patterns (e.g., alcohol use disorders) of these groups are well-known risk factors for pathological gambling. 3, 6, 21, 71
For example, Native Americans have been consistently found to have higher prevalence of psychiatric and substance use disorders than any other racial and ethnic group, 68, 72–74
factors strongly associated with pathological gambling. 3, 75
Our findings suggest that pathological and disordered gambling may share the same risk factors and that the increased risk for disordered gambling in certain racial and ethnic groups is partially due to the highest prevalence of these risk factors in those groups.
Cultural factors also appear to influence the prevalence of disordered gambling. For example, gambling is part of the tradition, history, and lifestyle of some Asian cultures. 71, 76, 77
As a result children often have increased exposure to and parental approval for gambling, 77
which has been shown to increase the risk for disordered gambling. 78, 79
In other cultures, acceptance of magical thinking and existence of fate may allow such beliefs to be extended to gambling. 9
Disordered gamblers have been previously shown to have cognitive distortions related to gambling. 80
Difficulties related to post-immigration adjustment, which affect many members of most racial and ethnic minorities, such as unemployment, language barriers, and social isolation have been associated with disordered gambling in Asians. 81, 82
In the case of Native Americans, the establishment of casino gambling on several reservations through 1988 Federal Indian Gaming Regulatory Act Disparity 83, 84
increased exposure to gambling activities in this population, leading to increased risk for disordered gambling 10
among vulnerable individuals. An alternative explanation for the higher risk among these racial and ethnic minority groups is that, cconsistent with the prospect theory, 85, 86
minority individuals, being often from disadvantaged backgrounds may place higher value on winning than Whites, while they see losses as a less adverse consequence. This differential value of risk would lead to increased proneness to gambling, as well as problem and pathological gambling
An important exception to this pattern of higher prevalence of disordered gambling among racial and ethnic minorities is found among Hispanics. Despite social adversity and high prevalence of risk factors for disordered gambling among Hispanics living in the US (e.g. poverty, low educational attainment, discrimination), findings of this study showed that neither disordered nor pathological gambling were more prevalent in this population than among Whites. Moreover, disordered gambling was significantly less prevalent among Hispanics than among other minority groups. This finding suggests the existence of protective factors among Hispanics that buffer the effect of their risk factors, and is consistent with the “Hispanic paradox”, 87
i.e., the presence of better health outcomes among Hispanics compared with Whites, despite lower socioeconomic conditions and poorer access to care. 54, 88, 89
Although the Hispanic paradox has been widely documented, its underlying mechanisms are unknown. Identification of those mechanisms could help devise effective, theory-based prevention programs for Hispanics and possibly other racial and ethnic groups, to the extent that those factors are present or can be developed in those groups.
The findings of this study should be interpreted in light of several limitations. First, the assessment of problem and pathological gambling was based on self-report, and not subject to verification by collateral informants or other objective indicators. However, a growing body of research indicates that self-reports of gambling behavior may be more accurate than reports by third parties, provided there is no contingency attached to the gambling behavior reported 90
. Second, the NESARC samples the civilian non-institutional population residing in households and group quarters age 18 years and older, and does not provide information on other groups that may be at increased risk for disordered gambling, such as youth under the age of 18 and individuals in jail.
Third, to ensure stability of estimates due to the small sample sizes of Native Americans and Asian respondents, we combined these two groups, which could conceal differences between them. However, we conducted supplementary analyses comparing the outcomes of these two groups and found no significant differences between the two groups other than greater lifetime prevalence drug use disorder, nicotine dependence and personality disorder among Native American than Asian disordered gamblers, suggesting the similarity of those two groups with respect to other variables examined in this study. Fourth, most but not all of the results presented in this study do not refer to DSM-IV Pathological gambling but to Disordered gambling which includes individuals meeting more than 3 criteria rather than 5 or more required for the diagnosis of Pathological gambling by the DSM-IV. Although the validity of this broader category needs additional confirmation, research supporting this category, includes the finding of a continuous liability model for genetic risk for problem and pathological gambling,89 as well as previous analysis of the NESARC data suggesting a that gambling disorders should be best thought as lying on a continuum2, 92–94
(Fifth, analyses of onset, types of gambling and venues, and treatment seeking behavior were limited to only those individuals who met DSM-IV criteria for pathological gambling. Finally, the NESARC, like most large-scale surveys, assumes that a nosological construct, in this case disordered gambling, is valid across cultures. Although the diagnosis seemed to applied equally well for Whites and Blacks in a recent study, 95
an important direction for future research will be the examination of this assumption and the degree to which language bias, and other cultural factors may lead to differential response patterns between gamblers from different racial and ethnic groups. Prior research suggests that the presentation of the psychiatric disorders may differ by racial and ethnic group,96, 97
which may lead to biased estimates when particular screeners 98
or universal nosological frameworks 99
Despite these limitations, this study constitutes a critical step improving the understanding of the prevalence and characteristics of disordered gambling across the major ethnic and racial groups in the US. The study found important differences in gambling behavior among racial and ethnic groups in a large nationally representative sample of the general population. As gambling opportunities continue to expand, the findings from this study should help inform future preventive and treatment interventions among minority racial and ethnic groups.