This report was prepared by the Responsible Gambling Council (RGC)

research team consisting of:

Monica A. White, PhD

Phil Mun, PhD

Nadine Kauffman, MA

Christina Whelan, MSc

Matthew Regan, MSW

Jon E. Kelly, PhD

We wish to acknowledge Anita Gupta, PhD, for assisting with the prepa-
ration of the report, and Jamie Wiebe, PhD, of Factz Research, for con-
ducting and analyzing the focus groups and interviews.

The Responsible Gambling Council (RGC) is an independent, non-profit or-

ganization committed to problem gambling prevention. RGC designs and
delivers highly effective awareness programs and promotes the identification
and adoption of best practices in problem gambling prevention through re-
search and information dissemination.

www.responsiblegambling.org
TABLE OF CONTENTS
LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

LITERATURE REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
EGM FEATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Speed of Play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Sensory Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Payment Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Payout Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Betting Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
EGM-based Inducements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Game Availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Programmed Gaming Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
EGM-based Responsible Gambling Features (RGFs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

VENUE FEATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Venue Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
EGM Accessibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Venue Conveniences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Venue Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Venue-based Harm Minimization Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

COMMUNITY ACCESSIBILITY FEATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Number of EGM Venues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Proximity of EGM Venues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
EGM Caps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Number of EGMs per Capita (Density) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
EGMs in Low Income Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

KEY INFORMANT QUESTIONNAIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Response Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
TABLE OF CONTENTS
SECTION A: CONTRIBUTORS TO PROBLEM GAMBLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Data Analysis Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

SECTION B: MODIFICATIONS TO REDUCE PROBLEM GAMBLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Data Analysis Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

FOCUS GROUPS WITH PROBLEM GAMBLERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
EGM Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Venue Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Community Accessibility Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
LIMITATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

SUMMARY & CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

APPENDIX 1: Key Informants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

APPENDIX 2: Key Informant Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

APPENDIX 3: Open-ended Responses to Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

APPENDIX 4: Complete Rankings of Contributors and Modifications . . . . . . . . . . . . . . . . . . . . . . . . . 93

APPENDIX 5: Focus Group Script . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

APPENDIX 6: Counsellor Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

APPENDIX 7: Counsellor Interview Script . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

LIST OF TABLES
TABLE 1. Questionnaire Response Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
TABLE 2. Most and Least Important EGM Contributors to Problem Gambling (Researchers) . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
TABLE 3. Most and Least Important EGM Contributors to Problem Gambling (Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
TABLE 4. EGM Feature Thematic Mean Importance Scores (Researchers and Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
TABLE 5. Most and Least Important Venue Contributors to Problem Gambling (Researchers) . . . . . . . . . . . . . . . . . . . . . . . . . . 35
TABLE 6. Most and Least Important Venue Contributors to Problem Gambling (Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
TABLE 7. Venue Feature Thematic Mean Importance Scores (Researchers and Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
TABLE 8. Community Accessibility Contributors to Problem Gambling (Researchers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
TABLE 9. Community Accessibility Contributors to Problem Gambling (Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
TABLE 10. Most Effective EGM Modifications and Perceived Evidence Strength (Researchers) . . . . . . . . . . . . . . . . . . . . . . . . . . 40
TABLE 11. Least Effective EGM Modifications and Perceived Evidence Strength (Researchers) . . . . . . . . . . . . . . . . . . . . . . . . . . 41
TABLE 12. Most Effective EGM Modifications and Perceived Evidence Strength (Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
TABLE 13. Least Effective EGM Modifications and Perceived Evidence Strength (Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
TABLE 14. Most Effective EGM Modifications (Counsellors) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
TABLE 15. Least Effective EGM Modifications (Counsellors) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
TABLE 16. Most Effective EGM Modifications (Problem Gamblers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
TABLE 17. Least Effective EGM Modifications (Problem Gamblers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
TABLE 18. Quartile Ranking (1-4) of Select EGM Modifications by Key Informant Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
TABLE 19. EGM Modification Thematic Mean Effectiveness Scores (Total Sample) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
TABLE 20. Most Effective Venue Modifications and Perceived Evidence Strength (Researchers) . . . . . . . . . . . . . . . . . . . . . . . . . 48
TABLE 21. Least Effective Venue Modifications and Perceived Evidence Strength (Researchers) . . . . . . . . . . . . . . . . . . . . . . . . . 49
TABLE 22. Most Effective Venue Modifications and Perceived Evidence Strength (Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . 50
TABLE 23. Least Effective Venue Modifications and Perceived Evidence Strength (Specialists) . . . . . . . . . . . . . . . . . . . . . . . . . . 51
TABLE 24. Most Effective Venue Modifications (Counsellors) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
TABLE 25. Least Effective Venue Modifications (Counsellors) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
TABLE 26. Most Effective Venue Modifications (Problem Gamblers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
TABLE 27. Least Effective Venue Modifications (Problem Gamblers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
TABLE 28. Quartile Ranking (1-4) of Most Effective Venue Modifications by Key Informant Group . . . . . . . . . . . . . . . . . . . . . . . . 54
TABLE 29. Quartile Ranking (1-4) of Least Effective Venue Modifications by Key Informant Group . . . . . . . . . . . . . . . . . . . . . . . . 54
TABLE 30. Quartile Ranking (1-4) of Select Venue Modifications by Key Informant Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
TABLE 31. Venue Modification Thematic Mean Effectiveness Scores (Total Sample) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
TABLE 32. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Researchers) . . . . . . . . . . . . . . 57
TABLE 33. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Specialists) . . . . . . . . . . . . . . . 58
TABLE 34. Community Accessibility Modification Effectiveness (Counsellors) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
TABLE 35. Community Accessibility Modification Effectiveness (Problem Gamblers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
TABLE 36. Item Ranking of Community Accessibility Modifications by Key Informant Group . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
TABLE A1. Rank Order of Mean Importance Scores: EGM Contributors (Researchers and Specialists) . . . . . . . . . . . . . . . . . . . . . . 93
TABLE A2. Rank Order of Mean Importance Scores: Venue Contributors (Researchers and Specialists) . . . . . . . . . . . . . . . . . . . . . 94
TABLE A3. Rank Order of Mean Importance Scores: Community Accessibility Contributors (Researchers and Specialists) . . . . . . . . . 94
TABLE A4. Rank Order of Mean Effectiveness Scores: EGM Modifications by Key Informant Group . . . . . . . . . . . . . . . . . . . . . . . 95
TABLE A5. Rank Order of Mean Effectiveness Scores: Venue Modifications by Key Informant Group . . . . . . . . . . . . . . . . . . . . . . 97

EXECUTIVE SUMMARY
BACKGROUND
In February 2006, the Saskatchewan Liquor and Gaming
Authority (SLGA), the organization which regulates all video
lottery terminals (VLTs) and slot machines, made a commit-
ment to review its policies regarding electronic gaming ma-
chines (EGMs) and problem gambling. To inform their re-
view, SLGA asked the Responsible Gambling Council (RGC)
to conduct a broad-based exploration of Key Informant opin-
ions regarding best practices in the management of EGMs.
As a non-profit organization whose mandate includes inves-
tigation and dissemination of best practices, RGC not only
agreed to conduct the research on behalf of the SLGA, it also
agreed to contribute financially to the initiative.
The relationship between EGMs and problem gambling is
somewhat ambiguous. There is research to suggest that the
speed of problem gambling onset is faster for EGM players
than for gamblers who engage in other forms of gambling.
This is corroborated by clinical studies that have shown that
EGM gambling tends to be the most common form of gam-
bling engaged in among individuals seeking treatment for
problem gambling. However, EGMs are among the most ac-
cessible and predominant form of gambling. Thus, it has been
argued that the greater number of EGM players creates the
appearance of a concomitant greater number of EGM prob-
lem gamblers. The RGC analyzed their 2005 prevalence data
on gambling and problem gambling in Ontario and found
that EGM play was the strongest independent predictor of
problem gambling, a finding that is supported by several oth-
er studies. Thus, while there may be inconclusive evidence as
to whether or not EGMs lead to problem gambling, there is
consensus in the literature that EGM use and problem gam-
bling are strongly related.
Numerous studies have attempted to shed light on the na-
ture of the relationship between EGMs and problem gam-
bling. For the purpose of this report, the variables that have
Electronic Gaming Machines and Problem Gambling
been examined in many of these studies are classified into
three general areas: 1) EGM features, 2) venue features, and
3) community accessibility features. Using these three areas
as its framework, the present study assesses, via the opinion
of various Key Informants, which features are most likely to
contribute to problem gambling, and which modifications to
these features are most likely to reduce EGM-related prob-
lem gambling risk. The report consists of a literature review
of available research on the three framework areas, a survey
of Key Informant opinion, focus groups with EGM problem
gamblers, a discussion of findings and limitations, and, lastly,
a summary and conclusion.
LITERATURE REVIEW
There is a growing body of research that has examined the
structural characteristics of EGMs that may be associated
with problem gambling. These characteristics include the ma-
chine’s speed of play, sensory effects (e.g., lights and sounds),
payment methods (e.g., bill acceptors, direct electronic fund
transfers), payout methods (e.g., tickets, tokens), betting op-
tions (e.g., minimum and maximum bet sizes), EGM-based
inducements (e.g., near-misses, prize advertisements), game
availability (e.g., type and number of games), programmed
gaming features (e.g., win frequency, payout rate), and EGM-
based responsible gambling features (e.g., machine RGFs,
time and money limits).
In addition to the features directly associated with EGMs,
some have hypothesized that the relationship between EGMs
and problem gambling may be partly due to features of the
venues that house the machines. That is, problem gambling
could be associated with the type of venue in which one
gambles (e.g., a hotel versus a casino), one’s access to EGMs
(which is affected by the number of EGMs in the venue, the
hours of operation, etc.), conveniences offered by the venue
(e.g., access to money and/or alcohol), the venue’s design and
advertising campaigns, and the harm minimization strategies
undertaken by the venue to mitigate problem gambling.
Lastly, at the broadest level, a third EGM-related area that has
been identified as being associated with problem gambling is
community accessibility. Features that have been discussed
in the literature that pertain to a community’s overall access
to EGMs include the number of EGM venues, proximity of
EGM venues, EGM caps, number of EGMs per capita, and
EGMs in low income areas.

Electronic Gaming Machines and Problem Gambling
KEY INFORMANT QUESTIONNAIRE
Key Informants from Canada and abroad were invited to
complete a questionnaire on EGM-related problem gambling.
Informants consisted of problem gambling Researchers, iden-
tified through the published literature and/or personal refer-
ral; gaming and problem gambling Specialists (i.e., health
and problem gambling professionals, regulators, opera-
tors), identified through gambling governing bodies and/or
personal referral; problem gambling Counsellors, recruited
through addiction agencies and/or personal referral; and
EGM Problem Gamblers themselves, recruited through prob-
lem gambling services.
The questionnaire was divided into two main sections. Section
A looked at the contributors to problem gambling, and asked
Researchers and Specialists to indicate their thoughts on the
importance of select EGM features, venue features, and over-
all community accessibility features as contributors to prob-
lem gambling. Section B looked at modifications and asked
all Key Informants to indicate their opinions on how effective
select modifications to the above features would be in reduc-
ing the risk of problem gambling. Researchers and Specialists
were also asked to indicate their opinion on the strength of
the evidence supporting each modification.
FOCUS GROUPS
Two focus groups with EGM Problem Gamblers were
conducted for this study: one in Regina, Saskatchewan, the
other in Ajax, Ontario. Participants were first asked about
their experiences with gambling and problem gambling.
They were then asked, using the three framework areas as a
guide, what they think it is that contributes to EGM-related
problem gambling, and what they think could be done to
reduce EGM-related problem gambling risk.
DISCUSSION
In reviewing the literature and synthesizing the opinions of a
cross-section of Key Informants for the present study, a num-
ber of findings emerged which identified potential EGM-re-
lated contributors to problem gambling, as well as possible
modifications to reduce problem gambling risk.

EGM Features that Contribute to Problem Gambling
With respect to EGM features, the Researchers and Specialists
regarded fast speed of play, direct electronic fund transfers
(which allow patrons to access bank or credit card funds di-
rectly while sitting at an EGM), the appearance of near-miss-
es, and bill acceptors as the most important contributors to
problem gambling. The importance of these items was sup-
ported by a thematic analysis which showed that features that
speed up play (e.g., short time intervals between bet and out-
come), involve payment methods (e.g., bill acceptors), and
give the appearance of near-misses were rated much higher
in importance than other EGM features.
EGM Modifications to Reduce Problem Gambling
Consistent with the finding that Key Informants identified
direct electronic fund transfers and bill acceptors at EGMs
as among the most important contributors to problem gam-
bling, the elimination of these features was ranked among the
modifications most likely to be effective in reducing problem
gambling risk.
Key Informants also endorsed mandatory player registration,
the use of smart cards, the optional or (preferably) mandato-
ry setting of pre-determined spending limits, and on-screen
running cash totals of the amount spent during an EGM ses-
sion. There is little doubt that the Key Informants were very
optimistic about the potential of smart card technology to
address problem gambling. However, this endorsement needs
to be assessed within some limitations of the present study.
Since no definition of “smart card” technology was provided
to Key Informants, it is not possible to know what specific
aspects of the technology they were endorsing. “Smart card”
is to some degree a global term, which can incorporate a va-
riety of features such as card-based access controls, player-
controlled self-limits, provider-controlled self-limits, and
self-exclusion.
From a broader perspective, the thematic analysis indicated
that Key Informants believed that modifications aimed at
limiting the amount of money spent and restricting payment
methods were most likely to reduce problem gambling risk.
However, although the Researchers rated speed of play and
the appearance of near-misses as important contributors to
problem gambling, they did not consider reducing the speed
of play or the appearance of near-misses as effective as reduc-
ing the potential for overspending. Overall, Key Informants
were more supportive of modifications to spending and ac-

cess to funds, rather than in modifications that might damp-
en the emotional experience and excitement of playing on
EGMs.
Venue Features that Contribute to Problem Gambling
According to the Researchers and Specialists in this study, the
most important venue-related contributors to problem gam-
bling were having ATMs located either on the gaming floor
or close to machines, 24-hour access to EGMs, and market-
ing that was targeted directly to the EGM player. Overall, easy
access to money in venues (specifically via ATM machines)
was considered a key contributor to problem gambling.
Venue Modifications to Reduce Problem Gambling
The venue modifications that Key Informants considered to
be most effective in reducing problem gambling risk were
prohibiting access to funds from credit cards at ATMs, dis-
allowing cheque-cashing at venues, and removing ATMs
from venues. As an alternative to removing ATMs, Key
Informants expressed strong support for introducing other
ATM restrictions, such as imposing tighter controls over
withdrawal limits, a point that is also supported by research
in the literature.
Community Accessibility Features that Contribute to
Problem Gambling
Overall, the Community Accessibility features that Key
Informants believed would be relatively more important
contributors to problem gambling were those related to EGM
distribution; that is, wide dispersion of EGMs throughout
the community, large number of community venues housing
EGMs, and convenient locations of EGM venues (e.g., close
proximity to high residential populations).
Community Accessibility Modifications to Reduce
Problem Gambling
Regarding modifications to community accessibility fea-
tures, there was considerable variation among the four Key
Informant groups such that there was no single item that all
groups agreed would be the single most effective modifica-
tion. However, the Key Informants as a group agreed that re-
ducing the number of EGM facilities and centralizing EGMs
to one or a few locations (preferably away from residential
areas) would likely be the most effective community acces-
sibility modifications.
Electronic Gaming Machines and Problem Gambling
SUMMARY & CONCLUSIONS
In a broad sense, Key Informants believed that certain fea-
tures intrinsic to EGMs, such as the speed of play and ap-
pearance of near-misses, contribute to the risk of problem
gambling. With respect to potential modifications, all Key
Informant groups supported changes that did not directly
involve the functioning of EGMs, but focused instead on the
management of money, pre-commitment, the use of smart
card technology, and restricting community access.
The Management of Money
The management of money emerged as an important issue
related to problem gambling, as many of the highest ranked
items and the thematic analysis focused on the on-screen dis-
play of money, access to money through ATMs, cheque-cash-
ing, direct electronic fund transfers, and the setting of spend-
ing limits. One of the most consistent opinions to emerge
from this study regarding effective modifications pertained
to limiting a player’s access to funds. Key Informants felt that
restricting direct electronic fund transfers from credit and
debit cards would be beneficial in reducing the risk of prob-
lem gambling.
Pre-commitment
Pre-commitment constitutes the creation of pre-set spending
or time limits that are established prior to the start of a gam-
bling session. There was considerable support among Key
Informants for the creation of pre-commitment initiatives
for gamblers, specifically for self determined, pre-set limits
concerning the amount of money gamblers could spend in a
given EGM session. It should be noted that Key Informants
also felt that the concept of pre-commitment would be more
effective in practice if it were to be a mandatory requirement
for gamblers rather than optional.
The Use of Smart Card Technology
The mandatory registration and use of smart cards was one of
the study’s most highly endorsed modifications for reducing
problem gambling risk. While the questionnaire did not pro-
vide an extensive opportunity for Key Informants to elaborate
on the type of smart card system that they had in mind, the
Informants appeared to understand that it involved a univer-
sal registration system and a requirement to have a card for
machine access. Given that smart card systems can vary sig-
nificantly in nature (e.g., by their time and money spending

Electronic Gaming Machines and Problem Gambling

limits, optional/mandatory features, types and levels of en-
forcement), Key Informants would likely have varying views
on the breadth and comprehensiveness of such systems.
Restricting Community Access
In terms of community accessibility, although there was
relatively strong support for all the modifications examined,
the study seemed to suggest that the Key informants over-
all preferred restrictions on the number of EGM venues and
the centralization of machines within a community as the
most effective modifications for reducing the risk of problem
gambling.
Other Notable Observations
Among the Key Informants, Researchers and Specialists were
asked to assess the strength of evidence for each EGM, ven-
ue, and community accessibility modification item. Overall,
there were low levels of confidence in the strength of the cur-
rent evidence base. There was also little connection between
the Key Informants’ perception of evidence strength, and the
strength of the evidence found in the literature.
ed problem gambling is limited and incomplete. Most work-
ing in the field agree that a strong relationship exists between
problem gambling and EGMs. Less clear is the question of
how best to address this relationship. While research on the
mechanics of EGMs provides insight into machine dynamics
and player behaviour, such research offers less guidance as
to what can be done to reduce problem gambling risk. This
study gathers the opinions of some of those who have helped
define the field and knowledge base in order to provide infor-
mation that will be of assistance to policy-makers responding
to the dilemmas posed by EGMs. In order for the findings
of this study to be useful, however, they must be interpreted
within a given jurisdiction’s socio-political, geographic, and
economic context.

Implications and Future Directions

The literature reviewed for this study demonstrated that the
current knowledge base regarding ways to reduce EGM-relat-



INTRODUCTION
In February 2006, the Saskatchewan Liquor and Gaming
Authority (SLGA), the organization which regulates all video
lottery terminals (VLTs) and slot machines, made a commit-
ment to review its policies regarding electronic gaming ma-
chines (EGMs) and problem gambling. To inform their re-
view, SLGA asked the Responsible Gambling Council (RGC)
to conduct a broad based exploration of Key Informant
opinion about best practices in the management of EGMs.ii
As a non-profit organization whose mandate includes inves-
tigation and dissemination of best practices, RGC not only
agreed to conduct the research on behalf of the SLGA, it also
contributed financially to the initiative.
BACKGROUND
Controversy and debate have surrounded EGMs for the last
14 years.4,5 The genesis of the controversy stems from Dr.
Robert Hunter, a psychologist at Las Vegas’ Charter Hospital,
who claimed that players of EGMs (particularly video poker)
 EGMs such as VLTs and slot machines are technologically complex, but
simple to use machines characterized by fast speed of play, bright colours,
music, flashing lights, and random payout schedules. Whereas slot ma-
chines used to pay out in the form of cash, they now, similar to VLTs, may
pay out in the form of tickets or tokens.1 While in the past slot machines
operated mechanically, today both slot and VLT machines have electronic
operations. The only real difference remaining between the two types
of machines seems to be the wider dispersal of VLTs in the community
compared to slots, which are typically associated with casinos. Given their
similarity and the fact that there does not appear to be any substantive
research that differentiates between the two types of machines in terms
of problem gambling outcomes, 2,3 no distinction was made between VLT
and slot machines in the present report. Moreover, it is expected that the
definition of what constitutes an EGM will be expanded in the future as
machines grow together.
ii It is important to note at the outset of this report that the causes of
problem gambling are complex. They involve a set of interactions between
individual players, the game they are playing, and the environment they
are playing in. Ultimately, the beliefs, attitudes, and behaviours of the in-
dividual player are the primary determinants of trouble-free gambling.
However, the providers of gambling, like the providers of any product,
Electronic Gaming Machines and Problem Gambling
“bottomed out” more quickly than those who played more
traditional games.4 This assertion was supported empirically
by two studies which found that, among problem gamblers,
the speed of problem gambling onset was faster for EGM
players compared to players of other forms of gambling
(such as cards, dice, horses, dogs, bingo and scratch cards).
The authors of these studies speculated that the association
between EGMs and problem gambling was due to the “rapid,
continuous and repetitive nature of EGMs”.6,7 Clinical studies
also show that among problem gamblers seeking treatment,
use of EGMs tend to be the most common form of gambling
engaged in.8-14
However, EGMs are also among the most accessible and
predominant form of gambling.15 In Canada, there are over
80,000 machines available across the country, generating by
far the greatest revenue over all other forms of gambling.16
Thus, it has been argued that the greater number of EGM
players in the population makes it seem that there is a con-
comitant greater number of EGM problem gamblers. However,
it may be that there are proportionally fewer EGM problem
gamblers compared to problem gamblers who engage in oth-
er forms of gambling.17 The RGC analyzed their 2005 preva-
lence data on gambling and problem gambling in Ontario
and found that EGM play was the strongest independent pre-
dictor of problem gambling, even after controlling for gender,
education, and other forms of gambling.2 Similarly, results of
an epidemiological study from Prince Edward Island found
that among gambling activities VLT play had the strongest
unique relationship to problem gambling.18 EGM play, in
comparison to other forms of gambling, was also found to
be most highly related to problem gambling in Brazil, with
EGM players not only displaying the greatest commitment to
gambling, but also the most distress.19
Thus, even though there is equivocation in the empirical evi-
dence as to whether EGMs lead to problem gambling, there is
consensus in the literature that EGM use and problem gam-
bling are strongly related. Numerous studies have attempted
to shed light on the nature of the relationship between EGMs
and problem gambling. For the purpose of this report, the
have a responsibility to take action to limit any potential abuse or harm
that may be related to the use of their product. The present report focuses
exclusively on the informed opinion of best practices for the provision
of EGM gambling, rather than on the best practices for the individual
gambler.

Electronic Gaming Machines and Problem Gambling

variables that have been examined in many of these studies

may be classified into three general areas: 1) EGM features,
2) venue features, and 3) community accessibility features.1,
20-23
Using these three areas as a framework, the present study
seeks to determine which features are seen as most likely
to contribute to problem gambling, and which modifica-
tions to these features may reduce EGM-related problems.
Towards that end, the study reviews the available literature
in the three areas and gathers the opinions of a cross-section
of Key Informants; specifically, gambling and problem gam-
bling Researchers, Specialists (i.e., health and problem gam-
bling professionals, regulators, operators), problem gambling
Counsellors, and EGM Problem Gamblers themselves. The
report consists of the following sections:

• A literature review of the three EGM frame-

work areas taken from academic research,
governmental reports, and policy documents
at both the national and international level
(Chapter 1);

• A description of the questionnaire that was ad-

ministered to Key Informants along with the
questionnaire’s findings (Chapter 2);

• The method and results of the focus groups

that were conducted with Problem Gamblers
(Chapter 3);

• A discussion of the study’s main findings and

limitations (Chapter 4); and finally,

• A summary and conclusion (Chapter 5).

To ensure the quality, objectivity and integrity of the research,

the present study was reviewed by an expert panel consisting
of Dr. Harold Wynne (Wynne Resources Limited, Alberta),
Dr. Nigel Turner (Centre for Addiction and Mental Health,
Ontario), and Mr. Michael O’Neil (South Australian Centre
for Economic Studies, South Australia). RGC assumes full
responsibility for the final content and conclusions of the
report.



1 LITERATURE REVIEW
EGM FEATURES
In the literature, there is a growing body of research that has
looked at the structural characteristics of EGMs that may be
associated with problem gambling.iii Structural characteris-
tics refer to features such as an EGM’s speed of play, sensory
effects, payment methods, payout methods, betting options,
EGM-based inducements, game availability, programmed
gaming features, and EGM-based responsible gambling fea-
tures (RGFs). The research literature found on each of these
features is discussed in turn below.
Speed of Play
Speed of play on an EGM refers to the time interval between
successive plays on a machine. The shorter the time interval,
the more frequently events (bets) can occur. EGMs are char-
acterized as having an event every few seconds. This differs
significantly from the lottery, for example, that occurs once
or twice per week. It has been suggested that the faster the
event frequency, the more likely it is that a gambling activity
will lead to problems.21 EGM speed can be broken down into
two sub-features: reel spin speed and stop buttons. They are
each discussed in turn.
Reel Spin Speed
Definition. Reel spin speed, measured in seconds, is the
length of time elapsed for a slot machine’s reels to complete a
round of spinning. It reflects the time between the onset of a
bet and its final outcome on a single round of play.
iii A number of terms have been used in the literature to describe prob-
lem gambling. Aside from the term problem gambling itself, some of these
terms include compulsive gambling, pathological gambling, probable path-
ological gambling, and disordered gambling. For the sake of simplicity, the
term problem gambling will be used throughout this report.
Electronic Gaming Machines and Problem Gambling
Association with problem gambling. Several studies in the
literature have explored how reel spin speed affects gam-
bling. One study conducted in Australian hotels and clubs
with problem gamblers and non-problem gamblers exam-
ined the impact that certain EGM modifications, including
reduced speed of play, had on player satisfaction, enjoyment,
behaviour, and expenditure. Results revealed that both the
non-problem and problem gamblers rated lower levels of en-
joyment and satisfaction with the slower 5-second reel spin
speed (lowered from 3.5 seconds). Rapid speed of play (i.e.,
3.5 seconds) was not found to have any positive or negative
impact on any of the parameters of play (i.e., time spent play-
ing, number of bets, net loss), nor was it found to be related
to problem gambling status, the severity of problems, or the
amount of money spent. Notwithstanding these findings, it
is not possible to tell from this study whether reductions in
speed of play would be differentially effective for problem
gamblers as compared to non-problem gamblers, as there
were insufficient numbers of problem gamblers in the re-
search.24, 25
A second study examining manipulation of speed of play
was conducted in a laboratory setting with non-problem
and problem VLT gamblers. This study sought to determine
participants’ self-reported reactions to the combined manip-
ulations of speed and sound under three conditions: 1) de-
creased speed/no sound, 2) standard speed/standard sound
(control condition), and 3) increased speed/standard sound.
Results revealed that a reduction in the speed of play and the
removal of sound altogether decreased ratings of enjoyment,
excitement, and tension-reduction in the problem gamblers
as compared to the non-problem gamblers. However, the lab
setting, the small sample size, the reliance on self-report, and
the confoundingiv of sound and speed of play in the study
limit the conclusions that can be drawn from the research.22
Finally, in our review of the literature, another laboratory
study was found which investigated the effects of VLT speed
of play among a community sample (N = 43). The particular
purpose of the study was to see if variations in speed of play
had an impact on player concentration, motivation to play,
loss of control, and number of games played. Participants
were randomly assigned to play either a high-speed (5-sec-
iv In research, confounding occurs when variables of interest are not
properly controlled for. This results in the researcher being unable to de-
termine the impact of any one variable on the observed result, thereby
limiting their ability to draw conclusions about cause and effect.

Electronic Gaming Machines and Problem Gambling
ond) machine (the typical speed that VLTs are played in the
community where the study took place) or a low-speed (15-
second) machine. Results revealed that gamblers who played
the high-speed machine, as compared to those who played the
low-speed machine, played more games and underestimated
the number of games played. However, speed of play did not
seem to have an impact on player concentration, motivation,
or loss of control over time or money spent. The authors of
the study concluded that speed of play does not seem to have
an impact on occasional VLT gamblers, and that speed re-
strictions are not an important harm minimization strategy.26
However, it should be recognized that there are some signifi-
cant limitations to the study’s generalizability. First, the study
was conducted in a laboratory setting and thus may not ap-
ply to actual gambling venues. Second, given the absence of
problem gamblers in the study, the findings cannot be used to
predict what impact speed of play may have on actual prob-
lem gamblers’ behaviour.
Stop Buttons
Definition. Stop buttons are a feature found on many types
of EGMs that allow gamblers to terminate the spinning of
the machines’ reels rather than wait until they have run their
full course. By controlling how long the reels spin, the gam-
bler is in a sense controlling the machine’s speed of play. For
instance, if the “natural” spinning duration of the reels is five
seconds but the gambler presses the stop button after two,
the game will end three seconds earlier than it would have
otherwise. While this may not have much of an impact on
speed of play after a single bet is made, it could have a signifi-
cant impact if the stop button is pressed consistently after two
seconds over many sequential bets. Eventually, more games
would be played within the same unit of time than would be
played had the reels stopped on their own.
Association with problem gambling. While a stop button al-
lows players to influence to some extent their length of play-
ing time, some players may mistakenly believe that, through
the stop button, they may influence their chances of winning.
A study looking at the effect of the stop feature among occa-
sional, non-problem, VLT gamblers demonstrated that play-
ers developed the illusion that their chances of winning were
improved when the stop feature was used. Specifically, 87%
believed that stopping the reels would bring different symbols
on the screen, 57% believed that they could control a game’s
outcome, and 26% believed that they could enhance their
10
probability of winning when using the device. Conversely,
those who played on a machine without a stop feature did
not develop the illusion of control to the same extent. They
also played significantly fewer games. 27 Since this study only
focused on occasional, non-problem gamblers, however, the
observed effects cannot be generalized to problem gamblers.
A second laboratory study, though, did explore the effect of
stopping the reels on VLT play with both problem and non-
problem VLT gamblers. Results revealed that irrespective of
gambling status, players were bothered when they could not
stop the reels and were more likely to choose to play a game
in which they could.22
There is also research from Nova Scotia that has looked at the
effects of disabling the stop button feature as well as reduc-
ing speed of play. (It also examined two other modifications
implemented in two separate phases: reduced VLT hours of
operation and the removal of VLTs altogether from certain
venues). Random sample surveys were conducted with the
general adult population (N = 403) and VLT players specifi-
cally (N = 865) at each phase of the study to ascertain the ef-
fect of these initiatives. The authors of the study reported that
disabling the stop button and reducing speed of play resulted
in a reduction of spending for 14% of the total VLT player
base, with problem gamblers decreasing their spending by
an average of $219 per week. VLT players also reduced their
playing time on the machines by an average of 211 minutes
per week, with problem gamblers reducing their time spent
playing by an average of 376 minutes per week. The study
also found that 8% of VLT players shifted gambling activities
as a result of the disabled stop button/reduced speed of play
initiative, and that 40% were in favour of the stop button re-
moval/reduced speed of play initiative.28 It should be noted,
however, that because modifications were implemented at the
same time in this study, it is difficult to know which one, or
whether their combination, lead to the observed outcomes.
Sensory Effects
Sound Effects
Definition. Sound effects are programmed noises that EGMs
make. They can include narration, background music, musi-
cal tunes after a win, and “realistic” noises such as the sound
of coins falling into a tray.20, 29
Association with problem gambling. It has been suggested in
the literature that certain features of music may be associ-

ated with gambling behaviour. For example, the quality of the
music that an EGM plays may be closely tied to the quality of
the machine, which may be the primary reason why a gam-
bler might select it to play on. The familiarity of the music
may represent something special to the gambler, which may
influence perseverance in the face of game complexity. The
distinctiveness of the music may make the game more mem-
orable to the player, which may facilitate further gambling.
Finally, the sounds associated with winning might create the
illusion that winning is more common than losing, since los-
ing is not identified by music.30, 31
A number of studies found in our review looked at the rela-
tionship between machine sound effects and problem gam-
bling. In the first study, participants (N = 382) ranked 13
structural characteristics (e.g., sound, graphics, background/
setting, game duration, rate of play, etc.) for their importance
to video game enjoyment. Results showed that almost two-
thirds of the sample said that realistic sound effects were the
most important feature related to game enjoyment. For the
purposes of this report, however, there are two noteworthy
limitations to this study. First, it focused solely on video
games, which are not an exact proxy for EGMs. Second, it did
not report findings from problem, or even high frequency,
players. That said, the authors of the study argued that the
structural features of EGMs and video games are essentially
the same, especially since many EGMs now use video game
technology. The authors recognized, however, that the conse-
quences of high frequency gambling are certainly greater than
the consequences of high frequency video game playing.29
The second study found in our review focused on adolescent
gamblers. In this study, respondents (N = 50) were surveyed
to find out which slot machine features were most attrac-
tive to them. Findings indicated that 30% of respondents felt
that the aura of slot machines (their music, lights and noise)
was one of their most attractive features. Furthermore, those
identified as problem gamblers in the study reported feeling
significantly more attracted to the aura of the machines than
non-problem gamblers32. A limitation of this study, however,
is that the independent effect of each structural characteristic
was not assessed.
Another empirical study examined the effects of sound on
persistence of EGM play. The researchers tested the length
of time that participants spent playing an EGM simulator
when sound effects made it appear that other gamblers were
winning in the next room. Results revealed that those who
Electronic Gaming Machines and Problem Gambling
heard the sound effects and perceived that other players were
winning gambled for longer periods of time and spent more
money doing so. These findings suggest that sounds do in
fact influence, or encourage, extended and/or continuous
play among EGM players. No mention was made in this
study, however, of whether the impact of sound effects would
be more pronounced for problem gamblers as compared to
non-problem gamblers.33
In terms of the impact that modifying EGM sound effects
might have on problem gambling, the laboratory study re-
viewed earlier, which looked at reaction to speed and sound
modifications with problem and non-problem VLT gamblers,
is relevant.22 Results of that study showed that a reduction in
speed of play and the removal of sound altogether decreased
ratings of enjoyment, excitement, and tension-reduction in
problem gamblers as compared to non-problem gamblers.
Note again, however, that speed of play and sound were con-
founded in this study, so one cannot know if the findings are
due to one factor over the other or a combination of the two.
No other studies exploring the independent effects of reduc-
ing sound volume or removing sound altogether from EGMs
were found.
Visual Effects
Definition. Visual effects on EGMs can include flashing lights,
primary colours, furnishings and iconology.5, 20
Association with problem gambling. The literature on visual
effects is quite limited and has not changed much in the last
13 years.31 One empirical study looking at the effect of co-
loured lighting on gambling behaviour found that non-prob-
lem gamblers placed more bets and lost more money when
they were exposed to red, as compared to blue, lighting (pre-
sumably because red lighting is more arousing). 34 However,
there was no inference as to whether this finding would be
observed among problem gamblers as well. Interestingly, it
has been noted that gambling venues in the USA and UK are
often decorated with colours that tend toward the red end
of the colour spectrum (i.e., black, red, purple).31, 34 It has
also been suggested that primary colours and flashing lights
contribute to the air of fun and excitement of playing on an
EGM.34,35
In addition to the above observations, one other study can
be mentioned here. It is the aforementioned questionnaire
study of adolescent gamblers which found that 30% of the
11
Electronic Gaming Machines and Problem Gambling
sample claimed that the aura of slot machines (their music,
lights and noise) was one of their most attractive features.
Moreover, those identified as problem gamblers in the study
reported being significantly more attracted to the aura of
EGMs as compared to non-problem gamblers.32 Recall, how-
ever, the limitations of this study: Due to the fact that the
separate structural features of EGMs (e.g., their music, lights,
and noise) were not investigated separately, it is difficult to
determine which one was most attractive to respondents.
Payment Methods
Bill Acceptors
Definition. Many EGMs are equipped with bill acceptors
which allow dollar bills to initiate play, in addition to coins
or tokens.
Association with problem gambling. Bill acceptors on EGMs
are convenient because they do not require gamblers to con-
tinually insert coins or tokens into the machines, or to have
the exact amount of change or tokens to play. However, the
insertion of a bill into a machine converts the full monetary
value of that bill into game credits, thereby enabling faster,
more continuous play. Indeed, one study was found in our
review showing that coinless machines can speed up play-
ing time by 15%, due to fewer breaks being taken to obtain
proper change and less downtime being spent refilling coin
hoppers.36 The risk of problem gambling potentially increases
with larger denomination bill acceptors because they effec-
tively allow larger amounts of money to be converted into
credits at one time.
While not specifically referring to problem gambling, the link
between gambling expenditures and bill acceptors has been
noted by policy analyst, Michael O’Neil. He observed a posi-
tive relationship between the two variables in two Australian
states: Victoria, where bill acceptors are allowed, and South
Australia, where they are not. While recognizing that there
are many factors involved in determining EGM gambling
losses, O’Neil reported that there was a significant difference
between the two Australian states in this regard: In Victoria,
net EGM gambling losses were over $A90,000 per machine,
while in South Australia, they were over $A50,000.37
 Research on bill acceptors seems to be focused only on the relation-
ship between denomination size and expenditure. No research was found
in our review that explored limitations to preloading bill acceptors (e.g.,
inserting multiple bills at one time).  
12
The direct link between problem gambling and bill acceptors
was identified in a different Australian study which showed
that over 65% of problem gamblers “often or always” used
bill acceptors, as opposed to 23% of non-problem gam-
blers. The authors of the study stated that the bill acceptors
decrease the need for breaks, and thus the opportunity to
reflect on gambling activity.38 Similarly, a community sur-
vey (N = 755) found a strong relationship between being a
regular or self-identified problem gambler and frequent use
of EGM bill acceptors: compared to recreational gamblers,
the majority of regular and problem gamblers always used
bill acceptors. They also tended to use bill acceptors of larger
denominations.39
A study exploring the impact of limiting EGM bill acceptors
to $20 was conducted in Queensland, Australia. Two meth-
ods of data collection were used. The first involved interviews
with study participants (N = 359); the second involved an
analysis of EGM revenues generated during the experimental
period. Results revealed that 61% of those interviewed ap-
proved of the $20 limit, 28% believed that the limit should
be reduced further, and approximately 20% reported changes
in their behaviour, especially if they were at high risk for
problem gambling (30-40% of high-risk problem gamblers
reported a change in behaviour). Specifically, those who said
they changed their behaviour reported spending less time
and money gambling, reducing their bet size, and visiting
the gaming venue less frequently. Interestingly, however, the
concomitant revenue analysis indicated that implementa-
tion of bill acceptors did not lead to a significant loss of EGM
earnings. The authors of this study recognized that the two
sets of results were counterfactual, and suggested that either
there was a discrepancy between participants’ reported and
actual behaviour, or that estimates suggesting that problem
gambling contributes significantly to gambling revenues are
inflated.40
A second study was found looking at the impact of modify-
ing EGMs in a number of ways, including limiting bill accep-
tors to a maximum of $20. The study sample included recre-
ational and problem gamblers frequenting clubs and hotels.
The results revealed that while limited denomination bill ac-
ceptors (i.e., $20) reduced overall machine expenditure, rec-
reational and problem gamblers did not differ in their rates of
expenditure reduction. Moreover, though problem gamblers
seemed to prefer using machines with higher denomination
bill acceptors, the authors of the study concluded that the use

of high denomination bill acceptors was not independently
associated with problem gambling status, severity of problem
gambling, amount of money lost, or persistence of play when
taking into account other factors such as age, gender, credits
wagered per bet, and play rate. This conclusion was consis-
tent with anecdotal reports obtained from problem gamblers
in focus groups who indicated that limiting the denomina-
tion of bill acceptors would be unlikely to lead to changes in
their patterns of play.24, 25
A final study comes from Nova Scotia, which has 15 years of
experience with bill acceptor equipped VLTs. An evaluation
of patrons’ opinions about bill acceptors and VLTs found that
non-problem and problem gamblers viewed bill acceptors as
an effective method to assist with the management of time
and money spent on EGMs, especially for players who set
budgets for play.41
Direct Electronic Fund Transfers
Definition. Direct electronic fund transfers allow patrons to
access bank or credit card funds directly while sitting at an
EGM. This capability makes accessing funds far more con-
venient than the alternative, which is to step away from the
EGM to obtain money from some other source (e.g., a nearby
ATM).
Association with problem gambling. When New Jersey reg-
ulators in 1996 agreed to let casino patrons use credit and
debit cards to purchase gambling chips and slot tokens, prob-
lem gambling experts sounded alarm bells, stating that such
technology would wreak havoc with some problem gamblers.
They also argued that it would make even casual gamblers
lose more than they had originally planned.42 However, no
empirical research was found in our review that explored
the actual implications of placing direct debit technologies
at EGMs. As well, no empirical research was found explor-
ing the effectiveness of eliminating direct electronic fund
transfers from machines. The apparent absence of this type
of research may be due to the fact that direct electronic fund
transfer technology is new and not yet widely practiced.
Credit Displays/Credit Conversions
Definition. Credit displays/credit conversions are not actu-
ally methods of payment; rather, they refer to what happens
to payment immediately after it is inserted into an EGM.
Because they are tied to payment, however, they are included
in the Payment Methods section of our review.
Electronic Gaming Machines and Problem Gambling
When money is inserted into an EGM, it is usually converted
automatically into credits that are displayed on the machine
and used to gamble. For example, if $5 were entered into a
machine that operated with 2 cent credits, there would be
a total of 250 credits displayed and made available. The dis-
play of money wagered in the form of credits is also called
tokenization.24
Association with problem gambling. While the ability to in-
sert money into a machine to obtain credits may be a con-
venient feature (i.e., it saves the gambler from having to ex-
change money for tokens), it has been hypothesized that this
could contribute to faster speed of play, since the gambler
essentially has a running credit on the machine. It has also
been hypothesized that a credit display instead of cash can
contribute to misjudgements about how much money one is
actually spending and, ultimately, increase the risk of prob-
lem gambling.20 Aside from converting money into credit,
EGMs can also convert wins into additional game credits, a
feature which could further prolong play and, again, increase
the risk that problems will occur.1
While our literature review did not find any empirical evi-
dence to support the above hypotheses, four related studies
were found. The first two, conducted in the 1960s, found
that gamblers tended to make more cautious decisions
about wagers when they gambled with real money as op-
posed to credits. The implication of these studies is that an
action, such as tokenization, which conceals the true value
of money may also contribute to reduced caution in wager-
ing decisions.43,44 The third study found in our review showed
that after tokenization was introduced in New South Wales,
Australia, the largest annual increase in EGM expenditure
was observed.23 Finally, a study of players awareness of, and
attitudes towards, modifications to VLTs found that players
rated displaying cash totals instead of credits to be a highly
effective modification for assisting them in keeping track of
how much money they were spending. No differences were
observed in this study, however, between non-problem and
problem gamblers.41
Payout Methods
Tickets or Tokens
Definition. The means of receiving one’s payout or winnings
from an EGM is entirely dependent on the design of the
machine. Some machines (e.g., those with Ticket-In Ticket-
13
Electronic Gaming Machines and Problem Gambling
Out (TITO) technology) deliver the payout or winnings in
the form of a ticket that must be redeemed by a cashier or
machine. This technology is rapidly becoming the industry
norm. Payouts can also be delivered in the form of tokens
that must be redeemed by a cashier. The difference between
ticket and token payout methods is that the latter may be
seen as more cash-like since tokens are physically similar to
coins.
Association with problem gambling. It has been hypothesized
in the literature that payouts in the form of tickets or tokens
instead of cash can distort player perceptions of win size.20
No evidence could be found in our review, however, to sup-
port this hypothesis. Similarly, no research could be found
that addresses the potential impact that modifications to pay-
out methods could have on problem gambling.
Cheques
Definition. The payout interval on an EGM refers to the delay
in time between when a player wins a game and when they
receive their winnings. One method of extending the payout
interval is to deliver the player’s winnings (when the win-
nings are relatively large) by cheque. If winnings are paid out
to the gambler this way, they cannot be cashed in for more
tokens or credits at the gaming venue, which is believed to be
a helpful tool in minimizing harm.
Association with problem gambling. Two studies were found
that investigated the effect of cheque payments on the behav-
iour of EGM players. The first study involved interviews with
self-identified problem gamblers (N = 16), recreational gam-
blers (N = 45), gaming managers (N = 60), community rep-
resentatives, counsellors, and expert analysts. It looked at the
impact of paying patrons with a cheque for winnings greater
than $1,000. While 55% of club managers, 66% of recreation-
al gamblers, and 72% of problem gamblers all affirmed that
the effort was an effective strategy to prevent gamblers from
spending their winnings, all groups claimed that many, if not
all, gamblers would play down their winnings on machines
or would cash out their winnings before reaching $1,000 to
avoid receiving a cheque.46
The second study looked at EGM players’ (N = 418) attitudes,
awareness, beliefs, perceptions, challenges and behaviours re-
lated to a number of harm minimization strategies, including
payment of winnings by cheque. Results revealed that 77% of
EGM players thought that payment by cheque for winnings
14
in excess of $2,000 would be an effective harm minimiza-
tion strategy. Problem gamblers, however, were more likely
than all others in the sample (25% versus 16%, respectively)
to say that cheque payment would not be an effective harm
minimization measure. Seventy-two percent of the sample
thought that placing restrictions on cashing winning cheques
at gaming venues would be an effective harm minimization
strategy.45
Betting Options
Bet Size (Amount/Lines)
Definition. Bet size is determined by a number of factors, in-
cluding the denomination of the machines (the value of each
credit), the number of lines one can bet on, and the num-
ber of credits played. For example, a small bet size can result
from betting on one line for one credit (each credit valued
at 5 cents) for a maximum bet size of 5 cents. Conversely, a
large bet size can result from betting on 10 lines for 10 credits
(each credit valued at 10 cents) for a maximum bet size of $1.
(Note, however, that in the latter example, a gambler does
not need to bet the maximum possible amount. He or she
could bet on all 10 lines but choose to use fewer credits (i.e.,
10 credits each valued at 5 cents, which would amount to a
50 cent bet)). In general, the higher the bet, the higher the
payout when one is presented with a winning combination
of symbols.
Association with problem gambling. A self-report study
conducted in the laboratory with problem and recreational
gamblers demonstrated that problem gamblers tend to use
the maximum credit function and that recreational gamblers
do not.Cited in 22 Other studies have shown that compared to
non-problem gamblers, problem gamblers are more likely to
place bets over $1, and that when the maximum possible bet
size is reduced, so is both gambling (i.e., duration, frequency,
expenditure, losses), and other behaviours often associated
with it (e.g., smoking and alcohol consumption).22,23
A study conducted in Australian hotels and clubs with prob-
lem gamblers and non-problem gamblers examined the im-
pact of certain machine modifications, including allowing
for a $10 versus $1 bet size option, on player satisfaction and
enjoyment, behaviour, and expenditure. While only a small
percentage of the sample reported wagering with bets great-
er than $1, problem gamblers were three times more likely
than recreational gamblers to wager with the larger amount.

Moreover, the modified machines allowing for $1 bets as
compared to $10 bets were associated with players gambling
for shorter periods, making fewer bets, losing less money, and
smoking/drinking less. The authors of the study concluded
that the reduction in maximum EGM bet size from $10 to $1
might be an effective harm minimization strategy for a small
proportion of players.23, 24
EGM-based Inducements
Near-misses
Definition. A near-miss on an EGM occurs when one ap-
pears to come close to, but does not actually succeed at, win-
ning a prize. For example, in the case of a three-reel slot ma-
chine where a winning jackpot is represented by three cherry
symbols, a near-miss would occur if the player received two
cherries and a star. However, in reality, a near-miss is always
a complete miss because it has no reward.
Association with problem gambling. A potential problem
with near-misses is that they could give the gambler a false
sense that a win is imminent and, as a result, prompt further
play.47,48 This possibility was explored in a study conducted
with a sample of non-problem gambling university students
( N = 72). In this study, the experimental group was exposed
to 27% near-misses, while a second, control group, was ex-
posed to none at all. Results revealed that those exposed to the
near-misses played 33% more games than the control group.
While this study was conducted with a sample of university
students as opposed to problem gamblers, it does suggest
that, in general, the perception of near-misses may be linked
to gambling persistence in the face of monetary loss.49
A second study, using an unspecified sample, examined
three rates of near-miss presentation--0%, 33% and 67%--on
gambling persistence using a computerized roulette game. A
near-miss was operationally defined as an outcome with few-
er than three numbers away from the number that had been
chosen for the wager. Results revealed that half of the par-
ticipants in the 33% condition made additional bets during
the free-choice period, while none of the participants in the
other conditions did.47, 50 One interpretation of this finding is
that too many near-misses decrease a player’s expectation of
a win, but when near-misses are intermittent, the player con-
tinues to believe that subsequent wins are likely. 51 Given that
the authors of this study did not describe the problem gam-
bling status of their sample, however, it is impossible to know
Electronic Gaming Machines and Problem Gambling
whether the impact of near-misses on gambling persistence
would be more or less relevant for problem gamblers.
A third study, conducted with a sample of undergraduate stu-
dents (N = 180) in the laboratory, examined three rates of
near-miss presentation--15%, 30% and 45%--on EGM gam-
bling persistence. Persistence was defined as the number of
trials played after the near-miss condition was presented over
the course of 50 plays. Results revealed that the 30% near-
miss condition led to greater persistence than did the 15% or
45% conditions. As in the previous study, the authors of this
study concluded that when there are too many near-misses,
participants no longer view them as indicators that a win is
close at hand.48 However, similar to the previous study, we
do not know from this research whether near-misses dif-
ferentially affect problem gamblers. It should also be noted
that the rates of near-miss presentation used in this study do
not reflect real-life gambling settings, where a near-miss may
occur only 3% to 20% of the time, depending on the prize
size that the symbols represent. (For example, a near-miss
representing large prizes will occur far less frequently than
near-misses representing smaller prizes). Due to this incon-
sistency, the external validity of this study is limited.
Reel Display
Definition. Some EGMs are programmed to prolong the pre-
sentation of a bet’s final outcome and thereby increase antici-
pation. For example, in the case of a three-reel slot machine,
each reel will stop spinning at different times so that the first
reel stops spinning first, the second stops next, and the third
stops last.
Association with problem gambling. A study with university
students (N = 28) who were occasional VLT players and not
considered to be problem gamblers explored the effects of in-
stantaneous versus sequential symbol presentation (i.e., each
symbol stops individually) of bet outcomes. Results indicated
that sequential presentation encouraged prolonged play, a
finding theorized to result from the generation of sustained
winning expectancy or anticipation.52 No other research on
this topic was found in our literature review.
Prize Advertisements
Definition. There are two forms of prize advertisements on
EGMs. The first involves obvious prize advertisements placed
on the EGM itself, such as signage indicating the size and
method of a win. The second involves prize symbols placed
15
Electronic Gaming Machines and Problem Gambling
on the EGM’s reels, which are viewed by the player as the
reels spin during play.
Association with problem gambling. No research was found
on the relationship between EGM prize advertisements and
problem gambling in our review.
Game Availability
Type of Games
Definition. The type of game available on an EGM can vary
from line games (e.g., slot-like games), to card games (e.g.,
poker), to keno (e.g., lottery).
Association with problem gambling. No evidence was found
in the literature indicating that the availability of any one
type of game on an EGM is more or less problematic than
another.
Number of Games
Definition. Some EGMs are equipped with multiple games,
allowing the player more options and potentially increasing
their duration of play on a given machine.
Association with problem gambling. It is possible that switch-
ing between games on an EGM could increase the amount of
time spent on that machine. A machine that has a number of
different games may also appeal to more people, thereby po-
tentially increasing machine traffic. 53 No research was found
in our literature review, however, bearing on the relationship
between EGM game number and problem gambling.
Bonus Features
Definition. Bonus features on EGMs, such as free games,
are added to make playing on the machines more exciting,
engaging, and to make players think that they are “getting
something for nothing.”30 In terms of the excitement factor
of bonus rounds, a study was conducted looking at frequent-,
infrequent- and non- gamblers’ (N = 63) excitement levels (as
measured by autonomic arousal) during EGM play. Findings
showed that in addition to wins, bonus rounds did indeed
increase excitement (i.e., they elicited an increase in arousal)
for all three groups.54
Association with problem gambling. There is some evidence
to suggest that bonus features, specifically free games, are po-
tent reinforcers for regular EGM players.55 In one study, the
strategy of gamblers (N = 220) was observed during EGM
16
play. Results showed that players often opted for a strategy of
playing a maximum number of lines with low bets because
this increased their chance of winning bonus rounds; how-
ever, this also resulted in more money being spent on EGM
play. Unfortunately, the data presented could not speak to
whether the effect of bonus rounds had a differential effect
on problem gamblers.55
Programmed Gaming Features
Prize Levels and Game Outcomes
Definition. The volatility of a game can be determined by
the level or magnitude of prizes (e.g., small, medium, large),
and the number of winning combinations required to win
prizes at each level (e.g., one versus multiple). For example,
in a slot machine setting, if only one combination of symbols
can bring about a win at each prize level, there would conse-
quently be only three methods of winning; however, in a situ-
ation that can increase the volatility of the game, there might
be five different combinations that bring about a small prize,
two different combinations that bring about a medium prize,
and only one combination that bring about a large prize, re-
sulting in eight different methods of winning. The increased
variability of the number and level of prizes impacts on the
amount of risk and unpredictability inherent in game play.
Association with problem gambling. As the number of pos-
sible winning combinations increases for each prize level, the
probability of winning increases as well, which in turn may
affect gambling behaviour. However, little research could be
found in our literature review on the relationship between
prize levels and problem gambling. One study was identi-
fied that looked at single- versus multiple- prize games using
simulated EGMs among a sample of university students (N
= 80). In the single-prize game condition, participants could
make a relatively safe bet or a more risky one by gambling to
win either 1) 9,000 tokens with probability of .001, or 2) zero
tokens. In the multiple-prize game condition, participants
could make a safe bet or gamble to win 1) 9,000 tokens with
probability of .0001, 2) 54 tokens with probability 0.15, or 3)
zero tokens. Results indicated that the average gambling rates
in the multiple-prize game were significantly higher than the
average gambling rates in the single-prize game (38% versus
27%, respectively). However, this difference in gambling rates
only emerged after the first 80 rounds of play. The authors
concluded that a reward structure comprised of frequent me-
dium prizes may prolong time spent gambling.56

Payout Rate
Definition. Payout rate refers to the average rate of return
on a given EGM over time.vi For example, if the payout rate
is 85%, gamblers would receive back 85% of the amount of
money inserted into an EGM. This is a long-run expected re-
turn, however, and is unlikely to be relevant for a given gam-
bling session. That is, the machine does not self-correct in
order to maintain the required return in a given game. Since
a higher payout rate is associated with a higher likelihood of
winning, it is associated with an increase in the game’s excite-
ment value.55 Gambling venues normally set their own pay-
out rate, usually based on the jurisdiction’s rules.57
Association with problem gambling. A study exploring the
association between payout rate and problem gambling was
conducted with college students (N = 63) who did not dis-
play symptoms of problem gambling. Using a laboratory slot
machine simulator, study participants were exposed to three
percentage payback values ranging from a relatively poor, to
a relatively good, rate of return (i.e., from 75%, to 83%, to
95%). Results revealed that the gamblers’ behaviour did not
vary as a function of the payback percentage.58 Although this
finding has not been confirmed by other research, it is possi-
ble that the participants were not sensitive to the experimen-
tal conditions due to the limited amount of time they were
allowed to play the machines (i.e., maximum 15 minutes).
Win Frequency
Definition. Win frequency refers to how often wins occur
within a given EGM playing session.
Association with problem gambling. Typically, small wins
(e.g., $20) occur more frequently than do large wins (e.g., >
$100).59 It may be the case that small EGM wins serve to keep
the player engaged in the game. Two studies in our review
were found that looked at the impact of small wins on gam-
bling behaviour. The first, a laboratory study, assessed high
frequency gamblers’ (N =10) behaviour with respect to win
magnitude on EGMs. Although this study did not look at the
frequency of small wins, it did examine the effects of a small
versus large win on behaviour. Results demonstrated that
players tended to increase their rate of play when small wins
occurred, while larger wins caused a break in their rate of
play.60 The second study, conducted with regular (N = 18) and
vi Machines can also be networked so that the payout rate is calculated
across a number of machines.
Electronic Gaming Machines and Problem Gambling
occasional (N = 21) gamblers, replicated these findings in a
real gambling venue: Gamblers disrupted their play when re-
ceiving larger wins, whereas gambling behaviour was main-
tained with smaller wins.61
EGM-based Responsible Gambling Features (RGFs)
Definition. With regard to EGMs, responsible gambling fea-
tures (RGFs) are modifications made to machines to help
players keep track of their time and/or money expenditures.
Research suggests that such RGFs may be useful because
problem gamblers, as compared to non-problem gamblers,
are less likely to budget their time and money when gam-
bling. They are also less likely to adhere to their budgets when
they do set them.64 Responsible gambling features on EGMs
may include machine RGFs (e.g., on-screen clocks, displays
of betting activity in cash amounts instead of credits), time
and money limits (e.g., card-based technologies), breaks in
play, and responsible gambling messages. Each of these fea-
tures is discussed below. (Note, however, that even though
time and money expenditures are separate variables, because
all RGF evaluations to date have used both as outcome mea-
sures, they are reported on together in the discussion that
follows).
Machine RGFs
Association with responsible gambling. In 2001, Nova Scotia
became the first province in Canada to incorporate four re-
sponsible gambling modifications into their VLTs. These
included: 1) permanent on-screen clocks denoting time of
day, 2) displays of betting activity in cash amounts instead
of credits, 3) pop-up reminders of the total time spent play-
ing (occurring at 60-, 90-, and 120- minute intervals), and 4)
five-minute cash-out warnings (at 145 minutes, with a man-
datory cash-out at 150 minutes). A concomitant analysis was
conducted with non-problem and problem VLT players ex-
ploring the efficacy of these responsible gambling modifica-
tions. The evaluation included a pre- and post- modification
assessment of players’ awareness of the new features, changes
in their behaviour, perceptions and attitudes, and recom-
mendations for further improvements to the modifications.
Findings revealed that, overall, awareness of the modified
VLTs ranged from 72% at the beginning of the study, to 97%
by the third phase of the study. The feature most preferred
by all players was the onscreen clock (60%). The features
least preferred by all players were the pop-up reminders and
17
Electronic Gaming Machines and Problem Gambling
mandatory cash-outs. Taken together, the modifications were
associated with reduced length of play. However, it should
be noted that the average expenditure on each machine
did not change, meaning that due to the shortened period
of time playing, the rate of expenditure actually increased.
The behavioural changes associated with the modifications
included a decline in the frequency of losing track of time
and money while playing, and a decline in the frequency of
spending more time playing than intended. There were also
associated improvements reported in the control of expendi-
ture. Displaying cash totals instead of credits was the modi-
fication rated as most effective in terms of helping players
keep track of money, although no differences were observed
between non-problem and problem gamblers in this regard.
Pop-up reminders were seen to be ineffective, since problem
gamblers tended to cash out at least once during their VLT
play (before they could be exposed to the pop up reminders),
thereby reducing this modification’s utility.41
In 2003/04, Nova Scotia assessed, using in-person market
tests with regular VLT players, the impact of three new VLT
modifications: 1) a time-limit option, 2) a 30-minute pop-
up message indicating the total time spent playing, and 3) a
mandatory response requirement to continue play. The eval-
uation included a pre- and post- modification assessment of
players’ awareness of the new features, changes in their be-
haviour, perceptions and attitudes, and recommendations
for further improvements to the modifications. Findings
indicated that for optional time limits, 72% of players were
aware of the feature, but 98% of those who were exposed to
the feature during play did not feel it would help them man-
age their budget. In terms of the 30-minute pop-up message,
75% of players were aware of the feature, but 84% of those
exposed to it during play thought it would have no impact
on their behaviour. Finally, in regard to the on-screen clock,
61% of players were aware of the feature, but 71% of those
exposed to it during play felt that it would have no impact on
their behaviour.63
A study was also conducted in Alberta that evaluated the
effectiveness of new responsible gambling features installed
on VLTs. A quasi-experimental design was used to examine
the awareness, knowledge, attitudes, and behaviour of play-
ers exposed to VLTs with responsible gambling features. The
features included: 1) time clocks, 2) pop-up time remind-
ers, 3) money counters (displays that showed the amount
of money spent during play), and 4) scrolling 1-800 banner
18
ads. Findings revealed that while the features were noticed
by players, the majority of players indicated that they never
used the features to limit the amount of time or money spent
on gambling. Interestingly, though, a majority of players be-
lieved that the clock and money counters were at least some-
what effective in helping them keep track of how much time
and money they spent. Additionally, a majority of players
believed that the money counter was at least somewhat effec-
tive in helping them decide whether to cash out or stop play-
ing. However, there was no difference found in the amount of
money spent by players before and after installation of VLTs
with responsible gambling features. Finally, the modifica-
tions did not have a differential effect on problem gamblers
as compared to non-problem gamblers. The authors of the
study concluded that, overall, it could not be argued that the
responsible gambling features led to a reduction in frequency
or duration of VLT play.64
Time and Money Limits (Card-based Technologies)
Definition. In addition to modifying EGMs with RGFs, it has
been suggested that one way to reduce problem gambling is
to enable the gambler to make reasoned decisions about their
money and time expenditure limits prior to gambling and
away from the gaming floor.59 This is generally referred to
in the literature as “pre-commitment,” and is primarily op-
erationalized in the form of “smart” or “pre-commitment”
cards.65 The cards are a laminated product similar to credit
cards that allow patrons to impose spending and other re-
strictions on their play, such as setting the duration of play
and/or a budget for a given time period.38, 66
Association with responsible gambling. Smart cards are seen as
an RGF because once pre-play limits have been programmed
onto the card, the player cannot change their mind during the
set period.65 Moreover, because patrons must register with the
venue to receive these cards, there is an associated reduction
in anonymity which may serve to increase accountability.66
To date, however, we could only find two studies that directly
evaluated the RGF effectiveness of smart cards.
The first study, still in progress in Nova Scotia, evaluated
the usability and usefulness of smart cards in encouraging
responsible play among a sample of non-problem and prob-
lem VLT gamblers. Findings revealed that 50% of study par-
ticipants thought that the cards would be useful if they were
made mandatory. Moreover, irrespective of gambling status,
87% of participants supported or strongly supported having

the cards made mandatory for anyone wanting to play VLTs
in Nova Scotia.67
A second, questionnaire-based study among patrons of two
Australian clubs (N = 134), assessed consumer responses to
a number of RGFs including the use of smart cards66 The
author of the study reported that the majority of gamblers
did not believe that the cards would help them manage
their spending, although they did believe that a player activ-
ity statement (generated from the smart card) was a useful
feature. Notwithstanding this, there was evidence to suggest
that problem gamblers were not generally inclined to use this
latter feature, thus the author recommended that other ap-
proaches be explored. The author also concluded that more
frequent players (i.e., more at-risk gamblers) may be attract-
ed to the cards on the basis of their usefulness and ease with
which they can be used across machines. This in turn might
actually encourage spending and facilitate the development
of problem gambling in at-risk players. However, this con-
cern is potentially offset by the lack of anonymity that accom-
panies the card’s use in Australian gambling venues (as many
gamblers indicated that they preferred to remain anonymous
while gambling). 66 In another examination of these data, the
author concluded that it is currently unclear whether card-
based technologies would work as an effective RGF.68
Breaks in Play
Definition. Breaks in play refer to the temporary suspension
or stoppage of play on an EGM after a certain period of time.
It is aimed at limiting lengthy, continuous playing sessions.
Association with responsible gambling. Research suggests
that problem gamblers find it especially difficult to stop play-
ing EGMs once a gambling session has begun.41 This lack
of control is confirmed with gamblers who are considered
to be high frequency players (i.e., they play once per week
or more).65 Given these findings, some have suggested that
EGMs be outfitted with technology that would enforce session
breaks; however, others have argued that this may not be an
effective RGF.45 Only one research study bearing on this issue
was found in our review and it supports the latter argument.
The study was conducted in Victoria, Australia and involved
a survey of 1) EGM players, 2) venue operators, managers
and staff, and 3) industry and community stakeholders. The
purpose of the study was to assess the effectiveness of vari-
ous harm minimization strategies, including breaks in play.
Results revealed that almost all EGM players initiate breaks
Electronic Gaming Machines and Problem Gambling
in play themselves (e.g., coffee breaks, smoke breaks, etc.),
but they still think that EGM technology initiating further
breaks in play would be an effective RGF. However, venue
managers disagreed about the effectiveness of such strategies,
arguing that there is no way of determining whether the per-
son playing a given EGM at the time of a break is the same
person who has been playing the EGM for prolonged periods
prior to the break. Moreover, players can simply switch to
another EGM during the break, rendering this RGF more of
an inconvenience than a deterrent.45
Responsible Gambling Messages
Definition. Many gamblers hold false beliefs about gambling
and the extent to which they can control or predict gambling
outcomes.69, 70 They also may lose track of how much time
and money they are spending while gambling. As a result,
providing information to gamblers during play that targets
their false beliefs and makes them more aware of their time
and money expenditures has been recommended as RGFs.
Association with responsible gambling. Two studies were
found that evaluated the effects of responsible gambling mes-
sages during play on gambling behaviour. The first, a labo-
ratory study, assessed the effectiveness of warning messages
intended to aid in controlling gambling. University students
(N = 120) who had previous experience with gambling were
recruited. All participants played a computerized roulette
game with imaginary money and received education discuss-
ing irrational beliefs expressed by gamblers. Those in the ex-
perimental condition viewed brief messages that addressed
irrational gambling beliefs while playing the game; those in
the control condition received the educational component
without any messages. Results revealed that participants in
the experimental (warning-message) condition reported sig-
nificantly fewer irrational beliefs and spent significantly less
money than did those in the control condition.71
A second study, conducted in Sydney, Australia, explored the
effectiveness of 10 harm minimization messages with regular
and problem gamblers using questionnaires and focus groups.
The main objective of the study was to identify messages that
would have the greatest potential to trigger gamblers to con-
sider changing their gambling behaviour and/or call a prob-
lem gambling helpline. Results revealed that for both regular
and problem gamblers, three messages were thought to be
more effective than the other seven. These included: a) “Have
you spent more money on gambling than you intended?”
19
Electronic Gaming Machines and Problem Gambling
b) “Are you gambling longer than planned?” and c) “Have
you ever felt bad or guilty about your gambling?” The gam-
blers reported that these messages may have the potential
to encourage responsible gambling behaviour and that they
may also cause players to re-evaluate their gambling activ-
ity. However, the second half of all 10 messages included the
tag line, “If gambling is a concern for you call (the helpline),”
which was found to be both exclusionary and extreme (since
it pertained only to problem gamblers). It therefore did not
resonate well with participants. The authors of the study con-
cluded that one needs to differentiate between regular and
problem gamblers when developing harm minimization
messages and approaches in order for them to be effective for
their intended audience.72
VENUE FEATURES
In addition to the features directly associated with EGMs,
some have hypothesized that the relationship between EGMs
and problem gambling may be due in part to the features of
the venues that house the machines. Such features include
venue type, EGM accessibility, venue conveniences, venue de-
sign, advertising, and venue-based harm minimization strate-
gies. What follows is a review of the literature on each of these
features.
Venue Type
Definition. Venue type refers to the kind of venue that
houses EGMs, such as casinos, racinos (racetracks with
EGMs), bars, restaurants, lounges, and hotels to name a few.
Association with problem gambling. Currently, there is very
little known about the effect that EGM venue type has on
problem gambling, as limited research could be found on the
issue in our literature review. It is quite conceivable, however,
that venue type would be related to problem gambling, as
some venues (e.g., bars) are generally more accessible than
others (e.g., casinos) and accessibility, as will be discussed
below, is positively correlated with problem gambling. Some
researchers have differentiated between clubs and hotels,
speculating that the anonymity found in the former may be a
facilitating factor for problem gambling.46
Only one study was found in our review that speaks to this
issue, albeit tangentially. The primary focus of the study, con-
ducted in New South Wales, Australia, was to assess the im-
20
pact of restricting EGM accessibility. Part of the study also
involved asking participants to indicate their gambling venue
of choice. Results revealed that problem gamblers tended to
prefer clubs (i.e., private or public sporting, community, and
ex-services facilites) over hotels because they perceived them
to be more comfortable and anonymous.73
EGM Accessibility
Number of EGMs
Definition. Patron access to gambling is dependent to some
degree on the number of EGMs located in a venue.
Association with problem gambling. Only one study was found
in our review that looked at the effect of reducing the number
of EGMs in a venue on problem gambling. The study is the
previously discussed Nova Scotia project that explored VLT
reduction in conjunction with several other modifications
(i.e., slowing speed of play, removing the stop button, and re-
ducing the hours of operation).22 In this study, 800 VLTs were
removed from retail locations in Nova Scotia on November
1, 2005. Following this initiative, telephone surveys were
conducted with the general adult population (N = 600) and
VLT players specifically (N = 711). In terms of findings, the
authors of the study reported that terminal reduction result-
ed in a decrease of spending for 12% of the total VLT player
base, with problem gamblers decreasing their spending by
an average of $146 per week. Similarly, VLT players reduced
their time spent playing VLTs by an average of 70 minutes per
week, with problem gamblers reducing their time spent play-
ing VLTs by an average of 199 minutes per week. Results also
showed that 8% of VLT players shifted gambling activities as
a result of the terminal reduction initiative, and that 50% of
VLT players were in favour of terminal reduction.28 However,
as mentioned previously, it is unclear which change caused
the reduction in play or whether a combination of them did.
Hours of Operation
Definition. The prevalence of EGM-related problem gam-
bling is directly related to the degree to which patrons can
access EGMs.38 It is therefore believed that increased hours
of operation may lead to longer durations of play and thus
greater money expenditures for problem gamblers. Given
this relationship, some regulators have recommended man-
datory venue closures to force breaks in play.46

Association with problem gambling. A study conducted in
New South Wales, Australia looked at the primary impact
that restricting access to EGMs (by shutting gaming ma-
chines down between 6 am to 9 am) had for problem gam-
blers, their families, recreational gamblers, and venue manag-
ers. The study was conducted using in-depth in-person and
telephone interviews. Findings revealed that while problem
gamblers and their families thought that the idea of a shut-
down was good in principle, in practice they did not think it
made sense as an effective harm reduction strategy. Their ra-
tionale was that since 6 am - 9 am is actually the least popular
time to gamble, the three-hour shutdown would only affect
hard core gamblers and/or shift workers. Moreover, they con-
sidered a three-hour shutdown to be too short a time to have
any real impact. Notably, problem gamblers also said that the
early morning timing of the shutdown actually made them
quite cynical about the government’s genuine interest in
helping problem gamblers. In contrast, the majority (72%) of
recreational gamblers supported the strategy; however, they
also contended that to be more effective, all gaming venues
should shut down during the same time period in order to
prevent people from traveling between venues. Finally, venue
managers reported a 9% reduction in total gaming machine
revenue on average during the shutdown.73
A second Australian study also looked at the effect of en-
forcing a three-hour shutdown in 13 clubs either between 4
am and 7 am, or between 6 am and 9 am, depending on the
jurisdiction. Evaluations were conducted using in-depth in-
person or telephone interviews with recreational gamblers,
self-reported problem gamblers, and club managers. Results
indicated that none of the participants found the strategy to
be effective, and the reasons cited were similar to those found
in the previous study; namely, many patrons did not visit the
site at the times selected for shutdown. The majority of club
managers reported that the shutdown impacted negatively on
their total gaming revenue, with reported reductions ranging
from 3% to 10%. Based on these findings, the authors of the
study recommended that the shutdown period be lengthened
from three to five hours, and that evaluation of the strategy
be continued.46
A third study, conducted in Nova Scotia, was found in our
review that showed that a reduction in VLT operating hours
resulted in a decrease in problem gambling spending. In this
study, unlike the two previous ones, the closing time was set
much earlier, at midnight, as opposed to 4 am or 6 am (no
Electronic Gaming Machines and Problem Gambling
opening time was indicated). The rationale for selecting the
midnight shutdown was based on data showing that problem
gamblers in Nova Scotia were more likely to play VLTs after
midnight (i.e., 57% of moderate to problem gamblers vs. 20%
of non-problem to low-risk problem gamblers played after
midnight). To evaluate the impact of this shutdown, a survey
was administered to the general population as well as to VLT
players specifically. Findings revealed that as a result of the
midnight closure, VLT players overall reported a 5% decrease
in spending; players who previously gambled past midnight
reported a 26% reduction in spending; and problem gam-
blers reported an 18% reduction in spending. An analysis of
the net revenues demonstrated that there was an estimated
reduction in revenue of 5% to 9% which resulted from the
closure. The authors of the study concluded that the change
seemed to have the desired effect of curbing problem behav-
iours of those most at risk.74
The above pattern of findings was found in a fourth study that
looked at the effect of hours of operation (boarding time) and
days of operation per year on riverboat and racino EGM use.
Using structural equation modeling with archival data col-
lected between 1991 and 1998 from riverboats and racinos
in Iowa, Illinois, and Missouri (N = 153 observations), the
authors of the study found that restricting boarding times re-
sulted in a 35% reduction in EGM gambling.75
Venue Conveniences
ATMs
Definition. It is often thought that access to ATMs (automat-
ed teller machines) at gaming venues can increase the risk of
problem gambling since they provide an easy opportunity to
obtain additional funds.
Association with problem gambling. There is some evidence
available to support the above contention. According to one
study, more problem gamblers compared to non-problem
gamblers reported visiting ATMs to withdraw money while
gambling. Of this group, 20% of problem gamblers indicated
that they always visited ATMs while playing.38 Similarly, a
telephone survey probing EGM players (N = 240) in Australia
about their ability to keep within pre-committed spending
limits found that 71% admitted to exceeding these limits, es-
pecially if they had cash on their person or they could access
it at an ATM.59
21
Electronic Gaming Machines and Problem Gambling
In response to the above findings, a number of ATM-related
harm reduction strategies have been suggested, including
placing limits on how much one can withdraw from gaming
venue ATMs, limiting the number of withdrawals one can
make from venue ATMs, removing ATMs from the gaming
floor, and prohibiting ATMs from gaming venues altogether.
The evidence to support these suggestions has thus far been
mixed.
One interview- and survey-based study with adult residents
in 13 regions of Australia found that more self-identified
problem gamblers (60%) visited ATMs at gaming venues than
did regular gamblers (25%), recreational gamblers (13%),
and non-gamblers (5%). It also found that ATM withdrawals
of $100 or more were more common among problem gam-
blers than non-problem gamblers, and that 93% and 90% of
regular and problem gamblers, respectively, spent their ATM
withdrawals at the gaming venue compared to 70% of recre-
ational gamblers. Notwithstanding these findings, the study
participants expressed little support for removing ATMs
from gaming venues altogether because of the inconvenience
it would pose to recreational gamblers. Notably, though, par-
ticipants did support both the notion of placing limits on the
number of ATM withdrawals one could make and the plac-
ing of bans on credit card cash advances (86% and 72% of
participants supported these ideas, respectively). The authors
concluded that there is limited evidence to support removing
ATMs from gaming venues completely as a means to help
reduce the risk of problem gambling. Instead, they suggested
that a more effective and acceptable strategy would be to es-
tablish daily maximum ATM withdrawal amounts.39
A second survey conducted in Victoria, Australia looked at
EGM players’ (N = 418) attitudes, awareness, beliefs, per-
ceptions, challenges and behaviours relating to a number of
harm minimization strategies. It found that moderate-risk
and problem gamblers made significantly more ATM with-
drawals than non-problem or low-risk EGM players. ATM
usage was also a significant, independent predictor of prob-
lem gambling. Furthermore, the majority of EGM players, ir-
respective of their problem gambling status, felt that ATMs
should not be located in the gaming venue at all. However,
more problem gamblers (10%), as compared to non-problem
gamblers (1.5%), maintained that ATMs should be located
on the gaming floor. The authors argued that this finding
suggests that removing ATMs from the gaming floor would
not inconvenience recreational gamblers.45
22
Cashing of Cheques
Definition. Cashing of cheques refers to a venue’s policy of
accepting cheques (e.g., personal, government-issued) from
patrons to assist them with accessing money for further
gambling.
Association with problem gambling. The relationship between
the ability to cash personal cheques at a gaming venue and
problem gambling does not appear to be well documented
in the literature. This may be due to the fact that many ven-
ues prohibit cheque-cashing from occurring at all or, if they
do allow it, that many patrons are not actually aware of the
venue’s cheque-cashing policies.11
Alcohol Service
Definition. Much of the expansion of EGM gambling is based
on the placement of machines in venues already approved
for alcohol sales. Therefore, alcohol service is often found on
the gaming floor and many casinos (outside of Canada) offer
complimentary alcoholic beverages to their patrons.
Association with problem gambling. A survey conducted in
Nova Scotia found that 74% of VLT players reported drink-
ing alcohol while gambling.76 Other research has found that
gamblers who drink alcohol during play are more likely to
be problem gamblers.77 Moreover, some studies have found
that EGM gamblers who drink even moderate amounts of
alcohol during play will spend more time gambling, will
take more risks while gambling, and will spend more money
gambling.78-80
Research also suggests that the impact of alcohol may differ
for non-problem as opposed to problem gamblers. For exam-
ple, one VLT study was found in our review that examined
the effects of moderate alcohol intake (3 alcoholic drinks)
among community gamblers characterized as either non-
problem gamblers or probable problem gamblers. Findings
indicated that alcohol use was associated with both greater
time spent playing VLTs and riskier betting, but only among
the probable problem gamblers.78
A further relationship between alcohol use and problem
gambling has been noted for problem gamblers with co-mor-
bid alcohol problems. Some researchers argue that problem
gamblers with co-morbid alcohol problems may have more
severe gambling problems, as well as more difficulties in gen-
eral (e.g., suicidal behaviour, drug problems) when compared
to those problem gamblers without alcohol problems.81 In

support of this argument, an examination of problem gam-
blers who called a gambling helpline found that those prob-
lem gamblers with alcohol problems had greater problems in
multiple areas (e.g., arrest, attempted suicide) as compared
to problem gamblers without alcohol problems.82 No studies
were found in our review that examined the impact of re-
stricting alcohol in gaming venues on problem gambling.
Venue Design
Clocks and Natural Light
Definition. The majority of gaming venues do not have visible
clocks and often have little if any natural light. It has been
suggested that venues should install clocks and increase nat-
ural light to help patrons who may dissociate from reality or
lose track of time while gambling.11
Association with problem gambling. There is skepticism in
the field as to whether the installation of clocks and windows
would have any tangible effect on gambling behaviour.38
Research has been conducted, however, confirming that ven-
ues are not particularly conducive for monitoring time of day
via wall clocks and natural light. In this regard, a mail-out
and on-site survey was conducted in New South Wales as-
sessing club patrons’ (N = 864) awareness and perceived ef-
fectiveness of certain responsible gambling strategies includ-
ing increasing the visibility of clocks in venues and improv-
ing access to natural light. The results of this study indicated
that only a few respondents were able to see the time of day
on a venue wall clock without getting up from their EGM
(38%), and that even fewer could see out of a window without
getting up from their EGM (10-15%).11
Similarly, a second survey was conducted looking at EGM
players’ (N = 418) attitudes, awareness, beliefs, perceptions,
challenges, and behaviours relating to a number of harm
minimization strategies, including placement of clocks and
windows for natural light. Results revealed that almost 25%
of EGM players indicated that they were “never” able to see
a wall clock, and 49% thought that clearly visible wall clocks
in gaming venues would be an effective measure for reduc-
ing problem gambling. As well, the majority of EGM players
stated that they were unable to see out of a window without
getting up from their EGM, and 46% said that the introduc-
tion of natural lighting in the gaming area would be an effec-
tive harm minimization strategy.45
Electronic Gaming Machines and Problem Gambling
Placement of EGMs
Definition. Some researchers have speculated that because
of their design or format, certain gaming venues (e.g., casi-
nos) are more conducive to player anonymity than are oth-
ers. Anonymity, in turn, is thought to increase the risk of
problem gambling since an individual can gamble as much
as they want to without their behaviour being readily noticed
by others.46
Association with problem gambling. To date, only one labora-
tory study was found in our review that explored the impact
of venue format on gambling behaviours and perceptions
with occasional (N = 60), at-risk (N = 60) and problem gam-
blers (N = 60). In terms of venue format, 3 arrangements were
tested: 1) EGMs were placed on a counter (to replicate a bar
style venue), 2) EGMs were placed against the wall (similar
to a casino), and 3) EGMs were isolated in cubicles. Results
revealed that among participants who reported being influ-
enced by EGM arrangement, 66% indicated that the cubicle
arrangement was the one that elicited impaired control. Of
those who thought that EGM arrangement could contribute
to excessive gambling, 74% identified the cubicle arrange-
ment as being most problematic. Notably, problem gamblers
preferred the cubicles because they were isolated, contributed
to anonymity, and were less distracting. They also recognized,
however, that the arrangement facilitated loss of control and
resulted in excessive gambling.83
Advertising
Prize Advertisements
Definition. Venue advertisements of EGMs may depict ordi-
nary people winning millions of dollars from a single coin in-
serted into a slot machine. Such advertising has been argued
to create unrealistic expectations of winning large sums of
money without providing the safeguards to prevent problem
gambling.84
Association with problem gambling. The literature on the re-
lationship between advertisements and problem gambling
appears to be sparse. Only one relevant study was found in
our review, but its main purpose was to look at the demo-
graphic and clinical features of problem gamblers (N = 131).
Relevant to this discussion was the study’s focus on triggers
that provoked the urge to gamble. Results indicated that 46%
of the sample reported that gambling-related advertisements
on television, radio, and billboards triggered their gambling.
23
Electronic Gaming Machines and Problem Gambling
Moreover, those participants who were triggered by the ad-
vertising also appeared to develop problem gambling soon
after their first play as compared to those whose gambling
was not triggered by the advertising.85
EGM Marketing
Definition. Targeted EGM marketing involves attempts by a
gaming facility to boost EGM play by enticing players with
offers of special deals and bonuses (e.g., additional credits or
bonus rounds for play, access to special jackpots).
Association with problem gambling. No research on the re-
lationship between EGM marketing and problem gambling
was found in our review.
Venue-based Harm Minimization Strategies
Self-exclusion Programs
Definition. For many years, gaming venues—particularly ca-
sinos—have offered self-exclusion (SE) programs to patrons
who wish to voluntarily ban themselves from the venues
whether that be for months, years, a lifetime, or an unspeci-
fied period of time.
Association with responsible gambling. To date, there is little
research on the effectiveness of SE, and among the few stud-
ies that have been done, the evidence has been mixed. One
study examined the effectiveness of a self-exclusion program
using questionnaire data from problem gamblers (N = 220)
who had self-excluded from a casino. Results indicated that
30% of participants new to the program completely stopped
gambling once enrolled. Of those who were repeat self-ex-
cluders (i.e., they had re-entered the self-exclusion program a
second time or more), 36% reported that in their last attempt,
they broke their ban and returned to the casino; 50% admit-
ted to gambling on other games such as VLTs during their
ban. Overall, however, attitudes toward the program were
quite positive, with a large proportion of first time self-ex-
cluders reporting a high rate of satisfaction (97%), and even
second time self-excluders reporting a high rate of satisfac-
tion (80%).86
A second evaluation of self-exclusion programs, conducted
in Victoria, Australia, relied on face-to-face interviews with
stakeholders from industry, gaming venues, Gambler’s Help
agencies, as well as self-excluded patrons themselves. After
reviewing the results of their extensive interviews, the authors
of the study concluded that the available data on self-exclu-
24
sion was extremely limited and not focused on outcomes.
What is more, they stated that it was not possible to mean-
ingfully comment on compliance by venues, rates of detec-
tion, or notification rates, and, as a result, the effectiveness of
self-exclusion as a harm minimization strategy. They further
stated that while all stakeholders want an enforceable system,
industry spends a great deal of its efforts “bluffing” about the
credibility of SE programs but does not do enough to support
their operation, such as developing systems that would actu-
ally make them effective.87
As with the above studies, most of the published research on
SE is casino-based. Thus, it reveals very little about the pos-
sible effectiveness of SE from other (non-casino) EGM ven-
ues. Nova Scotia is currently conducting a multi-phase study
that explores EGM-related SE, with a particular focus on
the ability of venue staff to accurately identify self-excluders
violating their bans. In one phase of the study, participants
consisted of EGM retailers (N = 45), designated and trained
program retail support staff (N ~ 150) and regular, local, and
non-local EGM players (N = 36). Results revealed that 35%
of the self-excluded EGM players were detected in a venue
during their ban and that the identification rate dropped to
10% when the players were non-local.88 Findings also showed
that the accuracy of identification improved 3.4 times if the
players were local (as opposed to non-local), 2.3 times if the
report was generated later in the day and 2.8 times if the re-
port was generated in a private facility compared to a public
facility. The researchers attributed the difficulty in recogniz-
ing and accurately reporting on SE participants who are vio-
lating their ban to a number of factors, including the busy
setting of the venues, lack of any objective means of confirm-
ing player identities, limited staff resource or interest, and SE
participants’ efforts to avoid detection.88
Employee Awareness Education
Definition. Educating venue employees about problem and
responsible gambling is an initiative often undertaken by
gaming venues to reduce the risk of problem gambling. The
rationale behind such initiatives is that trained employees
who have direct contact with patrons may be the main con-
duit for intervening with a problem gambler.55 Some exam-
ples of topics covered in employee awareness training include
the nature of problem gambling, recognizing the ‘red flag’/
warning signs of a problem gambler, and knowing what to do
with those observations.
 Electronic Gaming Machines and Problem Gambling

Association with responsible gambling. While mandatory those who actually changed their behaviour was even lower
employee awareness training programs can be found in most than the average, indicating that the initiatives were not very
gaming venues, voluntary training programs for VLT and effective for those most at risk.11
lottery retailers are an emerging trend. In Alberta, there is an
A previously discussed study conducted in Alberta evalu-
awards/incentive program to motivate retailers to participate
ated the effectiveness of new responsible gambling features
in both mandatory and voluntary training programs offered
installed on VLTs to mitigate problem gambling.64 As part
by the province. However, no research evaluating the efficacy
of pre-test data collection (prior to installation of new VLTs
of this program was identified in our review.64 Indeed, only
with responsible gambling features), information was gath-
one study, conducted in Quebec, was found which examined
ered about patrons’ awareness of responsible gambling sig-
the efficacy of staff training for EGM venues. In this research,
nage, as well as patrons’ responses to signage. Findings re-
an awareness campaign named “As luck would have it” was
vealed varying levels of awareness of responsible gambling
made available to gambling retailers of VLT establishments
signage, with half of all sampled patrons reporting aware-
in order to educate them about chance and randomness, the
ness of stickers on the front of VLTs. Additionally, a majority
link between misconceptions and excessive gambling, the
of players believed that signs, stickers, and posters were at
symptoms of problem gambling, and ways to intervene with
least somewhat effective in informing them about problem
a problem gambler. An after-campaign evaluation revealed
gambling and about what help was available. However, al-
that the retailers who received the training claimed to have
most none of the patrons reported changes in behaviour in
a better understanding of problem gambling, and had used
response to seeing signs, posters, or stickers (e.g., by cashing
some of the intervention methods more often with patrons
out, stopping play, leaving the venue, or calling a helpline).
as compared to before the training.89
Thus, while patrons indicated awareness of signage, they did
Customer Awareness Education not use the information.65

Definition. Many gaming facilities have undertaken initia-

tives to educate patrons about problem and responsible gam- COMMUNITY ACCESSIBILITY FEATURES
bling by making pamphlets available on site and increasing
A third category of features associated with EGMs and prob-
signage throughout the venue.
lem gambling may be referred to as community accessibility
Association with responsible gambling. Empirical support features. These include the number of EGM venues, proximity
for customer awareness education initiatives is limited. One of EGM venues, EGM caps, number of EGMs per capita, and
study was found in our review that evaluated club patrons’ EGMs in low income areas. Following a brief description of
awareness and perceived effectiveness of the customer edu- the background literature on community accessibility, each
cation initiatives in 10 clubs in Sydney, Australia. Findings of these variables will be discussed in turn.
revealed that there was a high level of awareness of the sig-
Background. Currently, there is evidence in the research lit-
nage and information measures employed. Specifically, 86%
erature suggesting a positive link between gambling oppor-
of respondents noticed signage advising patrons of the risks
tunities and problem gambling, both in Canada and the rest
of gambling, over 70% noticed signage about the club’s re-
of the world.13,38,90-94 One example of this is found in a replica-
sponsible gambling house policies, and over 67% noticed sig-
tion study that compared two surveys conducted in Quebec:
nage about the chances of winning a major prize.11 However,
The first in 1989, the second in 1996.96, 97 Not only did the
despite the high level of awareness, the majority of respon-
study find past- year gambling participation rates to have
dents claimed that the signage had little effect on either their
significantly increased between the two survey years (from
gambling perceptions or behaviours. Specifically only 44%
54% to 63%), it also found lifetime rates of pathological gam-
of respondents reported that the measures were effective in
bling to have increased (from 1.2% to 2.1%). As highlighted
changing the way that they thought about their gambling,
by the authors of the study, these increases co-occurred with
and less than 20% reported that they actually reduced how
increases in opportunities to gamble on lottery tickets, casi-
often they gambled or how much time or money they spent
nos, and VLTs in the province.95 Similarly, a study in Ontario
doing so. Moreover, for problem gamblers, the proportion of
found that gambling participation among substance abusers

25
Electronic Gaming Machines and Problem Gambling
seeking treatment nearly doubled after the introduction of
the Niagara Falls casino.92
Further, a study conducted using Statistics Canada data
showed that those provinces with the highest density of VLTs
per 1,000 population and a permanent casino had the high-
est rates of self-identified problem gamblers.98 Moreover,
research conducted in Manitoba, where there is widespread
availability of VLTs in bars and restaurant lounges (i.e., a per
capita density of one VLT per 200 people), demonstrated that
the prevalence of problem and probable problem gambling
(5.6%) was higher than that reported in any other Canadian
province, across a number of prevalence studies.93 Finally,
a meta-analysis of 34 studies of gambling problems among
adults in North America from 1977-1997 indicated that
problem gambling increased over time as gambling oppor-
tunities multiplied.99 However, it is important to note that all
of the above studies are correlational and thus do not speak
to causation.
Moreover, the above studies are predominantly based on data
collected in the early 1980s and 1990s, when gambling was first
introduced on a wide scale. More recent studies, conducted
in the last 10 years, show that there is little or no increase in
the prevalence of moderate or severe problem gambling rates.
For example, recent research in Ontario found no significant
difference in the prevalence of moderate or severe problem
gambling between 2001 and 2005.2 Research in Quebec found
a combined problem gambling rate of 2.4% in 1996 and 1.8%
in 2002. 97,100 Research in British Columbia found that levels
of problem gambling and probable pathological gambling
among past year and weekly gamblers remained unchanged
between 1993, 1996, and 2002.101 Research in Alberta found
similar prevalence rates of problem gambling between 1994,
1998, and 2001. Finally, research in Manitoba found a “mi-
nor” increase in “probable pathological gambling” in 2001
(2.3%) compared to 1995 (1.9%).102
The relative stability of problem gambling rates from 2000
onward has been explained by both the saturation and so-
cial adaptation models of the impact of gambling exposure
on problem gambling rates.103 The saturation model predicts
an initial increase in problem gambling rates following the
introduction of gambling opportunities, followed by a pla-
teau. The social adaptation model predicts a gradual plateau
in problem gambling rates, followed by a decrease as the nov-
elty of the new gambling opportunities diminish.
26
Given the conflicting correlational evidence regarding com-
munity accessibility and problem gambling, numerous stud-
ies have been conducted which attempt to make sense of the
underlying relationship between the two variables. These
studies are discussed below.
Number of EGM Venues
Definition. It has been suggested that the absolute number of
EGMs in a community is not as problematic as the number
of venues housing those machines.
Association with problem gambling. Dispersing gambling op-
portunities over a larger area is thought to be more harmful
than consolidating gambling opportunities to a smaller area,
since the former is more likely associated with a greater num-
ber of people having access to such opportunities.38 Indeed,
focus groups with occasional, at-risk, and problem gamblers
(N = 99) have shown that widespread EGM distribution is
not well regarded, as it is seen to contribute to a loss of con-
trol over gambling among those with gambling problems.
Conversely, confining machines to a limited number of loca-
tions is seen as a factor that would promote control.27, 83
Another study was found in our review that supports the
above. It looked at two regions of Australia with very different
levels of community accessibility. The first region, Western
Australia, had EGMs localized in one casino; the second re-
gion, Victoria, had EGMs located in 540 venues. Data was
obtained from community surveys undertaken to assess at-
titudes and behaviours relevant to participation in gambling,
and from interviews with a variety of stakeholders. Results
revealed that compared to Western Australia (where gam-
bling was localized to one casino), the monetary expenditure
per adult in Victoria (where gambling was widely dispersed)
was nearly 2.5 times greater, participation rates of EGM gam-
bling were 17.5 times greater, and the estimate of problem
gambling was 3 times higher.104
Proximity of EGM Venues
Definition. The proximity of EGM venues refers to the geo-
graphical or spatial distance of EGM venues to potential
consumers.
Association with problem gambling. Venues that are conve-
niently located in or near large populations can facilitate EGM
participation by increasing ease of access. A survey conducted
with community adults in the region of Suburban Canberra,

Australia, (N = 2,447) examined whether geographical prox-
imity was a significant factor influencing gambling-related
activity. The results revealed that those who lived within close
proximity (i.e., within 4 kms) of an EGM site reported great-
er gambling frequency and monetary gambling expenditure
than those who lived further away.105 Although this study did
not directly examine the relationship between proximity and
problem gambling, it does suggest that the close proximity of
EGM venues increases opportunity to gamble and, therefore,
the risk of excessive gambling. Evidence for a link between
proximity and problem gambling has been found in other
studies. In a national survey of adults in the United States
(N = 2,947), for example, it was found that respondents who
lived within 50 miles of a casino exhibited approximately
double the rate of casino gambling participation, and prob-
lem gambling compared to respondents who lived between
51 and 250 miles away from a casino.94
EGM Caps
Definition. The expansion of EGM availability and its link
to increased risk of problem gambling has led many juris-
dictions to impose caps on the absolute number of EGMs
allowed in a community. However, some have argued that
controls on the location of EGM gaming venues (e.g., venue
specific capping) might be a better way of reducing problems
associated with EGMs than restrictions on the absolute num-
ber of machines per se.38
Association with problem gambling. Only one study look-
ing at EGM caps was found in our review. It took place in
Victoria, Australia, where the number of EGMs was capped in
five vulnerable areas (as defined by social disadvantage, den-
sity of EGMs per capita, and socioeconomic status). Results
showed that the capping of EGMs in these areas was not as-
sociated with a reduction in gaming revenue. Additionally,
there was no evidence that problem gambling behaviours (as
measured by problem gambling counselling rates and other
forms of help seeking behaviour) were at all affected by the
EGM caps.107
While no other studies have examined EGM caps, it should
be noted that policy analyst Michael O’Neil has concluded
that the removal of 3,000 machines from South Australian
venues did not affect overall net EGM revenue. Additionally,
he reported that the majority of regular and problem gam-
blers did not believe that the reduction of EGM machines
Electronic Gaming Machines and Problem Gambling
had a positive effect on problem gambling in general or on
their own behaviour specifically.37
Number of EGMs per Capita (Density)
Definition. One common definition of EGM accessibility is
the density of EGMs within a population, defined by the num-
ber of EGMs per capita (e.g., per 1,000 people). Five EGMs
per 1,000 people can be considered relatively low, while 48
EGMs per 1,000 people can be considered quite high.
Association with problem gambling. It has been shown that
the relationship between EGM density and gambling expen-
diture is quite strong.28, 107, 108 For instance, recall the previous-
ly discussed study conducted in Nova Scotia that looked at
the effect of reducing EGM number on problem gambling. It
found that removing 800 VLTs from retail locations through-
out the province resulted in a decrease of time and money
expenditures among both problem and non-problem VLT
players.28
Another study, conducted in Australia, explored the associa-
tion between EGM density and gambling participation uti-
lizing interview data. An analysis of four regions, each with
a different per capita concentration of EGMs, showed that
the higher the concentration, the greater the participation in
EGM-related gambling. Specifically, in those areas where the
concentration of EGMs was highest, a greater proportion of
the population spent more time and money gambling than
did those in areas where the concentration was lower.108 This
study, though, did not look at the relationship between EGM
density and problem gambling per se.
A third study was found in our review which looked at the
relationship between EGM accessibility and expenditure
in Victoria, Australia, where the government has enacted a
policy to impose caps on EGMs in disadvantaged communi-
ties. The study used Geographical Information Systems tools
to map EGM expenditure. Results showed that there was no
direct or uniform relationship between EGM density and ex-
penditure or measures of social disadvantage.109 The authors
concluded that using EGM density as a measure of accessi-
bility is too simplistic because it does not take into consid-
eration other factors, such as type or combination of gam-
ing machines, proximity of venues to community facilities,
consumer preferences, venues’ marketing strategies, changes
in urban and economic conditions, etc.108 Again, however,
27
Electronic Gaming Machines and Problem Gambling
this research did not examine the relationship between EGM
density and problem gambling per se.
EGMs in Low Income Areas
Definition. Gaming facilities are often situated close to socio-
economically disadvantaged areas, ostensibly because they
facilitate economic development and job creation.106, 110
Association with problem gambling. Research has found that
patrons of casinos are more likely to be locals rather than
travelers. 111,112 This means that if casinos are placed in disad-
vantaged communities, the local community housing the ca-
sino may bear the biggest share of problem gambling; yet so-
cio-economically disadvantaged communities are least likely
to have the resources available to handle this problem.113
A number of studies were found in our review which con-
firms that EGMs do tend to be placed in low income areas
(although not all studies focused on the link between EGMs
placed in low income areas and problem gambling per se).
For example, one study combined spatial and statistical anal-
yses of data including youth surveys (N = 1,206) to assess 1)
whether VLT numbers varied according to socio-economic
status, and 2) what impact this might have on adolescent
gambling behaviour. The results of this study demonstrated
that VLT machines were more often located in inner-city and
lower income neighbourhoods than in neighbourhoods that
were considered more suburban and affluent. It also found
that the odds of VLT use were 40% greater for students at-
tending schools in neighbourhoods with high VLT access.114
An Australian study examined the geographical distribution
of EGMs with respect to socioeconomic status and found
that there were greater concentrations of EGMs in socio-eco-
nomically deprived areas. The authors of the study described
this as an inequitable distribution, due to the fact that the
people in these areas were least able to afford this expense.115
Similarly, an analysis of problem gambling geography in New
Zealand was performed with the aim of determining how
problem gambling services can be better provided to the pop-
ulation. In doing so, the spatial distribution of gaming ven-
ues was determined with respect to problem gambling risk
factors. Non-casino gaming machines (NCGM) were found
to be located in more socio-economically deprived areas.
For example, the two most deprived areas in New Zealand
housed approximately 35% of the total number of NCGMs,
while the two most affluent areas housed approximately 7%
28
of the total number of NCGMs. In addition, according to the
results obtained from the 2002/2003 New Zealand health sur-
vey,115 the overall problem gambling rates (not just the rates
for gaming machine-associated problem gambling) were 2.3
times greater in the areas with the most socio-economic de-
privation as compared to the most affluent areas (1.9% vs.
0.8%, respectively). The authors suggested that greater local
accessibility to gaming venues with respect to problem gam-
bling risk should be further investigated.112
Finally, the effect of neighbourhood disadvantage, gambling
availability, and problem gambling was examined in the
United States using a national telephone survey. Gambling
availability was defined as the distance from the nearest gam-
bling facility. Findings showed that relative socioeconomic
disadvantage was positively associated with frequency of
gambling (defined as the frequency with which respondents
gambled on 15 different types of gambling activities), while
close proximity of a gambling facility to a respondent’s home
(i.e., within 10 miles) was associated with problem gambling.
Although these findings are not isolated to EGM-related
gambling alone, they do suggest that increased availability of
gambling facilities may promote problem gambling in disad-
vantaged communities.106
SUMMARY
Numerous studies have attempted to shed light on the factors
that either increase, or decrease, EGM-related problem gam-
bling. While much has been learned from these studies, they
are not without limitations. As a result, the literature may
provide little guidance to policy makers who often have to
use this research to make timely decisions about EGMs. One
potential way to circumvent this problem is to ask what those
who have extensive experience with EGM-related problem
gambling think about the issue. That is, what do those work-
ing in the field as well as EGM problem gamblers themselves
believe most likely contributes to problems associated with
EGMs, and what do they believe would most likely reduce
their risk. The next two chapters of this report endeavour to
do just that.
 Electronic Gaming Machines and Problem Gambling

2 KEY INFORMANT Response Rate

The Key Informant Researchers, Specialists, and Counsellors
were initially sent an electronic (e-mail) letter asking them
QUESTIONNAIRE if they would like to participate in the study and fill out the
questionnaire. (Counsellors were also asked if they would
like to participate in the interviews.) The letter consisted of
a description of the study along with instructions on how to
access the questionnaire (online via a link to the Responsible
Gambling Council’s web site). A second, reminder letter
was sent to potential participants ten days later. Problem
Gamblers were asked to fill out the questionnaire when they
signed up for the focus groups.

METHODOLOGY In total, 49 Researchers and Specialists were invited to com-

plete the questionnaire; of that total, 25 completed it. Eight
Participants Counsellors were invited to complete the questionnaire; five
A total of 69 Key Informants from across Canada and abroad completed it. All twelve Problem Gamblers who signed up
were asked to provide their opinions on EGM-related prob- for the focus groups were asked to fill out the questionnaire;
lem gambling via questionnaires, interviews, and/or focus all did so.viii Table 1 shows the response rate for each Key
groups. Key Informants included: Informant group and the Key Informants overall. As can be
seen from the table, the overall response rate for the ques-
1. Problem gambling Researchers, identified
tionnaire was 60.9%.
through the published literature and/or per-
sonal referral;
TABLE 1. Questionnaire Response Rates
2. Gaming and problem gambling Specialists
(i.e., health and problem gambling profession-
Asked to
als, regulators, operators), identified through Complete
Completed Response
Group Questionnaire Rate
gambling governing bodies and/or personal Questionnaire
(n) (%)
(n)
referral;
Researchers/
. Problem gambling Counsellors, recruited Specialists
49 25 51.0

through addiction agencies and/or personal

Counsellors 8 5 62.5
referral; and
Problem
. EGM Problem Gamblers, recruited through Gamblers
12 12 100.0
problem gambling services.
Total 69 42 60.9
The purpose of this chapter is to describe the questionnaire
that was administered to Key Informants and to report on
the findings that were obtained. Chapter 3 discusses the
method and results of the focus groups, while Appendices 6 Questionnaire
and 7 cover the Counsellor Interviews.vii For a complete list The comprehensive questionnaire given to Key Informants
of Key Informants asked to participate in this study, please was divided into two main sections, each of which is de-
see Appendix 1. scribed in detail below. Note that while the questionnaire

viii Counsellors and Problem Gamblers were each given a $50 honorari-
vii Due to the fact that the findings from the Counsellor interviews did um for filling out the questionnaires and participating in the interviews
not add any unique information beyond the results of the questionnaire (Counsellors) and focus groups (Problem Gamblers). The honorarium was
and focus groups, they are not included in the main report. a gift certificate to a local grocery store.

29
Electronic Gaming Machines and Problem Gambling
administered to each Key Informant group was generally the
same, due to the highly technical nature of some items, the
Counsellors and Problem Gamblers received a modified ver-
sion that had some items omitted. For a complete copy of the
questionnaire, please see Appendix 2.
Section A: Contributors to Problem Gambling
In the first section of the questionnaire, respondents were
asked to indicate, on a 5-point scale ranging from Not at all to
Extremely, their thoughts on the importance of certain EGM
features, venue features, and overall community accessibil-
ity features as possible contributors to problem gambling.
Following this, they were asked to rank what they believed
to be the top three contributors for each area. They were then
asked to indicate any important contributor that had not
been previously mentioned. Given that all quantitative ques-
tions were subsequently ranked, the open-ended portion of
the questionnaire requesting a top-three ranking was deemed
redundant, and thus is not included in this report. For the
open-ended responses to the question regarding additional
features not mentioned, please see Appendix 3
Section B: Modifications to Reduce Problem Gambling
In the second section of the questionnaire, respondents were
asked to indicate, on a 5-point scale ranging from Not at all to
Extremely, their opinion on how effective select modifications
to EGM features, venue features, and overall community ac-
cessibility features would be in reducing the risk of problem
gambling. They were also asked to indicate, on a 3-point scale
ranging from Weak to Strong, their opinion on the strength
of the evidence supporting each modification. Similar to
Section A, a top-three ranking of the most effective modifica-
tions was requested, along with any additional modification
that had not been previously mentioned. Again, given that all
quantitative questions were subsequently ranked, the open-
ended portion of the questionnaire requesting a top-three
ranking was deemed redundant and therefore not included
in this report. For the open-ended responses regarding addi-
tional modifications not mentioned, please see Appendix 3.
Finally, participants were asked to give their thoughts re-
garding any improvements they would make to venue-based
harm minimization strategies (i.e., self-exclusion programs,
patron information and education initiatives, and staff train-
ing initiatives). For the sake of brevity, the findings related to
the open-ended part of this section are not included in this
report.
30
SECTION A: CONTRIBUTORS TO PROBLEM
GAMBLING
Data Analysis Plan
Only Researchers and Specialists were asked to complete
Section A of the questionnaire. For the most part, responses
from the group of Researchers were analyzed separately from
the group of Specialists. Given that the size of the sample was
small, very few between-group statistical comparisons were
conducted.
Section A includes 47 items that are potential contributors
to problem gambling as identified in the literature, rated on
a 5-point scale (i.e., Not at all important, Slightly important,
Moderately important, Very important, Extremely important).
All 47 items can be subsumed under one of the three areas
that form the general framework of this review; namely,
EGM features, venue features, and community accessibility
features. For each of the three framework areas, all items were
examined using two approaches: 1) Calculation and rank-
ing of item mean importance scores for each Key Informant
group; and 2) Thematic analysis. Below is a more detailed de-
scription of the two analytical approaches, followed by the
results obtained from each of the three framework areas.
1) Mean Importance Scores for Each Key Informant Group
In order to determine which contributors in a given frame-
work area (e.g., EGM features) were seen as most and least
important, we first calculated the average (mean) score for
each contributor as well as the standard error (SE)ix. We then
ranked each items mean score against all others in the specif-
ic framework area. Contributors were considered to be most
important if they ranked in the top quartile of items, and
least important if they ranked in the bottom quartile. For
this set of analyses, the results for Researchers and Specialists
are examined separately. Please see Appendix 4 for tables of
all rank-ordered means by Key Informant group.
ix The standard error is the standard deviation of a sampling distribu-
tion. More generally, it indicates the amount of variation of some statistic,
in this case the mean, in units given by the question.116
 A quartile divides the sorted data set into four equal parts so that each
part represents 1/4 of the sample. Thus, the top quartile cuts off the high-
est 25% of data, while the bottom, or 4th quartile, cuts off the lowest 25%.
 Electronic Gaming Machines and Problem Gambling

2) Thematic Analysis

After examining the results of the individual item rankings

within a given framework area, we organized the items into
clusters based on functional similarities; some of which have
been previously identified in the literature. xi For example, in
the case of EGM features, we created a first grouping of items
that referred to speed of play, a second grouping of items that
referred to sensory effects, a third group of items that referred
to payment methods, and so on. Note that given the low
number of items (i.e., 6) in the third framework area (com-
munity accessibility), we decided that an item-based analysis
was sufficient and, therefore, the thematic analysis was ap-
plied only to the first two framework areas (i.e., EGM and
venue features).

Bi-variate correlations were conducted between individual

item means within a thematic cluster. This was done in or-
der to identify any clusters that contained negatively corre-
lated items, as these items could suppress the cluster’s mean
importance score (i.e., two negatively correlated items in a
cluster could cancel each other out). Thus, all clusters include
items that had either a significant positive correlation or no
significant correlation with each other.

A thematic mean importance score was calculated by sum-

ming together all individual respondents’ item scores within
a given cluster and dividing by the total number of respon-
dents. A higher mean indicates greater thematic importance
for the respondents. We looked at 95% confidence inter-
vals (CIs) to determine if any of the thematic clusters were
deemed to be more important than the others, based on the
mean scores calculated for the total sample (Researchers and
Specialists combined).xii Lastly, we also looked at any possible
differences in thematic mean scores between Researchers
and Specialists using t-tests.

xi Placement of items into clusters is thematically, not statistically,

determined. As such, it is possible to group items into other thematic
arrangements.
xii The mean is essentially an estimate of central tendency. Its 95% confi-
dence interval indicates the range within which one can be 95% confident
that the true mean falls. For example, a mean of 2.7 with a CI:1.8 – 3.6
would indicate that the true mean falls somewhere between 1.8 and 3.6.
Thus, when determining whether two means are different, one can look to
see if their confidence intervals overlap. If they do, it is probable that the
means are no different, since they can assume the same values. If they do
not overlap, one can conclude with some degree of certainty that they are
indeed different.

31
Electronic Gaming Machines and Problem Gambling

TABLE 2. Most and Least Important EGM Contributors to Problem Gambling (Researchers)

Mean Importance
EGM Feature Score Item Rank N
(SE)
Most Important Contributors
Fast speed of play (e.g., shorter time between initial bet and outcome) 4.54 (.18) 1 13
Direct electronic fund transfers at machine (e.g., direct debit) 4.38 (.27) 2 13
Appearance of almost winning (i.e., near-miss) 4.23 (.23) 3 13
Bill acceptors 4.15 (.36) 4 13
Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors) 3.92 (.29) 6 13
Player controlled stop button 3.92 (.21) 6 13
Large mixture of small, medium, and large prize values, that increases the volatility of the
3.92 (.24) 6 13
game (i.e. game is less predictable)
Least Important Contributors

Higher house advantage or edge (i.e., average amount per bet taken by gaming
2.54 (.35) 26 13
operator)

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 2.54 (.29) 26 13
Offering winning outcomes less frequently through a lower hit-rate (i.e., lower chances of
2.54 (.27) 26 13
a win occurring)
Payout in tokens instead of cash 2.69 (.33) 23.5 13
Multiple game possibilities on one machine (e.g., poker, video slots, keno) 2.69 (.26) 23.5 13
Payout in tickets instead of cash 2.85 (.36) 21.5 13
Type of games available on one machine (e.g., poker, video slots, keno) 2.85 (.25) 21.5 13

Results tors, speed seems to be an underlying theme (i.e., fast speed

EGM Features that Contribute to Problem Gambling
1) Mean Importance Scores for Each Key Informant Group
Researchers’ Opinions. Researchers were asked to assess the
importance of 27 EGM features in contributing to problem
gambling. The mean importance scores for these features
ranged from 4.54 to 2.54. The EGM features that were per-
ceived to be the most and least important contributors to
problem gambling for this group are presented in Table 2.
As can be seen from the table, fast speed of play had the high-
est mean importance score (M = 4.54), followed by direct
electronic fund transfers at machine (M = 4.38), the appear-
ance of almost winning (M = 4.23), and bill acceptors (M =
4.15). Machines equipped with high denomination bill ac-
ceptors, stop buttons, and variable prize value mixtures each
had identical scores (M = 3.92). Among most of these fac-
of play, stop button) as is method of payment (i.e., direct elec-
tronic fund transfers, bill acceptors).
The EGM features that were seen to be the least important
contributors to problem gambling were related to the pro-
grammable mathematical aspect of the machines. That is,
higher and lower house advantage (which reflect the average
amount that the operator takes from each bet) and lower hit
rates (which decrease the chances of a player winning on in-
dividual spins), all shared the lowest mean scores (M = 2.54).
Other items rated among the lowest were the number (M =
2.69) and type (M = 2.85) of games available on machines,
and payouts in non-cash currencies (i.e., tickets: M = 2.85;
tokens: M = 2.69).
Specialists’ Opinions. Specialists were also asked to assess the
importance of the 27 EGM features in contributing to prob-
lem gambling. The mean importance scores for these features

32
 Electronic Gaming Machines and Problem Gambling

TABLE 3. Most and Least Important EGM Contributors to Problem Gambling (Specialists)

Mean Importance
EGM Feature Score Item Rank N
(SE)

Most Important Contributors

Direct electronic fund transfers at machine (e.g., direct debit) 4.00 (.25) 1 12

Appearance of almost winning (i.e., near-miss) 3.83 (.32) 2 12

Fast speed of play (e.g., shorter time between initial bet and outcome) 3.75 (.31) 3 12

Bill acceptors 3.58 (.31) 4.5 12

Frequent presentation of big prize symbols shown during play (e.g., reel placement) 3.58 (.31) 4.5 12

Least Important Contributors

Multiple game possibilities on one machine (e.g., poker, video slots, keno) 2.08 (.29) 27 12

Small denomination minimum betting amounts (e.g., 5¢, 10 ¢) 2.36 (.31) 26 11

Type of games available on one machine (e.g., poker, video slots, keno) 2.42 (.36) 24 12

Sound effects (i.e., music, buzzing and ringing) 2.42 (.29) 24 12

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 2.42 (.19) 24 12

Offering winning outcomes less frequently through a lower hit-rate (i.e., lower chances of
2.50 (.29) 22 12
a win occurring)

Visual effects 2.58 (.29) 21 12

ranged from 4.00 to 2.08. The EGM features perceived to be nomination minimum betting amounts (M = 2.36), among
the most important and least important contributors to prob- the least important EGM contributors to problem gambling.
lem gambling for this group are presented in Table 3.

As shown, the Specialists thought that the most important

EGM contributors to problem gambling were direct elec-
tronic fund transfers at machines (M = 4.00), followed by the
appearance of almost winning (M = 3.83), and fast speed of
play (M = 3.75). Lastly, bill acceptors and frequent presenta-
tion of big prize symbols during play were also ranked highly
as important contributors to problem gambling (M = 3.58
for each).

In terms of the least important contributors, Specialists rated

items related to game options very low (i.e., number of games
on EGMs: M = 2.08; type of games available on EGMs: M =
2.42), as well as lower house advantage (M = 2.42) and lower
hit rates (M = 2.50). The Specialists also rated machine sound
(M = 2.42) and visual (M = 2.58) effects, as well as small de-

33
Electronic Gaming Machines and Problem Gambling

TABLE 4. EGM Feature Thematic Mean Importance Scores (Researchers and Specialists)

Thematic Mean
Cluster Item Importance Score
(95% CI)

- Fast speed of play (e.g., shorter time between initial bet and outcome) 3.92 (3.58-4.26)
Speed of Play
- Player controlled stop button N=25

- Bill acceptors
Payment - Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors) 3.72 (3.31-4.13)
Methods - Direct electronic fund transfers at machine (e.g., direct debit) N=25
- Display machine activity in credits instead of cash

- Appearance of almost winning (i.e., near-miss)

EGM-based 3.68 (3.36-4.00)
- Prominent big prize advertising on machine
Inducements N=25
- Frequent presentation of big prize symbols shown during play (e.g., reel placement)

- Large denomination maximum betting amounts (e.g., $5, $10)

- Small denomination minimum betting amounts (e.g., 5¢, 10 ¢)
3.21 (2.91-3.52)
Betting Options - Large denomination minimum betting amounts (e.g., $1, $5)
N=25
- Large range between minimum and maximum betting amounts (e.g., 1¢ to $5)
- Large number of lines to bet on in slots (e.g., 5 lines compared to 3 lines)

- Large mixture of small, medium, and large prize values, that increases the volatility of the
game (i.e. game is less predictable)
- Higher house advantage or edge (i.e., average amount per bet taken by gaming operator)
Programmed - Lower house advantage or edge (i.e., average amount per bet taken by gaming operator)
2.92 (2.67-3.17)
Gaming - Offering winning outcomes more frequently through a higher hit-rate (i.e., higher chances
N=25
Features of a win occurring)
- Offering winning outcomes less frequently through a lower hit-rate (i.e., lower chances of a
win occurring)
- Wide variation in possible game outcomes (i.e., high outcome volatility)

- Payout in tickets instead of cash 2.84 (2.33-3.35)

Payout Methods
- Payout in tokens instead of cash N=25

- Sound effects (i.e., music, buzzing and ringing) 2.82 (2.40-3.24)

Sensory Effects
- Visual effects (i.e., lights, colours) N=25

- Type of games available on one machine (e.g., poker, video slots, keno)
Game - Multiple game possibilities on one machine (e.g., poker, video slots, keno) 2.81 (2.49-3.13)
Availability - Bonus round game features that reward players with further play on related games with N=25
different features

34
 Electronic Gaming Machines and Problem Gambling

2) Thematic Analysis TABLE 5. Most and Least Important Venue Contributors to

Problem Gambling (Researchers)
For this analysis, the 27 EGM feature items were grouped to-
gether into eight clusters. Thematic mean importance scores Mean
for each cluster, based on the total Key Informant sample Importance Item
Venue Feature N
(Researchers and Specialists), are shown in Table 4 (at left). Score Rank
(SE)
As can be seen in the table, three thematic clusters stand out Most Important Contributors
as the most important contributors to problem gambling:
ATMs located on gaming floor
Speed of play (M = 3.92), payment methods (M = 3.72), and or close to machines
4.08 (.31) 1.5 13
EGM-based inducements (M = 3.68). Although each of these 24 hour access to EGMs in
4.08 (.24) 1.5 13
clusters had different means, based on observation of their venue
confidence intervals, it appears that these three clusters were EGMs located in non-
rated significantly higher than all other clusters. dedicated gaming venue (e.g., 3.85 (.34) 3.5 13
bar, hotel)
We also compared the differences between Researchers and Targeted player marketing
3.85 (.22) 3.5 13
Specialists on their thematic mean importance scores and for EGMs
found only one thematic cluster for which the groups differed Least Important Contributors
in opinion: Researchers (M = 4.23) rated speed of play as a No clocks in venue 2.31 (.26) 14 13
more important contributor to problem gambling than did
Low visibility of the EGMs
the Specialists (M = 3.60) (t = 2.09, df = 23, p<.05). within the venue
2.46 (.33) 13 13

No windows in venue 2.54 (.27) 12 13

Venue Features that Contribute to Problem Gambling
EGMs located in a dedicated
1) Mean Importance Scores for Each Key Informant Group gaming venue (e.g., casino, 2.92 (.29) 11 13
racetrack)
Researchers’ Opinions. Researchers were asked to assess the
importance of 14 venue features in contributing to prob-
lem gambling. The mean importance scores for this group
were found to range between 4.08 and 2.31. Table 5 presents
Researchers’ mean scores and standard errors (SE) for the
most and least important contributors to problem gambling.

As the table shows, two items shared the highest mean impor-
tance scores. These were ATM machines located on the gam-
ing floor or close to machines, and 24-hour access to EGMs
in venues (M = 4.08 for both). These items were followed by
EGMs located in non-dedicated gaming venues and targeted
player EGM marketing; each received identical mean scores
of 3.85. Venue contributors that Researchers perceived to be
least important for problem gambling were the absence of
venue clocks (M = 2.31) and windows (M = 2.54), low visibil-
ity of EGMs within the venue (M = 2.46), and EGMs located
in a dedicated gaming venue (M = 2.92).

35
Electronic Gaming Machines and Problem Gambling

Specialists’ Opinions. Specialists also assessed the importance TABLE 6. Most and Least Important Venue Contributors to
of 14 venue-related features in contributing to problem gam- Problem Gambling (Specialists)
bling. Mean importance scores for Specialists were found to
range from 3.73 to 1.91. Results are presented in Table 6. Mean
Importance Item
Venue Feature N
As shown, Specialists rated ATMs on the gaming floor or close Score Rank
to EGMs to be the most important contributor to problem (SE)
gambling (M = 3.73), followed by targeted player EGM mar- Most Important Contributors
keting (M = 3.40), and 24-hour access to EGMs within the ATMs located on gaming floor
3.73 (.33) 1 11
venue (M = 3.36). On the other hand, they rated the lack of or close to machines

clocks (M = 1.91) and windows in venues (M = 2.18), and Targeted player marketing
3.40 (.31) 2 10
for EGMs
low visibility of EGMs within venues (M = 2.27), to be the
24 hour access to EGMs in
least important contributors to problem gambling. A large 3.36 (.39) 3 11
venue
number of EGMs in the venue also received a relatively low
Least Important Contributors
score (M = 2.33).
No clocks in venue 1.91 (.21) 14 11
2) Thematic Analysis No windows in venue 2.18 (.33) 13 11

The 14 venue contributors were collapsed into 5 broader Low visibility of the EGMs
2.27 (.27) 12 11
within the venue
clusters: venue conveniences, EGM accessibility, advertising,
Large number of EGMs within
venue type, and venue design. Thematic mean importance venue
2.33 (.26) 11 12
scores, generated from the entire sample of Researchers and
Specialists, are presented in Table 7 on the opposite page.

As can be seen from the table, although items related to
venue conveniences had the highest mean score (M = 3.53),
when considering the confidence intervals, this score was
not significantly higher than the scores for EGM accessibil-
ity, advertising, or venue type. Items related to venue design,
however, had significantly lower scores (M = 2.29) than did
the other four thematic clusters.
When examining differences in thematic mean scores be-
tween the two Key Informant groups, we found that EGM
accessibility was a more important cluster for Researchers
(M = 3.69) than it was for Specialists (M = 2.83) (t = 2.4,
df = 23, p<. 05). A between-group difference was also ob-
served for venue type, with it being more important, again, to
Researchers (M = 3.38) than Specialists (M = 2.71) (t = 2.4,
df = 23, p=.05).
Community Accessibility Features that Contribute to
Problem Gambling
1) Mean Importance Scores for Each Key Informant Group
Researchers’ Opinions. Researchers were asked how impor-
tant six items related to community accessibility were for
contributing to problem gambling. The mean importance
scores ranged from 4.46 to 4.00. Since there were only six
items, the mean importance scores and standard errors for
every item in this framework area are presented in Table 8.
As the table shows, Researchers generally rated each of the
community accessibility items as highly important (i.e., M ≥
4.00). The highest mean score was given to the item, large
number of venues with EGMs (M = 4.46), while the low-
est mean score was given to the item, large total number of
EGMs in community (M = 4.00).
Specialists’ Opinions. Specialists were also asked how impor-
tant the six items related to community accessibility were as
contributors to problem gambling. Specialists mean impor-
tance scores ranged from 3.82 to 3.20. All Specialists’ mean
scores and standard errors (SE) for this framework area are
presented in Table 9.
As seen in the table, the most important contributor to prob-
lem gambling for Specialists was wide dispersion of EGMs
throughout community (M = 3.82). This item was followed
by a large number of community venues with EGMs (M =
3.64), convenient location of EGM venues (M = 3.55), large
number of EGMs per capita (M = 3.45), and large total num-
ber of EGMs in community (M = 3.36). The item seen as least
important was over concentration of EGMs in low income
neighbourhoods (M = 3.20).

36
 Electronic Gaming Machines and Problem Gambling

TABLE 7. Venue Feature Thematic Mean Importance Scores (Researchers and Specialists)

Thematic Mean
Cluster Item Importance Score
(95% CI)

- ATMs located on gaming floor or close to machines

Venue 3.53 (3.15-3.91)
- ATMs located anywhere in the EGM venue
Conveniences N = 24
- Easy access to alcohol

- Large number of EGMs within venue

EGM 3.28 (2.88-3.68)
- 24 hour access to EGMs in venue
Accessibility N = 25
- Full access to EGMs for play in venue

- Frequent big prize advertising or promotion in the venue

3.19 (2.82-3.57)
Advertising - General gambling marketing
N = 24
- Targeted player marketing for EGMs

- EGMs located in non-dedicated gaming venue (e.g., bar, hotel) 3.14 (2.78-3.50)
Venue Type
- EGMs located in a dedicated gaming venue (e.g., casino, racetrack) N = 25

- No clocks in venue
2.29 (1.97-2.61)
Venue Design - No windows in venue
N = 24
- Low visibility of the EGMs within the venue (e.g., hidden from view)

TABLE 8. Community Accessibility Contributors to Problem TABLE 9. Community Accessibility Contributors to Problem
Gambling (Researchers) Gambling (Specialists)

Mean Mean
Community Accessibility Importance Item Community Accessibility Importance Item
N N
Feature Score Rank Feature Score Rank
(SE) (SE)
Large number of community Wide dispersion of EGMs
3.82 (.35) 1 11
venues (bars, lounges, casinos, 4.46 (.18) 1 13 throughout community
other) with EGMs
Large number of community
Wide dispersion of EGMs venues (bars, lounges, casinos, 3.64 (.28) 2 11
4.38 (.21) 3 13 other) with EGMs
throughout community
Convenient location of EGMs Convenient location of EGMs
sites (e.g., close proximity to 4.38 (.18) 3 13 sites (e.g., close proximity to 3.55 (.31) 3 11
high residential populations) high residential populations)
Over concentration of EGMs in Large number of EGMs per
4.38 (.21) 3 13 3.45 (.31) 4 11
low income neighbourhoods capita in community
Large number of EGMs per Large total number of EGMs in
4.23 (.28) 5 13 3.36 (.34) 5 11
capita in community community
Large total number of EGMs in Over concentration of EGMs in
4.00 (.30) 6 13 3.20 (.36) 6 10
community low income neighbourhoods

37
Electronic Gaming Machines and Problem Gambling

SECTION B: MODIFICATIONS TO REDUCE effective).xiv Mean effectiveness scores were then ranked
PROBLEM GAMBLING against other items within their specific framework area. The
most effective modifications were identified as those items
Data Analysis Plan which ranked in the top quartile among all items for the spe-
Section B of the questionnaire can be broken down into cific framework area, while the least important were identi-
two quantitative parts. The first asked respondents about fied as those that ranked in the bottom quartile.xv
the effectiveness of 76 potential modifications for reducing
In addition, after responding to each question about a
problem gambling risk using a 5-point scale (i.e., Not at all
modification’s effectiveness for reducing problem gambling,
to Extremely effective). The second asked respondents about
Researchers and Specialists were asked to assess the strength
the strength of the evidence supporting these 76 modifica-
of the evidence supporting the effectiveness of that modifica-
tions using a 3-point scale ranging from Weak to Strong.
tion for reducing problem gambling risk. For each of the two
Researchers, Specialists, Counsellors, and Problem Gamblers
Key Informant groups, the proportion who endorsed one of
were all asked to complete the first part of the questionnaire,
the three strength of evidence options (i.e., Weak, Moderate,
while only Researchers and Specialists were asked to com-
Strong) was calculated.
plete the second part (i.e., strength of evidence).
2) Comparisons Between Key Informant Groups
As with section A, after examining the results of the indi-
vidual item rankings, we organized like items into clusters To get a sense of the similarities and differences in opinion
based on functional similarities.xiii All 76 modification items between the Key Informant groups, we compared quartile
in section B (across both parts) were subsumed under one rankings (i.e., 1-4) of key items (i.e., top-rated items, bot-
of the three general framework areas; namely, EGM features, tom-rated items and other notable items, where appropriate)
venue features, and community accessibility features. The across the four groups. Please see Appendix 4 for complete
data were analyzed using the following approaches applied to tables of the rank-ordered mean effectiveness scores by Key
each framework area: 1) Mean effectiveness scores were cal- Informant group.
culated for each modification within a Key Informant group;
Because the Counsellors and Problem Gamblers were not
2) Researchers’ and Specialists’ opinions on the strength of
given some of the modification items, these items were omit-
the evidence were then tabulated for each modification; 3)
ted from this analysis. For this set of analyses, therefore, the
Quartile placement of top and bottom ranking items were
Researchers’ and Specialists’ mean effectiveness scores were
compared between Key Informant groups; and 4) A thematic
subsequently re-ranked based on the shorter list of modifi-
analysis was conducted. Below is a more detailed description
cations that were assessed by the Counsellors and Problem
of the analytical approaches, followed by the results from
Gamblers.
each of the three framework areas.
3) Thematic Analysis
1) Mean Effectiveness Scores and Opinion Regarding
Evidence Strength for Each Key Informant Group After examining the results of the individual item rankings
within a given framework area, we organized like items into
To determine which of the modifications in a given frame-
clusters based on functional similarities; some of which have
work area were seen as most and least effective for reducing
problem gambling risk, we employed the same approach re-
ported in Section A. That is, for each modification item, the
mean effectiveness score and standard error (SE) were calcu-
lated based on a 5-point scale (Not at all effective to Extremely
xiv The standard error is the standard deviation of a sampling distribu-
tion. More generally, it indicates the amount of variation of some statistic,
in this case the mean, in units given by the question.

xv A quartile divides the sorted data set into four equal parts so that each
xiii Placement of items into clusters is thematically, not statistically, part represents 1/4 of the sample. Thus, the top quartile cuts off the high-
determined. As such, it is possible to group items into other thematic est 25% of data, while the bottom, or 4th quartile, cuts off the lowest 25%.
arrangements.

38
 Electronic Gaming Machines and Problem Gambling

been previously identified in the literature. xvi For example, in report their opinions regarding the strength of the evidence
the case of EGM features, we created a first gro uping of items for the most and least effective modifications.
that referred to speed of play, a second grouping of items that
Researchers’ Opinions. Researchers were asked to assess 46
referred to sensory effects, a third grouping of items that re-
EGM-related modifications. Table 10 on the next page shows
ferred to payment methods, and so on. Note that given the low
the modifications that they believed to be most effective,
number of items (i.e., 5) in the framework area pertaining
based on each item’s mean effectiveness score and standard
to community accessibility, we decided that an item-based
error (SE). The table also presents the Researchers’ percep-
analysis was sufficient and, therefore, thematic analysis was
tions of the strength of evidence for each modification’s
applied only to the first two framework areas (i.e., EGM and
effectiveness.
venue modifications).
As can be seen, researchers’ mean effectiveness scores ranged
Bi-variate correlations were conducted between individual
from 3.77 to 1.38. The most effective modifications were those
item means within a thematic cluster. This was done in order
related to restricting expenditures. The most effective item
to identify any clusters that contained negatively correlated
identified was eliminating electronic fund transfers at EGMs
items, as these items could suppress the cluster’s thematic
(M = 3.77), followed by removing bill acceptors completely
mean effectiveness score (i.e., two negatively correlated items
(M = 3.50), and removing only large bill acceptors (M = 3.46).
in a cluster could cancel each other out). Thus, all clusters
Moreover, providing mandatory (M = 3.38) and optional (M =
include items that had either a significant positive correlation
3.00) pre-determined spending limit capacities were also rated
or no significant correlation with each other.
very highly.
A thematic mean effectiveness score was then calculated
In addition, Researchers felt that restrictions based on time
by summing together all individual respondent item scores
would be effective, as mandatory setting of pre-determined
within a given cluster and dividing by the total number of re-
time limits (M = 3.15) and optional setting of pre-determined
spondents. A higher mean indicates greater perceived effec-
time limits (M = 3.00) were rated very highly. Generally, of the
tiveness for that modification theme. We then looked at 95%
most effective EGM modifications, mandatory, as opposed to
confidence intervals to determine if any of the total thematic
optional, features scored higher. This can be seen by the top
mean scores were significantly higher than the others, sug-
five items, including requiring mandatory registration and use
gesting greater perceived effectiveness for that thematic clus-
of smart cards for play. Moreover, the top five items were all
ter.xvii Lastly, we looked for any possible differences in the-
based on externally-enforced play and expenditure restric-
matic mean scores between the four Key Informant groups
tions. Other items that scored highly were related to decreas-
using one-way ANOVA and non-parametric testing (i.e.,
ing speed of play (i.e., increasing time between the outcome of
Kruskal-Wallis), where applicable.
one bet and the next bet, M = 3.31) and providing on-screen
running cash totals of amount spent (M = 3.15).
Results
EGM Modifications to Reduce Problem Gambling With respect to their opinions on the strength of evidence
supporting a modification’s effectiveness, there was no item
1) Mean Effectiveness Scores for Each Key Informant Group
that the majority of Researchers felt had strong evidential
What follows is a presentation of the most and least effective support. The item that Researchers believed had the stron-
modifications as identified by each of the four Key Informant gest supporting evidence was mandatory registration and use
groups. However, for the Researchers and Specialists, we also of smart cards (33%). They felt that most other modifications
had either weak or moderate supporting evidence; however,
when combining the moderate and strong response options,
xvi Placement of items into clusters is thematically, not statistically,
determined. As such, it is possible to group items into other thematic
arrangements.
Thus, when determining whether two means are different, one can look
xvii The mean is essentially an estimate of central tendency. Its 95% confi- to see if their confidence intervals overlap. If they do, it is probable that
dence interval indicates the range within which one can be 95% confident the means are no different, since they can assume the same values. If they
that the true mean falls. For example, a mean of 2.7 with a CI:1.8 – 3.6 do not overlap, one can conclude with some degree of certainty that they
would indicate that the true mean falls somewhere between 1.8 and 3.6. are indeed different.

39
Electronic Gaming Machines and Problem Gambling

TABLE 10. Most Effective EGM Modifications and Perceived Evidence Strength (Researchers)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
EGM Modification N N
Score Rank
Weak Moderate Strong
(SE)
% % %
Eliminating electronic fund transfers at the
3.77 (.36) 1 13 61.5 38.5 7.7 13
EGMs i.e., direct debit

Removing bill acceptors from EGMs 3.50 (.36) 2 12 33.3 50.0 16.7 12

Removing large bill acceptors from EGMs

3.46 (.33) 3.5 13 38.5 46.2 15.4 13
(e.g., 20 or 50 denominations)
Requiring mandatory registration and use of
3.46 (.40) 3.5 13 58.3 8.0 33.3 12
smart card to begin play
Requiring players to set pre-determined
3.38 (.33) 5 13 50.0 33.3 16.7 12
spending limits
Increasing time between the outcome of one
3.31 (.29) 6 13 53.8 46.2 0.0 13
bet and the next bet (i.e., slowing play)
Requiring players to set a pre-determined
3.15 (.30) 7.5 13 61.5 38.5 0.0 13
time limit
Providing running cash totals of amount
3.15 (.41) 7.5 13 41.7 41.7 16.7 12
spent on screen
Providing an option to set personal pre-
3.00 (.25) 9.5 13 50.0 50.0 0.0 12
determined spending limits
Providing an option to set personal pre-
3.00 (.25) 9.5 13 61.5 38.5 0.0 13
determined time limits

several modifications emerged as having a relatively reason-
able evidence base. Specifically, 65% of Researchers indicated
that there was reasonable evidence to support completely
removing bill acceptors or removing large denomination bill
acceptors from EGMs, and 58.4% indicated that there was rea-
sonable evidence to support providing EGMs with on-screen
running cash expenditure totals. Conversely, approximately
60% of Researchers indicated that there was only weak evi-
dence available to support eliminating electronic fund trans-
fers, requiring players to set pre-determined time limits, and
providing players with an option to set pre-determined time
limits. For the Researchers’ opinions on the least effective
EGM modifications, along with their perceived strength of
evidence, please see Table 11 (at right).
As the table shows, the Researchers’ lowest mean effectiveness
scores were given to the following modifications: increasing
house advantage (M = 1.38), decreasing house advantage (M =
1.77), increasing minimum bet size (M = 1.54), and providing
a problem gambling Helpline number and message on the back
of printed payout tickets (M = 1.77). As well, while the fol-
lowing modifications did not receive the lowest mean effec-
tiveness scores, several modifications pertaining to providing
problem/responsible gambling messaging on or through the
machines placed within the bottom quartile. In particular,
providing responsible gambling messages at the beginning of
play (M = 1.85), during play (M = 1.92) and through a player
initiated button (M = 1.92) were perceived to have minimal
effectiveness.
Consistent with their views on the least important contribu-
tors to problem gambling, removing certain types of games (M
= 1.85) and decreasing game variety (M = 1.85) were seen as
being relatively ineffective modifications. Lastly, payouts in
cash instead of tickets and payouts in cash instead of tokens also
received low scores (M = 1.92 and M = 1.85, respectively).
Not surprisingly, those EGM modifications that Researchers
considered to be least effective were also the same modifica-
tions that Researchers believed had weaker evidential sup-
port. In fact, there were only two modifications that were

40
 Electronic Gaming Machines and Problem Gambling

TABLE 11. Least Effective EGM Modifications and Perceived Evidence Strength (Researchers)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
EGM Modification N N
Score Rank
(SE) Weak Moderate Strong
% % %
Increasing house advantage (i.e., average
1.38 (.18) 46 13 69.2 23.1 7.7 13
amount taken per bet by gaming operator)

Increasing minimum bet size 1.54 (.14) 45 13 69.2 30.8 0.0 13

Providing Helpline number and message on

1.77 (.17) 43.5 13 54.5 27.3 18.2 11
the back of printed payout ticket
Decreasing house advantage (i.e., average
1.77 (.38) 43.5 13 76.9 23.1 0.0 13
amount taken per bet by gaming operator)
Providing general information about
1.85 (.19) 40.0 13 66.7 8.3 25.0 12
responsible gambling on welcome screen

Paying out in cash instead of tokens 1.85 (.37) 40.5 13 69.2 30.8 0.0 13

Removing some types of games from EGMs

1.85 (.22) 40.5 13 75.0 25.0 0.0 12
altogether (e.g., poker, video slots, keno)

Decreasing game variety on a machine 1.85 (.22) 40.5 13 84.6 15.4 0.0 13

Add countdown clock showing time limit

1.92 (.27) 36.5 13 50.0 41.7 0.0 12
remaining
Displaying responsible gambling messages
1.92 (.18) 36.5 13 50.0 25.0 25.0 12
during play
Adding responsible gaming button leading
1.92 (.18) 36.5 13 58.3 33.3 8.3 12
to gambling information screens

Paying out in cash instead of tickets 1.92 (.40) 36.5 13 69.2 30.8 0.0 13

rated low on effectiveness for which 25% of Researchers
claimed strong support. These two modifications were pro-
viding general information about responsible gambling on the
welcome screen, and displaying responsible gambling messages
during play.
Specialists’ Opinions. Specialists were also asked to assess the
46 EGM modifications. Results revealed that their mean ef-
fectiveness scores ranged from 4.00 to 1.33. Table 12 on the
following page shows the modifications that the Specialists
believed to be the most effective, and their opinions about the
strength of the evidence supporting these modifications.
As can be seen in the table, among the items perceived to
be most effective, three modifications appear to stand out
among the rest: mandatory registration/use of smart card (M
= 4.00), eliminating electronic fund transfers at EGMs (M =
3.89), and pre-determined spending limit requirements (M =
3.63). In terms of the other types of spending restrictions,
the removal of bill acceptors (M = 3.22), the removal of high
denomination bill acceptors (M = 3.11), and the mandatory
(M = 3.13) and optional (M = 3.00) setting of pre-determined
time limits were also rated very highly by the Specialists. The
remaining items included in the top quartile were providing
on-screen running cash expenditure totals (M = 3.13) and re-
moving stop buttons (M = 3.00).
In terms of the strength of evidence supporting the most ef-
fective modifications, the highest proportion of Specialists
indicated that there was strong evidence for mandatory
registration and use of smart cards (25%), eliminating elec-
tronic fund transfers at EGMs (22.2%), and removing large
bill denomination acceptors from EGMs (22.2%). Overall,
the Specialists were considerably more optimistic than the

41
Electronic Gaming Machines and Problem Gambling

TABLE 12. Most Effective EGM Modifications and Perceived Evidence Strength (Specialists)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
EGM Modification N N
Score Rank
(SE) Weak Moderate Strong
% % %
Requiring mandatory registration and use of
4.00 (.38) 1 8 37.5 37.5 25.0 8
smart card to begin play
Eliminating electronic fund transfers at the
3.89 (.35) 2 9 33.3 44.4 22.2 9
EGMs i.e., direct debit
Requiring players to set pre-determined
3.63 (.32) 3 8 37.5 50.0 12.5 8
spending limits
Removing bill acceptors from EGMs 3.22 (.43) 4 9 0.0 88.9 11.1 9
Providing running cash totals of amount
3.13 (.35) 5.5 8 25.0 62.5 12.5 8
spent on screen
Requiring players to set a pre-determined
3.13 (.30) 5.5 8 37.5 50.0 12.5 8
time limit
Removing large bill acceptors from EGMs
3.11 (.42) 7 9 11.1 66.7 22.2 9
(e.g., 20 or 50 denominations)
Providing an option to set personal pre-
3.00 (.42) 8.5 8 37.5 50.0 12.5 8
determined spending limits
Removing player controlled stop button 3.00 (.42) 8.5 8 25.0 62.5 12.5 8

TABLE 13. Least Effective EGM Modifications and Perceived Evidence Strength (Specialists)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
EGM Modification N N
Score Rank
(SE) Weak Moderate Strong
% % %
Paying out in cash instead of tickets 1.33 (.24) 45.5 9 75.0 25.0 0.0 8

Increasing minimum bet size 1.33 (.24) 45.5 9 75.0 12.5 12.5 8

Paying out in cash instead of tokens 1.38 (.26) 44 8 75.0 25.0 0.0 8
Removing some types of games from EGMs
1.44 (.24) 42.5 9 88.9 11.1 0.0 9
altogether (e.g., poker, video slots, keno)
Decreasing game variety on a machine 1.44 (.18) 42.5 9 100.0 0.0 0.0 9
Increasing the chances of a win occurring
1.50 (.38) 41 8 62.5 37.5 0.0 8
(e.g., 8% to 30%)
Toning down lights and colours 1.56 (.24) 39.5 9 100.0 0.0 0.0 9
Decreasing house advantage (i.e., average
1.57 (.43) 39.5 7 85.7 14.3 0.0 7
amount taken per bet by gaming operator)
Adding countdown clock showing time limit
1.63 (.26) 37.5 8 75.0 25.0 0.0 8
remaining
Increasing house advantage (i.e., average
1.63 (.50) 37.5 8 75.0 25.0 0.0 8
amount taken per bet by gaming operator)
Displaying simultaneous (as opposed to
1.71 (.18) 36 7 71.4 28.6 0.0 7
sequential) presentation of reel outcomes

42
 Electronic Gaming Machines and Problem Gambling

Researchers were about the strength of evidence supporting TABLE 14. Most Effective EGM Modifications (Counsellors)
the proposed EGM modifications, as a significant majority
indicated that there was at least a moderate amount of evi- Mean
dence to support the modifications believed to be most ef- Effectiveness Item
EGM Modification Score
N
fective. The Specialists were in unanimous (i.e., 100%) agree- Rank
(SE)
ment that there was moderate to strong evidence supporting
the removal of bill acceptors from EGMs. Requiring mandatory
registration and use of smart 4.20 (.58) 1 5
Just below table 12, Table 13 shows the modifications that card to begin play
the Specialists believed to be the least effective based on Requiring players to set pre-
3.60 (.87) 2.5 5
their mean effectiveness scores and their opinion about the determined spending limits
strength of evidence supporting these modifications. Providing an option to set
personal pre-determined 3.60 (.68) 2.5 5
As the table shows, modifications perceived to be least effec- spending limits
tive for reducing problem gambling risk included cash pay-
Enforcing play stoppage, break
outs instead of tickets (M = 1.33) or tokens (M = 1.38) and or interruption
3.40 (.81) 5 5
increasing the minimum bet size (M = 1.33). Specialists also
Providing running cash totals of
did not seem to think that removing some types of games from amount spent on screen
3.40 (.98) 5 5
EGMs (M = 1.44) or decreasing game variety (M = 1.44) would
Eliminating electronic fund
be effective in reducing problem gambling. Other items rated transfers at the EGMs (i.e., direct 3.40 (.81) 5 5
as being relatively ineffective included those related to in- debit)
creasing and decreasing house advantage (M = 1.63 and M =
Displaying total time of play on
1.57, respectively), and increasing the chances of a win occur- screen
3.20 (.92) 7.5 5

ring (M = 1.50). The rest of the items falling into the bottom
quartile included toning down lights and colours (M = 1.56), Displaying time of day on screen 3.20 (.92) 7.5 5

adding countdown clocks to EGMs (M = 1.63), and displaying

simultaneous presentation of reel outcomes (M = 1.71).

In terms of evidence strength, more than three quarters of
the Specialists believed that the supporting evidence was
weak for 9 out of 11 least effective modifications, and 100%
believed that there was weak evidence to support decreasing
game variety and toning down lights and colours.
Counsellors’ Opinions. Counsellors were asked to assess the
effectiveness of 40 EGM modifications to reduce problem
gambling risk. Their mean effectiveness scores ranged widely
from 4.20 to 1.20. Table 14 presents the modifications that
Counsellors perceived to be most effective.
Counsellors also indicated effective modifications to be play
stoppages, breaks or interruptions (M = 3.40), and providing
on EGM screens running cash expenditure totals (M = 3.40),
time of play totals (M = 3.20), and time of day (M = 3.20).
While not scoring as highly as it did for Researchers and
Specialists, eliminating electronic fund transfers at EGMs was
rated as a relatively effective modification by Counsellors (M
= 3.40). Table 15 on the following page shows findings from
the other end of the spectrum; that is, those modifications
which Counsellors thought to be least effective.

As evidenced in the table, Counsellors believed the most ef-

fective EGM modification to be requiring mandatory registra-
tion/use of smart cards to begin play (M = 4.20), which was
the only item with a mean score higher than 4.0. This modifi-
cation was followed by requiring players to set pre-determined
spending limits, and providing an option to set pre-determined
spending limits, which both received mean effectiveness
scores of 3.60.

43
Electronic Gaming Machines and Problem Gambling

As Table 15 shows, Counsellors believed that increasing play- TABLE 15. Least Effective EGM Modifications (Counsellors)
ers’ chances of winning (M = 1.20), decreasing their chances
of winning (M = 1.80), and reducing house advantage (M = Mean
1.60) were among the least effective EGM modifications. EGM Modification
Effectiveness Item
N
Score Rank
Moreover, they did not feel that cash payouts instead of tokens (SE)
(M = 1.40) or tickets (M = 1.60) would be particularly effec-
Increasing the chances of a win
tive. Other items with low mean effectiveness scores included occurring (e.g., 8% to 30%)
1.20 (.20) 40 5
increasing the time elapsed between initial bet and outcome (M
Paying out in cash instead of
= 1.60), raising minimum bet size (M = 1.60), reducing sound tokens
1.40 (.25) 39 5

effect volume (M = 2.00), and decreasing game variety on ma- Increasing time elapsed
chines (M = 2.00). between initial bet and
1.60 (.25) 36.5 5
outcome (e.g., 2.5 to 5 sec. reel
Problem Gamblers’ Opinions. In keeping with the Counsellors, spin)
Problem Gamblers assessed 40 EGM modifications. Their Paying out in cash instead of
1.60 (.40) 36.5 5
tickets
mean effectiveness scores also varied widely, ranging be-
tween 4.00 and 1.25. Table 16 (opposite page) presents those Increasing minimum bet size 1.60 (.40) 36.5 5
modifications that Problem Gamblers perceived to be most
Decreasing house advantage
effective. (i.e., average amount taken per 1.60 (.40) 36.5 5
bet by gaming operator)
As indicated in the table, eliminating electronic fund transfers
(M = 4.00) and mandatory registration/use of smart cards (M Decreasing the chances of a win
1.80 (.37) 34 5
occurring (e.g., 25% to 5%)
= 3.73) had the highest mean effectiveness scores. Moreover,
Reducing volume of sound
for the Problem Gamblers, delaying immediate access to large effects (e.g., music and ringing)
2.00 (.45) 32.5 5
wins was perceived to be among the most effective modifica- Decreasing game variety on a
tions (M = 3.50), unlike for the other Key Informant groups. 2.00 (.55) 32.5 5
machine
However, Problem Gamblers were similar to the other Key
Informant groups in the sense that they also believed that
controls on money as opposed to time expenditures would
be more effective in reducing problem gambling. That is, = 1.73)--as well as decreasing (M = 1.83) or increasing (M =
while optional and mandatory capacities to set pre-deter- 1.92) house advantage, also received low effectiveness scores.
mined spending limits made the top quartile (M = 3.25 and Other items with low mean effectiveness scores included
M = 3.09, respectively), such time-based modifications did providing Helpline number and message on the back of payout
not. Problem Gamblers also felt that removing bill acceptors tickets (M = 1.55), adding a responsible gaming button to gam-
from EGMs (M = 3.08), as well as providing continuous on- bling information screens (M = 1.91), and removing certain
screen running cash totals (M = 3.17) and displaying machine types of games on EGMs (M = 2.00).
activity in cash value instead of credits (M = 3.08), were ef- 2) Comparisons Between Key Informant Groups
fective. Other items receiving high mean effectiveness scores
included enforcing play stoppages, breaks, or interruptions (M Based on the quartile rankings of the mean effectiveness
= 3.42) and eliminating bonus rounds (M = 3.08). The EGM scores for each Key Informant group, it appears that the Key
modifications that the Problem Gamblers thought were least Informants agreed on several modifications as being the most
effective for reducing problem gambling risk are shown in and least effective for reducing problem gambling risk.
Table 17.
Top Quartile: While there were no EGM modifications that
The table shows that Problem Gamblers felt that increasing received the exact same ranking by all Key Informant groups,
minimum bet size (M = 1.25) was the least effective modifi- there was some consensus in terms of their general quartile
cation. They also thought that paying out in cash instead of placement. That is, five items were ranked in the top quartile
tickets or tokens would be relatively ineffective, as each item of mean effectiveness scores for each group, suggesting some
received a mean score of 1.67. Manipulations to the chances agreement between the groups regarding the modifications
of winning--either wins overall (M = 1.67) or small wins (M

44
 Electronic Gaming Machines and Problem Gambling

TABLE 16. Most Effective EGM Modifications (Problem TABLE 17. Least Effective EGM Modifications (Problem
Gamblers) Gamblers)

Mean Mean
Effectiveness Item Effectiveness Item
EGM Modification Score
N EGM Modification N
Rank Score Rank
(SE) (SE)
Eliminating electronic fund
transfers at the EGMs e.g., direct 4.00 (.41) 1 11 Increasing minimum bet size 1.25 (.13) 40 12
debit
Providing Helpline number and
Requiring mandatory message on the back of printed 1.55 (.21) 39 12
registration/use of smart card to 3.73 (.41) 2 11 payout ticket
begin play
Paying out in cash instead of
Delaying immediate access to 1.67 (.26) 37 11
tokens
large wins (i.e., paying out large 3.50 (.42) 3 12
wins in the form of cheques) Paying out in cash instead of
1.67 (.26) 37 12
tickets
Enforcing play stoppage, break
3.42 (.36) 4 12 Increasing the chances of a win
or interruption 1.67 (.28) 37 11
occurring (e.g., 8% to 30%)
Providing an option to set Decreasing the chances of small
personal pre-determined 3.25 (.37) 5 12 1.73 (.27) 35 12
wins occurring
spending limits
Decreasing house advantage
Providing running cash totals of (i.e., average amount taken per 1.83 (.30) 34 12
3.17 (.44) 6 12
amount spent on screen bet by gaming operator)
Requiring players to set pre- Adding responsible gaming
3.09 (.37) 7 11
determined spending limits button leading to gambling 1.91 (.39) 33 12
Displaying machine activity in information screens
3.08 (.29) 9 12
cash value instead of credits
Increasing house advantage (i.e.,
Removing bill acceptors from average amount taken per bet 1.92 (.26) 32 11
3.08 (.38) 9 12
EGMs by gaming operator)

Eliminating bonus rounds (e.g., Removing some types of games

further play on a different game 3.08 (.36) 9 12 from EGMs altogether (e.g., 2.00 (.28) 31 12
with different features) poker, video slots, keno)

45
Electronic Gaming Machines and Problem Gambling

TABLE 18. Quartile Ranking (1-4) of Select EGM Modifications by Key Informant Group

Quartile Ranking by Key Informant Group

EGM Modification Problem
Researchers Specialists Counsellors
Gamblers

Removing bill acceptors from EGMs 1 1 2 1

Eliminating bonus rounds (e.g., further play

2 2 2 1
on a different game with different features)
Displaying machine activity in cash value
2 2 2 1
instead of credits
Delaying immediate access to large wins (i.e.,
2 3 2 1
paying out large wins in the form of cheques)

that would be most effective in reducing problem gambling. 3) Thematic Analysis

All Key Informant groups generally believed that the most ef-
fective modifications were mandatory registration/smart card
use, eliminating direct electronic fund transfers at EGMs, re-
quirement or option for players to set predetermined spending
limits, and running on-screen cash expenditure totals.
Bottom Quartile: The EGM modifications in the bottom
quartile that were agreed upon by all four Key Informant
groups included decreasing house advantage, paying out in
cash instead of tickets, paying out in cash instead of tokens,
and increasing minimum bet size. Some notable modifica-
tions were also found between the Key Informant groups.
These are reported in Table 18, which shows the quartile
ranking (i.e., 1-4) of each modification.
As indicated in the table, Researchers, Specialists, and
Problem Gamblers all ranked removing bill acceptors from
EGMs as a highly effective modification (i.e., placed in the
top quartile), but this item was ranked lower, in the second
quartile, by Counsellors. Problem Gamblers also appeared
to believe that several modifications would be more effec-
tive than did the Researchers, Specialists, and Counsellors.
Specifically, displaying machine activity in cash value instead
of credits, delaying immediate access to large wins (i.e., pay-
ing out large wins in the form of cheques), and eliminating
bonus rounds, all placed in the first quartile for the Problem
Gamblers, but no higher than the second quartile for the oth-
er three Key Informant groups.
For this analysis, 36 EGM modification items were grouped
together into 11 clusters. Total thematic mean effectiveness
scores for each cluster, based on the entire Key Informant
sample (Researchers, Specialists, Counsellors, and Problem
Gamblers), are reported in Table 19 on the next page.
In looking at the table, one can see that no one thematic clus-
ter stands out completely from the rest; rather, a gradual in-
crease in thematic mean effectiveness scores can be observed.
However, modifications concerning monetary controls and
payment methods appear to be seen as more effective than
all other clusters, except for modifications concerning time
of play controls. The former set of modifications related to
controlling or limiting monetary expenditure includes items
that either directly enforce expenditure controls (e.g., elimi-
nating electronic fund transfers, removing bill acceptors) or
empower the player to exert self-control (e.g., requirement or
option to set pre-determined spending limits). Restrictions
on betting options, which may be seen as restrictions on
spending, however, were not viewed as effective for reduc-
ing problem gambling. At the other end of the spectrum,
the items believed to be least effective were modifications to
the experiential and emotional characteristics of the game.
In particular, items related to programmable features, such as
manipulating house advantage, chances of winning, sensory
effects, and game type, were not seen to be as effective. Other
modifications perceived to be less effective concerned chang-
es to payout methods, betting options, and problem/responsible
gambling messaging on the machine.

46
 Electronic Gaming Machines and Problem Gambling

TABLE 19. EGM Modification Thematic Mean Effectiveness Scores (Total Sample)

Thematic Mean
Cluster Item Effectiveness Score
(95% CI)

- Providing an option to set personal pre-determined spending limits

Controls on 3.42 (3.09-3.75)
- Requiring players to set a pre-determined spending limit
Money Spent - Requiring mandatory registration and use of smart card to begin play. N = 38

- Removing bill acceptors from EGMs

Payment - Removing large bill acceptors EGMs (e.g., $20 or $50 denominations) 3.28 (2.92-3.64)
Methods - Eliminating electronic fund transfers at the EGMs i.e., direct debit N = 39
- Displaying machine activity in cash value instead of credits

- Adding countdown clock showing time limit remaining

Controls on - Providing an option to set personal pre-determined time limits 2.80 (2.49-3.12)
Time Spent - Requiring players to set pre-determined time limits N = 38
- Enforcing play stoppage, break or interruption

- Increasing time elapsed between initial bet and outcome (e.g., 2.5 to 5 sec. reel spin) 2.58 (2.25-2.90)
Speed of Play - Remove player controlled stop button. N = 39
EGM-based - Hiding spinning reels from player’s view 2.53 (2.19-3.01)
Inducements - Eliminating advertising of big prizes on machines N = 39

- Providing running cash totals of amount spent on screen

- Displaying total time of play on screen
- Display time of day on screen 2.49 (1.83-2.39)
EGM-based RGFs - Displaying responsible gambling messages during play N = 38
- Providing general information on welcome screen
- Adding responsible gaming button leading to gambling information screens

- Reducing volume of sound effects (e.g., music and ringing)

2.22 (1.88-2.57)
Sensory Effects - Eliminating sound effects and music
- Toning down lights and colours
N = 39

- Removing some types of games from EGMs altogether (e.g., poker, keno)
Game 2.19 (1.91-2.46)
- Decreasing game variety on a machine
Availability - Eliminating bonus rounds (e.g., further play on a different game with different features) N = 39

- Reducing maximum bet size

2.18 (1.94-2.42)
Betting Options - Increasing minimum bet size
- Decreasing # of lines on which one can bet (e.g., 5 to 2 lines) N = 39

Problem
- Providing on-screen Helpline number and message 2.11 (1.83-2.39)
Gambling Help - Providing Helpline number and message on the back of printed payout ticket N = 37
Messaging

- Delaying immediate access to large wins (i.e., paying out large wins in the form of
cheques) 2.06 (1.75-2.37)
Payout Methods - Paying out in cash instead of tokens N = 39
- Paying out in cash instead of tickets

- Decreasing house advantage (i.e., average amount taken per bet by gaming operator)
- Increasing house advantage (i.e., average amount taken per bet by gaming operator)
Programmed 1.99 (1.76-2.21)
- Decreasing the chances of a win occurring (e.g., 25% to 5%)
Gaming Features - Increasing the chances of a win occurring (e.g., 8% to 30%) N = 39
- Decreasing the chances of small wins occurring

47
Electronic Gaming Machines and Problem Gambling

TABLE 20. Most Effective Venue Modifications and Perceived Evidence Strength (Researchers)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
Venue Modification N N
Score Rank Weak Moderate Strong
(SE) % % %
Prohibiting access to funds from credit cards
4.00 (.32) 1 13 53.8 23.1 23.1 13
at ATMs
Removing ATMs from the casino gaming
3.85 (.39) 2.5 13 33.3 41.7 25.0 12
floor

Prohibiting the cashing of cheques at venue 3.85 (.36) 2.5 13 61.5 23.1 15.4 13

Removing ATMs from the casino 3.62 (.37) 4 13 33.3 41.7 25.0 12

Prohibiting access to free alcohol 3.46 (.33) 5.5 13 46.2 38.5 15.4 13

Prohibiting the service of alcohol at the EGM 3.46 (.33) 5.5 13 46.2 30.8 23.1 13

No statistically significant differences were found using an
ANOVA to compare the four Key Informant groups’ indi-
vidual thematic means. This finding suggests that there was
a general consensus in views across all four Key Informant
groups regarding the effectiveness of modifications to EGMs
for mitigating problem gambling.
Taken together, it appears that rather than manipulating the
experiential qualities of the game, the Key Informants in this
study believed that putting limits on, or empowering players
to limit their own behaviour in the face of game attractive-
ness and excitement would be the most effective approaches
to reducing problem gambling. Thus, while speed of play was
seen as one of the more important contributors to problem
gambling, modifications to reduce speed were considered less
effective than modifications allowing a player to control the
potential effects of a faster game.
Venue Modifications to Reduce Problem Gambling
1) MeanEffectiveness Scores for Each Key Informant Group
What follows is a presentation of the most and least effective
venue modifications identified by the four Key Informant
groups. For the Researchers and Specialists only, we also re-
port on the opinions regarding the strength of the evidence
for the most and least effective modifications.
Researchers’ Opinions. Researchers were asked to assess the
effectiveness of 25 possible venue modifications that might
help reduce the risk of problem gambling. The mean effective-
ness scores for each of the 25 items ranged from 4.00 to 1.77.
The items deemed to be most effective by the Researchers, as
well as their opinions regarding the strength of the evidence
for these modifications, are presented in Table 20.
As can be seen from the table, the most effective modifica-
tions, as judged by the Researchers, included prohibiting ac-
cess to funds from credit cards at ATMs (M = 4.00), removing
ATMs from the casino gaming floor (M = 3.85) or the casino
completely (M = 3.62), and prohibiting the cashing of cheques
at venues (M = 3.85). Moreover, restrictions on alcohol also
made the top quartile.
In terms of the evidence to support venue modifications, ap-
proximately 67% of the Researchers reported that removing
ATMs from the casino gaming floor or the casino altogether had
moderate to strong evidential support. Other modifications
for which a significant proportion of Researchers believed
that there was strong supporting evidence included prohib-
iting access to funds from credit cards at ATMs (23.1%) and
prohibiting the service of alcohol at EGMs (23.1%). The item
with the weakest evidence was prohibiting cheque-cashing at
venues, with 61.5% of the Researchers indicating that they
believed the supporting evidence for this item was weak. The
modifications deemed to be least effective by the Researchers
and their opinions regarding the strength of the evidence for
these modifications are presented in Table 21.

48
 Electronic Gaming Machines and Problem Gambling

TABLE 21. Least Effective Venue Modifications and Perceived Evidence Strength (Researchers)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
Venue Modification N N
Score Rank Weak Moderate Strong
(SE) % % %

Displaying time of day in gaming room 1.77 (.17) 25 13 66.7 25.0 8.3 12

Providing non-gaming entertainment on

1.92 (.31) 24 13 83.3 16.7 0.0 12
site

Providing windows in the gaming room 2.08 (.27) 23 13 58.3 33.3 8.3 12

Placing EGMs in a highly visible location in

2.23 (.30) 22 13 54.5 45.5 0.0 11
the facility

Reducing general gambling marketing 2.33 (.26) 21 12 58.3 41.7 0.0 12

Eliminating general gambling marketing 2.42 (.26) 20 12 66.7 33.3 0.0 12

As shown in the table, Researchers indicated that in terms of

least effective venue modifications, they did not think that
displaying time of day in the gaming room (M = 1.77) or pro-
viding windows in the gaming room (M = 2.08) would be very
effective for reducing problem gambling risk. Nor did they
believe that reducing or eliminating general gambling market-
ing would be very effective (M = 2.33 and M = 2.42, respec-
tively). Other items that rated low with this group were pro-
viding non-gaming entertainment on site (M = 1.92) and plac-
ing EGMs in a highly visible location in the facility (M = 2.23).
In terms of evidence strength, Researchers not only viewed
the above modifications to be least effective, they also felt
that there was weak or moderate evidence to support these
modifications. More than half of the Researchers believed
that there was weak evidential support for these items.

49
Electronic Gaming Machines and Problem Gambling

TABLE 22. Most Effective Venue Modifications and Perceived Evidence Strength (Specialists)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
Venue Modification N N
Score Rank Weak Moderate Strong
(SE) % % %
Prohibiting access to funds from credit cards
3.75 (.37) 1 8 25.0 50.0 25.0 8
at ATMs
Removing ATMs from the casino gaming
3.50 (.42) 2.5 8 12.5 37.5 50.0 8
floor

Prohibiting the cashing of cheques at venue 3.50 (.50) 2.5 8 37.5 37.5 25.0 8

Removing ATMs from the casino 3.38 (.32) 4.5 8 12.5 50.0 37.5 8

Providing a self-exclusion program 3.38 (.50) 4.5 8 0.0 87.5 12.5 8

Specialists’ Opinions. Specialists were asked to assess the ef-
fectiveness of 25 possible venue modifications that might help
reduce the risk of problem gambling. The mean effectiveness
scores for each of the 25 items ranged from 3.75 to 1.63. The
modifications that the Specialists believed to be most effec-
tive and their opinions regarding the strength of the evidence
for these modifications are presented in Table 22.
the number of EGMs in a facility (M = 1.63) and capping the
number of EGMs in a facility (M = 1.63), followed by prohibit-
ing prize advertising at gaming venues (M = 1.75). Specialists
also believed that displaying time of day, providing windows in
gaming rooms, and eliminating or reducing general gambling
marketing would not be very effective, as all of these items
had mean effectiveness scores of 1.88.

As shown in the table, prohibiting access to funds from credit
cards at ATMs received the highest score by the Specialists (M
= 3.75), followed by removing ATMs from the casino gaming
floor, and prohibiting the cashing of cheques at venues--both of
which had mean effectiveness scores of 3.50. Removing ATMs
from the casino and providing a self-exclusion program also
made the top quartile.
In terms of evidential support, all of the least effective venue
modifications had 50% or more of the Specialists believing
that there was a concomitant weak evidential support base.
Interestingly, at least one person (12.5%) believed that there
was strong evidence for reducing or capping the number of
EGMs in a facility, even though these two modifications were
seen to be the least effective among the group as a whole.

In terms of evidence strength, Specialists appeared to be

more likely than Researchers to believe that there was strong
evidence to support what they believed were effective modi-
fications. With the exception of providing self-exclusion pro-
grams, more than one-quarter of the Specialists believed that
their top modifications had strong supporting evidence of
effectiveness. In the case of removing ATMs from the casino
gaming floor, 50% of the Specialists claimed that there was
strong evidence to support this modification. Conversely, the
items that the Specialists believed to be least effective and
their opinions regarding the strength of the evidence for these
modifications are presented in Table 23 on the next page.

As the table shows, the modifications that received the low-

est mean effectiveness scores by the Specialists were reducing

50
 Electronic Gaming Machines and Problem Gambling

TABLE 23. Least Effective Venue Modifications and Perceived Evidence Strength (Specialists)

Mean Perceived Strength of Evidence

Effectiveness Item for Effectiveness
Venue Modification N N
Score Rank Weak Moderate Strong
(SE) % % %

Reducing the number of EGMs in a facility 1.63 (.26) 24.5 8 62.5 25.0 12.5 8

Capping the number of EGMs in a facility 1.63 (.26) 24.5 8 50.0 37.5 12.5 8

Prohibiting prize advertising at gaming

1.75 (.31) 23 8 62.5 37.5 0.0 8
venue

Displaying time of day in gaming room 1.88 (.30) 20.5 8 50.0 50.0 0.0 8

Providing windows in the gaming room 1.88 (.40) 20.5 8 50.0 50.0 0.0 8

Eliminating general gambling marketing 1.88 (.23) 20.5 8 75.0 25.0 0.0 8

Reducing general gambling marketing 1.88 (.23) 20.5 8 75.0 25.0 0.0 8

51
Electronic Gaming Machines and Problem Gambling

TABLE 24. Most Effective Venue Modifications (Counsellors) TABLE 25. Least Effective Venue Modifications (Counsellors)

Mean Mean
Effectiveness Item Effectiveness Item
Venue Modification N Venue Modification Score
N
Score Rank Rank
(SE) (SE)

Providing a self-exclusion Providing non-gaming

4.50 (.29) 1 4 1.80 (.49) 20 5
program entertainment on site
Reducing the number of EGMs
Restricting EGMs to dedicated 2.60 (.81) 17 5
in a facility
gaming venues (casino, 4.20 (.37) 3 5
racetrack) Capping the number of EGMs
2.60 (.81) 17 5
in a facility
Restricting daily ATM
4.20 (.37) 3 5 Displaying time of day in
withdrawal amount 2.60 (.68) 17 5
gaming room
Prohibiting access to funds Providing windows in the
4.20 (.49) 3 5 2.60 (.75) 17 5
from credit cards at ATMs gaming room
Allowing only one ATM Prohibiting prize advertising at
4.00 (.45) 5 5 2.60 (.68) 17 5
withdrawal per venue visit gaming venue

Counsellors’ Opinions. Counsellors were asked to assess
the effectiveness of 20 venue modifications. Their mean ef-
fectiveness scores ranged from 4.50 to 1.80. The items that
the Counsellors believed to be most effective are presented
in Table 24.
As can be seen in the table, the most effective venue modifi-
cation according to the Counsellors was providing self-exclu-
sion programs (M = 4.50). They also believed that restricting
EGMs to dedicated gaming venues (M = 4.20), limiting access
to ATMs through daily withdrawal restrictions (M = 4.20), de-
nying funds from credit cards at ATMs (M = 4.20), and allow-
ing only one ATM withdrawal per venue visit (M = 4.00) would
also be effective. Notably, these items appeared to have been
rated much higher by the Counsellors than they were by the
Researchers and Specialists. The items that the Counsellors
believed to be least effective are presented in Table 25.
As indicated in the table, one venue modification was seen
to be particularly ineffective by Counsellors: providing non-
gaming entertainment on site (M = 1.80). The next lowest
items all had identical scores of 2.60. The items were: reduc-
ing the number of EGMs in a facility, capping the number of
EGMs in a facility, displaying time of day, providing windows
in gaming rooms, and prohibiting prize advertising at gaming
venues.
Problem Gamblers’ Opinions. Like the Counsellors, the
Problem Gamblers were asked to assess the effectiveness of
20 venue modifications. In this framework area, the Problem
Gamblers, too, appeared to be somewhat more optimistic
about the effectiveness of venue modifications than were
the Researchers and Specialists. That is, Problem Gamblers’
mean effectiveness scores were considerably higher than
those of the Researchers and Specialists, ranging from 4.42
to 1.91. They also focused more on ATM access. The items
that the Problem Gamblers believed to be most effective are
presented in Table 26 on the next page.
As shown in the table, like the Counsellors, the most effective
modifications for the Problem Gamblers had means greater
than 4.0. These included prohibiting cheque-cashing at venues
(M = 4.42), restricting daily ATM withdrawal amounts (M =
4.25), allowing only one ATM withdrawal per venue visit (M =
4.25), removing ATMs from the casino altogether (M = 4.18),
and prohibiting access to funds from credit cards at ATMs (M
= 4.09). The items that the Problem Gamblers believed to be
the least effective are presented in Table 27.
As evidenced in the table, Problem Gamblers found placing
EGMs in a highly visible location in the facility (M = 1.91) to
be the least effective venue modification. They also saw pro-
viding other non-gaming entertainment attractions on site (M
= 2.45) and restricting EGMs to dedicated gaming venues (M
= 2.45) as being less effective than the other modifications.
Lastly, providing self-exclusion programs (M = 2.67) and win-
dows in gaming rooms (M = 2.73) were also rated among the
least effective venue modifications.

52
 Electronic Gaming Machines and Problem Gambling

TABLE 26. Most Effective Venue Modifications (Problem TABLE 27. Least Effective Venue Modifications (Problem
Gamblers) Gamblers)

Mean Mean
Venue Modification Effectiveness Item Effectiveness Item
Score
N Venue Modification Score
N
Rank Rank
(SE) (SE)

Prohibiting the cashing of Placing EGMs in a highly

4.42 (.29) 1 12 1.91 (.39) 20 11
cheques at venue visible location in the facility
Restricting daily ATM Providing non-gaming
4.25 (.35) 2.5 12 2.45 (.41) 18.5 12
withdrawal amount entertainment on site
Allowing only one ATM Restricting EGMs to dedicated
4.25 (.35) 2.5 12
withdrawal per venue visit gaming venues (casino, 2.45 (.46) 18.5 11
Removing ATMs from the racetrack)
4.18 (.38) 4 11
casino Providing a self-exclusion
2.67 (.41) 17 11
Prohibiting access to funds program
4.09 (.44) 5 11
from credit cards at ATMs Providing windows in the
2.73 (.45) 16 11
gaming room

53
Electronic Gaming Machines and Problem Gambling

TABLE 28. Quartile Ranking (1-4) of Most Effective Venue Modifications by Key Informant Group

Quartile Ranking by Key Informant Group

Venue Modification
Researchers Specialists Counsellors Problem Gamblers

Prohibiting access to funds from credit cards

1 1 1 1
at ATMs

Prohibiting the cashing of cheques at venue 1 1 2 1

Removing ATMs from the casino 1 1 2 1

TABLE 29. Quartile Ranking (1-4) of Least Effective Venue Modifications by Key Informant Group

Quartile Ranking by Key Informant Group

Venue Modification
Researchers Specialists Counsellors Problem Gamblers

Providing windows in the gaming room 4 4 4 4

Providing non-gaming entertainment on site 4 3 4 4

Displaying time of day in gaming room 4 4 4 3

Place EGMs in a highly visible location in the

4 3 3 4
facility

2) Comparisons between Key Informant Groups
Table 28 shows the Key Informant groups’ quartile rankings
on EGM venue modifications that they deemed to be most
effective for reducing problem gambling risk.
As can be seen in the table, there was no consistency in rank-
ings across all Key Informant groups regarding the most effec-
tive venue modifications, the one exception being prohibiting
access to funds from credit cards at ATMs, which was ranked in
the first quartile by all. Two other modifications placed in the
top quartile for three of the four groups: Prohibiting cheque-
cashing at venues and removing ATMs from the casino were
ranked in the top quartile for the Researchers, Specialists,
and Problem Gamblers, but fell slightly to the second quartile
in the Counsellors’ rankings. Table 29 shows the EGM venue
modifications that were perceived to be the least effective in
reducing problem gambling risk by Key Informant group.
As shown in the table, there was somewhat more consistency
in the rankings observed, as four items placed either in, or on,
the cusp of the fourth quartile across all four Key Informant
groups. The modifications that were perceived to be least ef-
fective for reducing problem gambling risk were providing
windows or displaying time of day in gaming rooms, provid-
ing non-gaming entertainment on site, and placing EGMs in
a highly visible location in the facility. Table 30 on the next
page shows some notable similarities and differences be-
tween Key Informant group rankings that also emerged. For
Counsellors and Problem Gamblers, restricting daily ATM
withdrawal amounts and allowing only one ATM withdrawal
per venue visit ranked in the first quartile, whereas for the
Researchers and Specialists, these items ranked in the second
and third quartiles.
There was also interesting divided opinion on two other
modifications. First, the Specialists and Counsellors rated

54
 Electronic Gaming Machines and Problem Gambling

TABLE 30. Quartile Ranking (1-4) of Select Venue Modifications by Key Informant Group

Quartile Ranking by Key Informant Group

Venue Modification
Researchers Specialists Counsellors Problem Gamblers

Restricting daily ATM withdrawal amount 2 2 1 1

Allowing only one ATM withdrawal per venue

2 3 1 1
visit

Providing a self-exclusion program 3 1 1 4

Establishing patron information & education

4 2 2 2
initiatives in venue

55
Electronic Gaming Machines and Problem Gambling

TABLE 31. Venue Modification Thematic Mean Effectiveness Scores (Total Sample)

Thematic Mean
Cluster Item Importance Score
(95% CI)

Removing ATMs from the casino

Removing ATMs from the casino gaming floor
Restricting daily ATM withdrawal amount
Allowing only one ATM withdrawal per venue visit 3.61 (3.27-3.96)
Venue Conveniences
Prohibiting access to funds from credit cards at ATMs N = 38
Prohibiting the cashing of cheques at venue
Prohibiting access to free alcohol
Prohibiting the service of alcohol at the EGM

Venue-based Providing a self-exclusion program

2.95 (2.58-3.31)
Harm Minimization Establishing patron information & education initiatives in venue
N = 38
Strategies Conducting venue staff training

Reducing the number of EGMs in a facility

2.77 (2.37-3.16)
EGM Accessibility Capping the number of EGMs in a facility
N = 38
Prohibiting venues from being open 24 hours/day

Providing non-gaming entertainment on site. 2.59 (2.23-2.95)

Venue Type
Restricting EGMs to dedicated gaming venues N = 37

2.54 (2.07-3.01)
Advertising* Prohibit prize advertising in gaming venue.
N = 38

Displaying the time of day in the gaming room

2.27 (1.91-2.63)
Venue Design Providing windows in the gaming room
N = 37
Place EGMs in a highly visible location in the facility

* The advertising thematic cluster includes only one item because not all of the other advertisement-related questions were answered by all participants..

self-exclusion programs very highly (i.e., in the 1st quartile), Counsellors, and Problem Gamblers), are presented in Table
while the Researchers and Problem Gamblers rated it in the 31.
3rd and 4th quartiles, respectively. Second, although patron
As can be seen from the table, all clusters had similar the-
information and education initiatives in the venues received
matic mean effectiveness scores, based on confidence inter-
a relatively high 2nd quartile ranking by the Specialists,
val overlap. However, further examination within the venue
Counsellors, and Problem Gamblers, the Researchers ap-
conveniences cluster (i.e., ATM, cheque-cashing, and alcohol)
peared to be significantly less enthused about its effective-
indicates that this cluster would have resulted in a higher rat-
ness, as they ranked it in the bottom quartile.
ing than the other clusters had alcohol amenities not been
3) Thematic Analysis included. That is, using a cluster consisting of only restric-
tions on ATM and cheque-cashing conveniences would have a
For this analysis, the 20 venue modification items were
significantly higher thematic mean score (M = 3.77; CI: 3.40-
grouped into six clusters. Total thematic mean effectiveness
4.13) as compared to the rest of the clusters.
scores, based on the total sample (Researchers, Specialists,

56
 Electronic Gaming Machines and Problem Gambling

TABLE 32. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Researchers)

Perceived Strength of Evidence

Mean Effectiveness for Effectiveness
Community Accessibility Modification Score N
(SE) Weak Moderate Strong
% % %
Limiting concentration of EGMs in low income
3.69 (.31) 38.5 30.8 30.8 13
neighbourhoods
Restricting EGMs to destination style gaming facilities, away
3.62 (.29) 46.2 38.5 15.4 13
from residential populations

Centralizing EGMs to one or a few locations 3.54 (.27) 38.5 46.2 15.4 13

Reducing the number of EGM facilities in a community 3.46 (.29) 53.8 15.4 30.8 13

Capping the number of EGM facilities in a community 3.08 (.31) 41.7 25.0 33.3 12

Using ANOVA to compare the four Key Informant groups’
thematic mean effectiveness scores, no statistically signifi-
cant differences emerged, which suggests that there was a
general consensus in views across all four groups regarding
the general effectiveness of venue modifications for mitigat-
ing problem gambling.
In conclusion, similar to their opinions on EGM features,
Key Informants believed that modifications to venue features
that affect expenditure and access to funds would be the most
effective measures to reduce problem gambling risk out of
the possible venue modifications examined.
Community Accessibility Modifications to Reduce Problem
Gambling
1) Mean Effectiveness Scores for Each Key Informant Group
The last section of the questionnaire asked respondents to
rate the effectiveness of five initiatives related to restricting
community accessibility to EGMs. What follows is a presen-
tation of the most and least effective modifications as iden-
tified by each of the four Key Informant groups. Again, for
the Researchers and Specialists, we also report their opinions
regarding the strength of the evidence for the most and least
effective modifications.
As shown, Researchers thought that the most effective com-
munity accessibility modification was limiting concentration
of EGMs in low income neighbourhoods (M = 3.69) and re-
stricting EGMs to destination style gaming facilities away from
residential populations (M = 3.62). These were followed by
centralizing EGMs to one or a few locations (M = 3.54), and
reducing (M = 3.46) and capping (M = 3.08) the number of
EGM facilities in a community.
In terms of evidence strength, at least 30% of the Researchers
thought that there was strong support for three community
accessibility modifications: limiting concentration of EGMs in
low income neighbourhoods, reducing the number of EGM fa-
cilities in a community, and capping the number of EGM facili-
ties in a community. In terms of weak support, the majority of
Researchers thought that there was insufficient evidence for
reducing the number of EGM facilities in a community (53.8%)
and restricting EGMs to destination style gaming facilities
away from residential populations (46.2%). The weak support
for this latter modification is notable given that Researchers
considered it to be one of the more effective modifications.

Researchers’ Opinions. The range of mean effectiveness scores

for the Researchers was 3.69 to 3.08, although the first four
items had fairly close scores. Results are presented in Table
32.

57
Electronic Gaming Machines and Problem Gambling

TABLE 33. Community Accessibility Modification Effectiveness and Perceived Evidence Strength (Specialists)

Perceived Strength of Evidence

Mean Effectiveness for Effectiveness
Community Accessibility Modification Score N
(SE) Weak Moderate Strong
% % %
Restricting EGMs to destination style gaming facilities, away
3.00 (.46) 57.1 42.9 0.0 7
from residential populations

Reducing the number of EGM facilities in a community 2.63 (.32) 37.5 50.0 12.5 8

Centralizing EGMs to one or a few locations 2.63 (.46) 25.0 50.0 25.0 8

Limiting concentration of EGMs in low income

2.43 (.43) 25.0 75.0 0.0 8
neighbourhoods

Capping the number of EGM facilities in a community 2.38 (.38) 25.0 75.0 0.0 8

Specialists’ Opinions. Specialists also rated the effectiveness of
the five modifications to community accessibility. The mean
effectiveness scores for this Key Informant group ranged from
3.00 to 2.38. These scores were generally lower than those of
the Researchers. Results are presented in Table 33.
Counsellors’ Opinions. The Counsellors’ mean effectiveness
scores for the five community accessibility modifications
had the widest range (3.80 to 2.00) of all the Key Informant
groups. Results showing their mean effectiveness scores and
standard errors are reported in Table 34 on the next page.

As seen in the table, the item considered to be most effective
by Specialists was restricting EGMs to destination style gam-
ing facilities away from residential populations (M = 3.00).
Reducing the number of EGM facilities and centralizing EGMs
to one or a few locations had the next highest mean effective-
ness scores (M = 2.63 each, respectively). The Specialists
thought that the least effective modifications were limiting
concentration of EGMs in low income neighbourhoods (M =
2.43) and capping EGM facilities in a community (M = 2.38).
As the table shows, the most effective modification accord-
ing to the Counsellors was centralizing EGMs to one or a
few locations (M = 3.80). The next most effective modifica-
tions were reducing and capping the number of EGM facilities
in a community, which both had a mean score of 3.00. The
Counsellors felt that limiting concentration of EGMs in low
income neighbourhoods (M = 2.20) and restricting EGMs to
destination style gaming facilities away from residential popu-
lations (M = 2.00) would be the least effective modifications.

In terms of the strength of evidence for these modifications,
Specialists appeared to be more pessimistic than Researchers.
In fact, none of the Specialists thought that there was strong
evidence for three modifications—restricting EGMs to desti-
nation style gaming facilities, away from residential popula-
tions; limiting concentration of EGMs in low income neigh-
bourhoods; and capping the number of EGM facilities in a
community—even though the first of these modifications was
considered by Specialists to be most effective. Nonetheless,
with the exception of restricting EGMs to destination gaming
facilities, at least half of the Specialists believed that there was
a moderate degree of evidence supporting the effectiveness of
the modifications.
Problem Gamblers’ Opinions. Problem Gamblers were asked
to assess the effectiveness of the five modifications to EGM
community accessibility. Their mean effectiveness scores had
a tight range, from 3.75 to 3.33. The results are presented in
Table 35.
As can be seen, the most effective modifications according to
Problem Gamblers were capping the number of EGM facilities
in a community (M = 3.75) and reducing the number of EGM
facilities in a community (M = 3.73). The least effective modi-
fication was centralizing EGMs to one or a few locations (M =
3.33). However, because the scores were so close, it is likely
that the Problem Gamblers considered these modifications
to be similarly effective in reducing problem gambling risk.

58
 Electronic Gaming Machines and Problem Gambling

TABLE 34. Community Accessibility Modification TABLE 35. Community Accessibility Modification
Effectiveness (Counsellors) Effectiveness (Problem Gamblers)

Mean Mean
Community Accessibility Effectiveness Community Accessibility Effectiveness
Score
N Score
N
Modification Modification
(SE) (SE)

Centralizing EGMs to one or a Capping the number of EGM

3.80 (.58) 5 3.75 (.37) 12
few locations facilities in a community
Reducing the number of EGM Reducing the number of EGM
3.00 (.84) 5 3.73 (.45) 11
facilities in a community facilities in a community
Capping the number of EGM Limiting concentration of EGMs
3.00 (.84) 5 3.58 (.43) 12
facilities in a community in low income neighbourhoods
Limiting concentration of EGMs Restricting EGMs to destination
2.20 (.74) 5
in low income neighbourhoods style gaming facilities, away 3.50 (.42) 12
from residential populations
Restricting EGMs to destination
style gaming facilities, away 2.00 (.55) 5 Centralizing EGMs to one or a
from residential populations 3.33 (.45) 12
few locations

TABLE 36. Item Ranking of Community Accessibility Modifications by Key Informant Group

Item Ranking by Key Informant Group

Community Accessibility Modification
Problem
Researchers Specialists Counsellors
Gamblers
Limiting concentration of EGMs in low income
1 4 4 3
neighbourhoods
Restricting EGMs to destination style gaming facilities, away
2 1 5 4
from residential populations

Centralizing EGMs to one or a few locations 3 2.5 1 5

Reducing the number of EGM facilities in a community 4 2.5 2.5 2

Capping the number of EGM facilities in a community 5 5 2.5 1

2) Comparisons Between Key Informant Groups
The item rankings of community accessibility modifications
for each Key Informant group are reported in Table 36.
As indicated in the table, no one community accessibility
modification emerged as the consensus choice for most ef-
fective modification. In fact, all four Key Informant groups
had a different number one ranked modification. Capping
the number of EGM facilities in a community was gener-
ally rated among the most effective modifications by the
Counsellors (2.5) and Problem gamblers (1), but last for
both the Researchers and Specialists (5). Conversely, the
Researchers and Specialists tended to believe that restricting
EGMs to destination style gaming facilities away from residen-
tial populations was one of the more effective items (ranking
of 2 and 1, respectively), while the Counsellors and Problem
Gamblers ranked it in the bottom half of the items (5 and 4,
respectively).
Despite these contrasts, it should be remembered that the
modifications for Researchers and Problem Gamblers had
very close mean effectiveness scores, which suggests that
the items were perceived rather similarly in terms of effec-

59
Electronic Gaming Machines and Problem Gambling

tiveness. Thus, in general, all groups thought that reducing

the number of EGM facilities and centralizing EGMs to one-
or a few locations may be a good strategy. These items were
ranked first and second for the Specialists and Counsellors,
and, given that there was little difference between the top and
bottom mean scores for Researchers and Problem Gamblers,
respectively, we may surmise that the bottom and top items
were seen to be close in terms of effectiveness.

60

3 FOCUS GROUPS WITH
PROBLEM GAMBLERS
METHODOLOGY
Two focus groups with EGM Problem Gamblers were con-
ducted for this study, both by Dr. Jamie Wiebe of Factz
Research. One focus group was held in Regina, Saskatchewan
(N = 4); the other in Ajax, Ontario (N = 8). Participants were
recruited via a flyer that was shown to them by the counsellor
who ran their group therapy sessions. Of the 12 participants,
7 were female, 5 were male. Most were between 40 and 50
years of age (Mean = 52; Range = 37-75).
During the focus groups, participants were first asked about
their history of gambling and problem gambling. They were
then asked to give their opinions on the three EGM frame-
work areas (i.e., EGM features, venue features, community
accessibility features), and the modifications in these areas
they thought would reduce EGM-related problem gambling
risk. (For more detail on what was asked in the focus groups,
please see Appendix 5.). Each focus group lasted approxi-
mately 1.5 hours. In exchange for their time, participants
were given $50 worth of gift certificates to a local grocery
store. The results of the focus groups are presented below.
Note that for the sake of brevity, only the findings relevant to
the present report are provided.
RESULTS
History of Gambling and Problem Gambling
In general, participants were first introduced to EGMs by
chance, through friends or family, out of curiosity, or because
the EGM venue was accessible. Participants reported gam-
bling on EGMs for approximately one to seven years before
they felt that they had developed a problem. Most reported
difficulties with slot machines only; two reported difficulties
Electronic Gaming Machines and Problem Gambling
with both slot machines and VLTs. Only a few participants
were currently gambling; most stopped because of financial
consequences or feelings of guilt, shame, or remorse.
EGM Features that Contribute to Problem Gambling
All participants felt that there were specific features associated
with EGMs that contributed to problems. Commonly men-
tioned were features that increase losses, such as fast speed of
play and number of betting lines. Others talked about features
that increase the sense of control over a game’s outcome, such
as bonus rounds. Some mentioned that intermittent wins in-
crease the belief that wins are inevitable; similarly, some said
that new machines make them believe that an EGM is more
likely to pay out soon. Several said that the hope of winning
a large jackpot contributed to problems. Others said that the
sounds and graphics of the machines produce an adrenaline
rush.
All participants felt that EGMs create more problems than
other forms of gambling. In this regard, as stated above,
many mentioned speed of play as an important factor, in that
money is lost very quickly. Others said that EGM jackpots are
relatively large, compared, for instance, to games like black-
jack. Some talked about how the colors and movements on
the screen of EGMs create excitement. Others said that bonus
rounds create instant gratification that you do not get from
other forms of gambling. A few mentioned the random nature
of EGM games and feeling that a win is around the corner. As
one participant noted, “You keep thinking that you are going
to win. If credit goes down, you just feed the machine.” One
participant felt that EGMs were different because there is no
personal element. “If there was personal interaction, I would
take it more personally that you are taking my money and
would walk away, but it’s a machine and there is no emotional
attachment.”
Venue Features that Contribute to Problem Gambling
Participants were asked whether there were features specific
to the EGM gaming venue that they felt contributed to prob-
lems. A few talked about the excitement and exhilaration cre-
ated from the venue’s sounds and lights. The most common
feature identified was accessibility to cash, through ATMs and
lines of credit.
Many participants noted the features of EGM venues that
they believed did not affect problem gambling. One of these
was access to alcohol. As one participant stated, “People that
61
Electronic Gaming Machines and Problem Gambling
get drunk at casinos are not gamblers, they are there for fun.”
Another venue feature that some participants believed did
not contribute to problems was the number of machines at
a venue—that people with gambling problems will line up
for machines regardless, particularly if the machines have not
paid out recently. Other participants, however, felt that fewer
machines might prevent problems from developing in the
first place, with one participant stating, “You don’t become a
problem gambler if you can’t get on a machine.”
When asked what initially drew them to the EGM venue, a
few participants talked about the venue’s social aspect and
novelty; that it was a new place to experience with friends
and family. Many described the excitement created from all
of the sounds, sights and smells: “The casino was new, a new
experience. It was exciting, the big talk of the town. I felt like
a high roller—here we are, just like Vegas. I wanted to be part
of the excitement, in the now, in the know, not wanting to
miss anything.” A couple of participants said that they ex-
perienced large wins the first few times they played slot ma-
chines at a venue; one participant described the wins as “The
moment of reckoning: I felt invincible…heck of a lot easier
sitting in front of a slot machine than working.” Others men-
tioned the anonymity as a drawing factor: “Nobody knew me.
I was allowed to be someone different…as opposed to who I
was at home, under pressure, fulfilling the roles.” One partici-
pant talked about loneliness and hating to come home to an
empty house; the venue was a safe place to go to and, having
saved all her life, she felt that she deserved to spend money
on herself.
Community Accessibility Features that Contribute to
Problem Gambling
All participants felt strongly that increased community accessi-
bility to EGMs contributed to gambling problems. A few said
that they had stopped gambling and moved to an area that
did not have machines, but then they started gambling again
when machines were brought into their neighbourhood.
EGM Modifications to Reduce Problem Gambling
Participants were asked what modifications to EGMs they
thought would help reduce problems. This produced a va-
riety of responses. Many said that reducing the speed of play,
betting lines, and maximum bets would help. One participant
suggested having just three reels on a machine: “It is too over-
stimulating with all of the lines. It would be boring with just
62
3 reels.” Another participant suggested limiting the number
of lines: “People feel that if they max bet, you will win more
money, especially if you are down. Limiting max bets might
not stop a problem gambler, but will take him a lot longer to
lose his house.” Many participants recommended having pre-
determined spending limits. Some felt that money should be
displayed on an EGM in dollars and cents, rather than cred-
its. Two participants felt that pop-up messages showing the
amount of time and money spent would help: “If I knew I
was feeding the machine for X hours and putting X dollars
in, I would be walking away.” A few, however, felt that this
information would not be useful, as one participant stated, “I
knew how long I had been there and how much money I had
spent. I didn’t care.” One participant felt that having infor-
mation on the odds of winning and signs of a problem would
be beneficial. Most, however, felt that warnings wouldn’t help
“until you know what it is like to be addicted.”
Venue Modifications to Reduce Problem Gambling
When asked what modifications they would make to EGM
venues to reduce problem gambling, many participants
suggested eliminating access to money (e.g., through ATMs,
cheque-cashing, lines of credit, etc.). Some felt that having
to leave the venue to obtain additional cash would give them
time to think about what they were doing. One participant,
however, felt that while removing ATMs from gaming venues
would be a slight inconvenience, they would still leave the
venue to access more money if they wanted it. Another com-
mon suggestion noted by participants was mandatory smart
cards that had maximum limits on the amount of money
that could be spent; participants said that the cards should
apply to all EGM venues. One participant recommended a
“no re-entry rule,” whereby if a gambler leaves the venue, he
or she cannot not re-enter it for a specified period of time.
Responding to this suggestion, another participant felt that
a no-entry rule would indeed have helped him, as he would
normally leave his bank cards in the car, enter the venue with
his cash limit, but then go back to his car for more money to
try to win back the money he had lost. Some felt that infor-
mation in the venue regarding signs of a problem and where
to find help would be helpful. Others disagreed, saying that
they would only call a helpline once they hit rock bottom,
and that “a gambler in action is focused on the machine, not
messages.”
 Electronic Gaming Machines and Problem Gambling

Community Accessibility Modifications to Reduce

Problem Gambling
In terms of community accessibility modifications, most
participants believed that EGMs should not be located in
residential areas, but that a person should have to drive to a
destination location to play them. As one participant stated,
“It’s not the absolute number of machines, but the location.
They should not be in residential areas. Once they came in
my neighbourhood, I knew I was in trouble.” A couple of par-
ticipants, however, felt that removing EGMs from residen-
tial areas would help prevent problems, but would not help
those with problems already: “Problem gamblers will gamble
anywhere.”

The Importance of Prevention

Overall, most participants felt that it is far easier to prevent
gambling problems from developing than to reach those who
have problems already. Recommendations for prevention
included the same suggestions identified as helping those
with problems; namely, mandatory smart cards with spend-
ing limits, eliminating access to money in the gaming venue,
displaying dollars rather than credits on the machines, and
removing EGMs from residential neighbourhoods. Another
common suggestion related to advertising; specifically, that
there should be less promotional advertising and more public
awareness advertising of the risks associated with gambling.
A number of participants also identified the importance of
targeting youth, and educating them on the risks of gambling
before they reach legal gambling age.

63
Electronic Gaming Machines and Problem Gambling
4 DISCUSSION
The present study reviewed the literature and synthesized
the opinions of a cross-section of Key Informants via ques-
tionnaires and focus groups. A number of findings emerged
which identified potential EGM-related contributors to prob-
lem gambling, as well as possible modifications to reduce
problem gambling risk. Major findings for each of the three
framework areas (i.e., EGM features, venue features, commu-
nity accessibility features) are reviewed below, followed by a
discussion of the study’s limitations.
FINDINGS
EGM Features
Contributors
With respect to EGM features, the Researchers and Specialists
thought that fast speed of play, direct electronic fund transfers,
the appearance of near-misses, and machine bill acceptors
were the most important contributors to problem gambling.
The importance of these items was supported by a thematic
analysis which showed that features that speed up play (e.g.,
that shorten the time interval between bet and outcome), in-
volve faster payment methods (e.g., bill acceptors), and give
the appearance of near-misses were rated much higher in im-
portance than other EGM characteristics. On the other hand,
the type and number of games offered on a machine, house
advantage, and lower winning rates were thought to be the
least significant contributors to problem gambling.
Modifications
Since Key Informants identified direct electronic fund trans-
fers and bill acceptors at machines as the most important
EGM contributors to problem gambling, it is not surprising
that the elimination of these features were ranked among the
most effective EGM modifications to reduce problem gam-
bling risk. The general consensus among Key Informants
regarding direct electronic fund transfers is particularly in-
64
teresting, given that no empirical research on this topic was
found in the literature review. In this regard, the finding is
not only relevant for policy makers, but contributes uniquely
to the current knowledge base about EGM-based harm mini-
mization strategies.
The finding that Key Informants identified removing bill ac-
ceptors as an effective method to reduce problem gambling
risk is supported by studies from the literature review show-
ing that a significant number of problem gamblers report of-
ten or always using bill acceptors as compared to non-prob-
lem gamblers.38, 39
Key Informants also highly endorsed registration and use
of smart cards, mandatory (preferred) or optional setting of
pre-determined spending limits, and providing on-screen
running cash totals of amount spent. There is little doubt that
the Key Informants were very optimistic about the poten-
tial of smart card technology to address problem gambling.
However, this endorsement needs to be assessed within some
limitations of the present study. Since no definition of “smart
card” technology was provided to Key Informants, it is not
possible to know what specific aspects of the technology they
were endorsing. “Smart card” is to some degree a global term,
which can incorporate a variety of features such as card-based
access controls, player-controlled self-limits, provider-con-
trolled self-limits, and self-exclusion, among other features.
Recall that of the two studies reviewed related to smart cards,
the one from Nova Scotia reported strong support for man-
datory registration and use of the cards, while the study from
Australia suggested that rather than help manage spending,
card-based technologies might actually facilitate it. 67, 68
From a broader perspective, the thematic analysis indicated
that Key Informants believed that modifications to limit ac-
cess to funds and payment method restrictions were most
likely to reduce problem gambling risk. However, although
the Researchers rated speed of play and the appearance of
near-misses as important contributors to problem gambling,
they did not rate reducing speed of play or the appearance of
near-misses as effective as imposing restrictions on spending.
This suggests that the Key Informants believed less in chang-
ing participants’ experience of the game and more in impos-
ing spending controls or empowering individuals to exercise
their own self-control in their spending. The relative lack of
interest among Key Informants in decreasing speed of play is
consistent with studies reported in the literature review that
suggested speed restriction reduced gamblers’ enjoyment

and satisfaction 22, 24-25 and was not an important harm mini-
mization strategy.26
Items related to machine-based game outcomes (e.g., hit
rates), sensory stimulation (e.g., sound effects), and type of
games offered (e.g., poker) were ranked by Key Informants
among the bottom half of the areas examined. Here again,
the Key Informants appeared to be more interested in mea-
sures that protect players from the potential risks of EGMs,
rather than in measures that might dampen their emotional
experience of playing on the machines and make them less
exciting.
While the Key Informants generally seemed to be interested
in features that control or limit player spending, it should
be noted that there were some exceptions. They gave rela-
tively low ratings to restrictions on betting options, but high-
er ratings to reducing speed of play and the appearance of
near-misses.
Venue Features
Contributors
According to the Researchers and Specialists in this study,
the most important EGM venue contributors to problem
gambling were ATMs located on the gaming floor or close
to machines, 24-hour EGM access, and marketing targeted
directly to the EGM player. Overall, easy access to money,
via ATM machines specifically, was seen as a very important
contributor to problem gambling. Conversely, some of the
venue features normally associated with isolation and dis-
sociation, such as the absence of clocks and windows, were
judged to be relatively unimportant. Offering EGMs in a
dedicated gaming venue such as a racetrack or casino was
also reported to be among the least significant contributors
to problem gambling.
Modifications
Although there was relatively less consensus among the four
Key Informant groups about the most effective venue modi-
fications to reduce problem gambling risk, prohibiting access
to funds from debit and credit cards, disallowing cheque-
cashing at venues, and removing ATMs from the casino al-
together were generally seen to be among the more effective
measures. This fits somewhat with the findings in the litera-
ture that support placing bans on credit card cash advances
and removing ATMs from the gaming floor.45, 39 It is clear that
in addition to removing ATMs, there was considerable sup-
Electronic Gaming Machines and Problem Gambling
port among Key Informants for introducing other forms of
ATM restrictions. These included tighter controls over with-
drawal limits which, again, was supported by research in the
literature. 39
Consistent with their views on the least important venue
contributors to problem gambling, Key Informants were in
high agreement that the least effective venue modifications
were placing EGMs in highly visible locations in the gaming
facility and providing windows and clocks in gaming rooms.
Providing non-gaming entertainment on site was also ranked
very low, suggesting that such a diversion would be ineffec-
tive for displacing problem gambling behaviour.
Community Accessibility Features
Contributors
Overall, the community accessibility features that Key
Informants believed would be relatively more important
contributors to problem gambling were those related to EGM
distribution; that is, wide dispersion of EGMs throughout
the community, large number of community venues housing
EGMs, and convenient locations of EGM venues (e.g., close
proximity to high residential populations). Researchers gen-
erally rated all of the community accessibility features higher
than did the Specialists.
Modifications
In terms of relative rankings, there was considerable varia-
tion among the four Key Informant groups. There was no one
item that all groups agreed was the most effective community
accessibility modification. However, it appears that the Key
Informants as a group would agree that reducing the number
of EGM facilities and centralizing EGMs to one or a few lo-
cations would be the most effective community accessibility
modification. Consistent with their views on the most signif-
icant contributors to problem gambling, the Researchers and
Specialists supported the centralization of EGMs in fewer fa-
cilities, away from residential areas, as the best way to reduce
problem gambling risk.
LIMITATIONS
There are several possible limitations to the present study that
should be acknowledged. First, the questionnaire and focus
groups gathered the opinions of Key Informants regarding
the importance of various contributors to problem gambling,
65
Electronic Gaming Machines and Problem Gambling
and the potential effectiveness of a number of modifications
to reduce problem gambling risk; it did not empirically test
these contributors or modifications directly.
Second, although the questionnaire used in the study was de-
veloped based on a thorough review of the literature and was
subsequently reviewed and revised by experts in the field, it
did not undergo any psychometric testing. As a result, the
reliability and validity of the questionnaire is unknown.
Moreover, while many questionnaire items were very clearly
defined (e.g., hit rates) others were less so (e.g., smart cards),
limiting the definitiveness of the conclusions that could be
drawn. Further, although the range of topics covered in the
questionnaire was quite extensive, it asked respondents to
provide their opinions on items in isolation, or independent
from each other. In practical application, however, these
items interact in a potentially infinite number of ways. By fo-
cusing on items in isolation, the questionnaire may limit the
generalizability of its findings.
66
Third, although every effort was made in the present study
to conduct an exhaustive review of the literature and gather
the opinions of a cross-section of Key Informants, the study
does not purport to be either definitive or representative. For
example, given the relatively small size and specialized nature
of the sector, the pool of Key Informants from which we had
to select our participants was relatively small, limiting the
number of individuals we could ask to participate. Of those
who were asked to participate, the overall response rate was
60.9%.
Finally, although two focus groups with EGM problem gam-
blers were conducted for this study, it is generally ideal to
conduct at least four to six in order to increase the likeli-
hood that saturation will be reached (i.e., that all novel ideas
and opinions will be generated by participants).113 Given the
consistency in findings obtained from the focus groups and
questionnaires filled out by all Key Informants in this study,
however, we have increased confidence in the integrity of our
data.

5 SUMMARY &
CONCLUSIONS
On behalf of the Saskatchewan Liquor and Gaming Authority
(SLGA), the Responsible Gambling Council (RGC) conduct-
ed a study on the relationship between EGMs and problem
gambling, and the modifications most likely to reduce the risk
of problem gambling among EGM users. The study reviewed
the available literature in these areas and brought together
the opinions of a cross-section of 42 Key Informants, includ-
ing Researchers in the field, Gaming and Problem Gambling
Specialists (i.e., health and problem gambling professionals,
regulators, operators), problem gambling Counsellors, and
EGM Problem Gamblers themselves.
Overall, the study showed that the current knowledge base, as
found in the literature review, regarding ways to reduce EGM-
related problem gambling is limited and incomplete. While
most in the field would agree that a strong relationship exists
between problem gambling and EGMs, the nature and extent
of this relationship is far from clear. Even less clear, particu-
larly for policy makers, is the question of how best to address
the relationship. While experimental studies examining the
mechanics of EGMs provide insight into machine dynamics
and player behaviour, they often tell us little about what can
be done in actual practice. This study gathered the opinion
of those who have helped to define the field and knowledge
base, in order to elicit information that is concrete and prac-
tical, and, ultimately, to provide assistance to policy-makers
in responding to the dilemmas posed by EGMs. However, it
should be noted that in order for this study to have real util-
ity, findings must be interpreted within a jurisdiction’s socio-
political, geographic, and economic context.xviii
The framework for this report, derived from the literature, fo-
cused on three main areas: EGM features, venue features, and
xviii For example, if a given jurisdiction has many community EGM
sites which cannot be readily centralized, other modifications, such as
reducing EGM site operation hours, might be warranted (at least in the
interim). This might be the case even if the latter modification does not
receive the strongest endorsement by Key Informants.
Electronic Gaming Machines and Problem Gambling
community accessibility features. Key Informant opinion was
collected through in-depth questionnaires and focus groups.
Researchers, Specialists, and Problem Gamblers were asked
for their opinions about the importance of various features
in contributing to problem gambling; all Key Informants
were asked for their views on the potential effectiveness of
select modifications to reduce the risk of problem gambling.
Questionnaire data were analyzed by ranking mean item
scores and conducting thematic analyses to determine if cer-
tain clusters of items were seen to be more important and/
or effective than others. Focus group data were assessed for
common themes. Results showed a remarkable level of agree-
ment among all Key Informant groups regarding the most
important contributors to problem gambling. There was less
agreement regarding the modifications that would reduce
problem gambling, although consensus was observed across
a number of them.
In a broad sense, Key Informants believed that certain
features intrinsic to EGMs contribute to the risk of prob-
lem gambling, such as speed of play and the appearance of
near-misses. Other intrinsic features, such as the number
of games that can be played on the machines, their payout
schedules, and the house advantage were seen as less im-
portant. When considering potential modifications, all Key
Informant groups supported changes that did not involve the
core operation of EGMs or the player’s experience of them.
The changes that were supported include the management of
money, pre-commitment, the use of smart card technology,
and restricting community access. Each of these is discussed
in more detail below.
The Management of Money
Throughout the study, the management of money emerged as
an important issue related to problem gambling. Many of the
highest ranked items and the thematic analysis focused on
the on-screen display of money (i.e., the provision of running
cash totals), access to money (through ATMs, cheque-cash-
ing, and direct electronic fund transfers), and the setting of
spending limits. At the least intrusive level, Key Informants
endorsed displaying dollars as opposed to credits on EGMs.
Interestingly, the issue of payouts in tickets versus tokens or
cash did not emerge as one of the most important items.
One of the most consistent opinions about effective modi-
fications across the Key Informant groups related to the re-
striction of player access to funds; that is, restricting direct
electronic fund transfers that involve any use of credit or deb-
it cards—either on EGMs or on portable machines that can
67
Electronic Gaming Machines and Problem Gambling
be used right at the EGM or gaming table. Although there is
currently little research available on ATM access as it relates
to problem gambling, there was a clear consensus among the
Key Informants that removing ATMs from the gaming floor
or from the premises completely would help reduce the risk
of players developing gambling problems.
While removing bill acceptors altogether or removing large
denomination bill acceptors from EGMs were rated highly
as effective modifications by the Researchers and Specialists,
these items did not receive as much endorsement from the
Counsellors or Problem Gamblers. These modifications may
be of decreasing concern as TITO (Ticket-in Ticket-out) sys-
tems become a larger part of the EGM landscape.
Pre-commitment
The concept of pre-commitment was pioneered by Mark
Dickerson in Australia and has been adopted in a variety
of ways in recent years. The core of pre-commitment is the
creation of pre-set spending or time limits prior to the ac-
tual gambling session. There was considerable Key Informant
support in the present study for the general creation of pre-
commitment initiatives for gamblers. However, while there
was support for all initiatives, the Key Informants tended
to see money limits as more effective than time limits. They
also tended to prefer mandatory requirements over optional
ones.
The Use of Smart Card Technology
The use of smart cards was one of the most highly endorsed
modifications to reduce problem gambling risk found in this
study. As discussed earlier, however, the questionnaire did
not provide a definition of smart card technology, nor did it
provide an extensive opportunity for Key Informants to elab-
orate on the type of smart card system that they had in mind.
Nevertheless, at a very minimum, the Key Informants seemed
to understand that it involved a universal registration system
and a requirement to have a card for machine access. Given
that smart card systems can vary significantly on a number
of characteristics (e.g., time and money spending limits, op-
tional/mandatory features, type and level of enforcement),
Key Informants would, undoubtedly, have varying views on
the breadth and comprehensiveness of such systems.
Restricting Community Access
While there was no consensus amongst the study’s Key
Informants as to what might constitute the most effective
68
community accessibility modification, restricting the number
of EGM venues within a given community and concentrating
machines in centralized locations seems to be the preferred
options for reducing the risk of problem gambling. The Key
Informants rated the effectiveness of all the community ac-
cessibility modifications relatively high, though, making it
difficult to clearly identify a single modification as being no-
tably more effective than the others.
Other Notable Observations
Strength of Evidence
Both the Researchers and the Specialists were asked to assess
the strength of evidence for each modification item within
the three framework areas. While the Specialists were more
optimistic than the Researchers were regarding such evi-
dence, overall, there appeared to be low levels of confidence
in the strength of the current evidence base. Moreover, there
was little connection between Key Informant perception of
evidence strength and the actual strength of evidence uncov-
ered in the literature review.
EGM-based Inducements
There are many features that can be programmed into EGMs
to promote further play, such as prize advertisements and free
games. While these features were mentioned many times in
the focus groups and questionnaire as contributors to prob-
lem gambling, they did not get enough attention as modifica-
tions to be considered top priorities. However, the frequency
of their mention suggests that many Key Informants believed
that this area warrants further consideration and study.
Responsible Gambling Messages
Rankings related to responsible gambling messages on ma-
chines or in venues appeared in the mid-range of the themat-
ic rankings. This would suggest that there is reasonable sup-
port for such messages, but little confidence that they would
have a large influence on problem gambling.
Conclusion
Taken together, the literature and opinions from this study’s
Key Informants suggest a strong relationship between EGMs
and problem gambling; however, the nature of this relation-
ship is unclear. Many modifications to EGM features, venue
features, and community accessibility features were readily
endorsed by Key Informants. There is now a need for fur-
ther research to assess the impact and effectiveness of these
modifications in practical application that takes into account
jurisdictional social, political, economic, and geographical
dynamics.

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treatment-seeking substance abusers. Canadian
Journal of Psychiatry, 48(1), 40-44.
93. Cox, B. J., Kwong, J., Michaud, V., & Enns, M. W.
(2000). Problem and probable pathological gam-
bling: Considerations from a community survey.
Canadian Journal of Psychiatry, 45, 548-53.
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The Lewin Group & Christiansen/ Cummings
Associates. (1999). Gambling impact and beha-
viour study. Report to the National Gambling
Impact Study Commission.
95. Ladouceur, R., Jacques, C., Ferland, F., & Giroux, I.
(1999). Prevalence of problem gambling: A re-
plication study 7 years later. Canadian Journal of
Psychiatry, 44,
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96. Ladouceur, R. (1991). The prevalence estimates of
pathological gambling in Quebec. Canadian
Journal of Psychiatry, 36, 732-734.
97. Ladouceur, R. (1996). The prevalence of pathological
gambling in Canada. Journal of Gambling Studies,
12(2), 129-142.
98. Cox, B. J., Yu, N., Afifi, T. O., & Ladouceur, R. (2005).
A national survey of gambling problems in Ca-
nada. Canadian Journal of Psychiatry, 50(4), 213-
217.
99. Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (1997).
Estimating the prevalence of disordered gambling
behavior in the United States and Canada: A
Meta-analysis. Boston, Massachusetts: President
and Fellows of Harvard College.
100. Ladouceur, R., Jacques, C., Chevalier, S., Sévigny, S.,
& Hamel, D. (2005). Prevalence of pathological
gambling in Quebec in 2002. Canadian Journal of
Psychiatry, 50,
451–456.
101. Ministry of Public Safety and Solicitor General.
(2003). British Columbia problem gambling preva-
lence study. Victoria, BC: Author.
102. Brown, D., Patton, D., Dhaliwal, J., Pankratz, C., &
Broszeit, B. (2002). Gambling involvement and
problem gambling in Manitoba. Winnipeg, MB:
Addictions Foundation of Manitoba.
103. Hodgins, D. (2006, April). What is the impact of
gambling availability on gambling problems? Pa-
per presented at the 5th Annual Alberta Confer-
ence on Gaming Research, Banff, AB.
104. O’Neil, M., & Whetton, S. (2004). Inquiry into the
management of electronic gaming numbers. (Eco-
nomic Issues No. 9). The South Australian Centre
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105. Marshall, D., McMillen, J., Niemeyer, S., & Doran,
B. (2004). Gaming machine accessibility and use
in suburban Canberra: A detailed analysis of the
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mission. Canberra, Australia.
106. Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell,
M., & Parker, J. C. (2004). Risk factors for patho-
logical gambling. Addictive Behaviours, 29, 323-
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107. The South Australian Centre for Economic Studies.

(2005). Study of the impact of caps on electronic
gaming machines – Final report. Office of gaming
and racing. Melbourne, Australia.
108. Marshall, D. (2005). The gambling environment and
gambler behaviour: Evidence from Richmond-
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109. McMillen, J., & Doran, B. (2006). Problem gambling
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Gambling Studies, 6(1), 5-29.
110. Gilliland, J. A., & Ross, N. A. (2005). Opportunities
for video lottery terminal gambling in Montréal:
An environmental analysis. Canadian Journal of
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55-59.
111. Wheeler, B. W., Rigby, J. E., & Huriwari, T. (2006).
Pokies and poverty: Problem gambling risk fac-
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112. Hinch, T., & Walker, G. (2003). Casino patrons, travel
behaviour, place attachment, and motivations: A
study of Alberta residents. Prepared for the Al-
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113. Marshall, D., & Baker, R. G. (2001). Clubs, spades,
diamonds and disadvantage: the geography of
electronic gaming machines in Melbourne. Aus-
tralian Geographical Studies, 39(1), 17-33.
114. Wilson, D. H., Gilliland, J., Ross, N. A., Derevensky,
J., & Gupta, R. (2006). Video lottery terminal
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115. Ministry of Health. (2006). Problem gambling geog-
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117. Morgan, D. L. (1997). Focus groups as qualitative re-
search (2nd ed.). Thousand Oaks, CA: Sage.

74

APPENDIX 1:
KEY INFORMANTS
A total of 69 Key Informants from across Canada and
abroad were asked to participate in this study. They in-
cluded: 1) problem gambling Researchers, identified
through the published literature and/or personal referral;
2) gaming and problem gambling Specialists (i.e., health
and problem gambling professionals, regulators, opera-
tors,) identified through gambling governing bodies and/or
personal referral; 3) problem gambling Counsellors, iden-
tified through addiction agencies in Saskatchewan and
Ontario and/or personal referral; and 4) EGM Problem
Gamblers themselves, recruited through problem gambling
services in Saskatchewan and Ontario. The names of the
Key Informants asked to participate in the study are listed
below.xix
PROBLEM GAMBLING RESEARCHERS
Canadian
Pamela Collins, Project Co-coordinator, Dalhousie
Gambling Lab, Department of Psychology,
Dalhousie University.
Brian Cox, Professor, Departments of Psychiatry and
Psychology, University of Manitoba.
Shawn Currie, Researcher, Alberta Gaming Research
Institute.
Jeffrey Derevensky, Department of Educational and
Counselling Psychology, McGill University.
Harley Dickinson, Professor, Department of Sociology,
University of Saskatchewan.
Katharine Diskin, PhD Candidate, University of
xix In order to preserve anonymity and confidentiality, the names of the
Problem Gamblers who participated in this study are not reported here.
Electronic Gaming Machines and Problem Gambling
Calgary.
David Hodgins, Professor, Department of Psychology,
University of Calgary.
David Korn, Professor, Department of Public Health
Sciences, University of Toronto.
Robert Ladouceur, Professor, Department of
Psychology, Université Laval.
Tracy Schrans, Owner and Vice President, Focal
Research Consultants Ltd.
Garry Smith, Gambling Research Specialist, Alberta
Gaming Research Institute, Faculty of Extension,
University of Alberta.
Sherry Stewart, Professor, Department of Psychology,
Community Health and Epidemiology, Dalhousie
University.
Tony Toneatto, Research Scientist, Centre for Addiction
and Mental Health.
Nigel Turner, Research Scientist, Centre for Addiction
and Mental Health.
Jamie Wiebe, President, Factz Research.
Robert Williams, Professor, School of Health Sciences,
University of Lethbridge.
Harold Wynne, President, Wynne Resources.
American
Bo Bernhard, Assistant Professor of Sociology,
University of Nevada, Las Vegas.
Robert Breen, Associate Director, Rhode Island
Gambling Treatment Centre.
Mark Dixon, Associate Professor, Behavior Analysis and
Therapy program,
Rehabilitation Institute of Southern Illinois University.
Lia Nower, Assistant Professor of Social Welfare,
University of Missouri.
Rachel Volberg, President, Gemini Research Ltd.
Jeffrey Weatherly, Department Chair, Department of
Psychology, University of North Dakota.
Mark Zimmerman, Associate Professor, Department of
Psychiatry and Human Behavior, Brown University.
75
Electronic Gaming Machines and Problem Gambling

International Kyle Prettyshield, Program Manager, First Nations

Addiction Rehabilitation Foundation (Saskatchewan).
Alex Blaszczynski, Professor, School of Psychology,
University of Sydney. Robert Simpson, Chief Executive Officer, Ontario
Problem Gambling Research Centre.
Peter Collins, Professor and Director, Centre for the
Study of Gambling, University of Salford. Bill Ursel, Director, Problem Gambling Unit, Canadian
Mental Health Association.
Paul Delfabbro, Senior Lecturer, School of Psychology,
University of Adelaide.
American
Mark Dickerson, Professor, School of Psychology,
University of Western Sydney. Keith Whyte, Executive Director, National Council on
Problem Gambling.
Nicki Dowling, School of Psychology, Psychiatry and
Psychological Medicine, Monash University.
International
Mark Griffiths, Professor, Division of Psychology,
Nottingham Trent University.
Mark Henley, Manager, Advocacy and Communication,
Nerilee Hing, Associate Professor, School of Tourism Uniting Care Wesley Adelaide.
and Hospitality Management, Southern Cross
University.
Regulators
Charles Livingstone, Senior Research Fellow, Australian
Institute for Primary Care, LaTrobe University.
Canadian
Jan McMillan, Professor, Centre for Gambling
Research, Australian National University. Donna Klingspohn, Manager, British Columbia
Michael O’Neil, Director, The South Australian Centre Problem Gambling Program.
for Economic Studies. Elizabeth Stephenson, Director, Research &
Louise Sharpe, Senior Lecturer, Director of Clinical Communications, Manitoba Gaming Control
Research, School of Psychology, University of Sydney. Commission.

Michael Walker, Senior Lecturer, School of Psychology, Kent Verlik, Director, Social Responsibility, Ministry of
University of Sydney. Gaming (Alberta).

International
SPECIALISTS
Linda Woo, Executive Director, Licensing and Gaming
Services, Queensland Office of Gaming Regulation.
Health and Problem Gambling Professionals

Operators
Canadian

Steve Christensen, Program Consultant, Community International

Care Branch, Saskatchewan Health.
Rob d’Hondt, Manager and Senior Trainer/Consultant,
Sharon Jackson, Problem Gambling Program Manager,
d’Hondt Training & Consultancy, Hulst, The
Walter Thorpe Recovery Centre.
Netherlands.
Gerry Kolesar, Supervisor, Problem Gambling Services,
Addictions Foundation of Manitoba.

76
 Electronic Gaming Machines and Problem Gambling

PROBLEM GAMBLING COUNSELLORS

Saskatchewan

Cathy Dickson, Prince Albert Parkland Regional Health

Authority.
Don Ozga, Regional Health Authority, Regina
Qu’Appelle.
Barb Papp, Saskatoon Regional Health Authority.

Ontario

Evelyn Bakich, Sister Margaret Smith Centre.

Rachel Fraser, Addictions Assessment Services of
Ottawa-Carleton.
Janine Robinson, Centre for Addiction and Mental
Health Problem Gambling Service.
Lisa Root, Niagara Alcohol & Drug Assessment Service,
Gambling Support Services.
Randy Uyenaka, Pinewood Centre of Lakeridge Health.

77
Electronic Gaming Machines and Problem Gambling

APPENDIX 2:
KEY INFORMANT
QUESTIONNAIRE

The Responsible Gambling Council (RGC) would like to learn more about the relationship between EGMs and problem gam-
bling from experts such as you. To assist us in this endeavor, we have developed the following questionnaire, which we hope
you will complete. We expect it should take no longer than one hour and would be most appreciative if you could return it to
us no later than July 7, 2006.

Unless you indicate otherwise, your responses to this questionnaire will be kept confidential. That is, your answers will be saved
on a secure server, only members of the RGC research team and the Saskatchewan Liquor and Gaming Authority (SLGA) will
have access to them, and your name will not be associated with your responses in any published reports. However, if you are
open to us citing your ideas directly in our final report, please check the appropriate box at the end of the questionnaire. This
will ensure that if we do include any of your quotes, they will be properly credited to you. Please note that while your answers
will not be associated with your name unless you check this box, we will include in the final report the names of experts we
consulted with for the purpose of this study.

We may want to follow up with you at a later date to explore further some of your opinions and ideas expressed in the survey.
If you are open to potentially being re-contacted, please check the appropriate box at the end of the questionnaire.

If you would like to see and print the questionnaire in its entirety before you begin, please click here.

78
 Electronic Gaming Machines and Problem Gambling

SECTION A: CONTRIBUTORS TO PROBLEM GAMBLING

The following is a compilation of some of the key features of electronic gaming machines (EGMs i.e., slots and video lottery
terminals), venues, and accessibility factors said to contribute to problem gambling. In your opinion, using the 5-point scale
provided, please indicate the importance of each feature as a contributor to problem gambling.

Moderately
Important

Important

Important

Important

Important
Extremely
Not at all

Slightly
In your opinion, how important are the following factors as contributors to EGM-

Very
related problem gambling?

EGM Features
Fast speed of play (e.g., shorter time between initial bet and outcome) 1 2 3 4 5

Sound effects (i.e., music, buzzing and ringing) 1 2 3 4 5

Visual effects (i.e., lights, colours) 1 2 3 4 5

Bill acceptors 1 2 3 4 5

Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors) 1 2 3 4 5

Direct electronic fund transfers at machine (e.g., direct debit) 1 2 3 4 5

Display machine activity in credits instead of cash 1 2 3 4 5

Payout in tickets instead of cash 1 2 3 4 5

Payout in tokens instead of cash 1 2 3 4 5

Large denomination maximum betting amounts (e.g., $5, $10) 1 2 3 4 5

Small denomination minimum betting amounts (e.g., 5¢, 10 ¢) 1 2 3 4 5

Large denomination minimum betting amounts (e.g., $1, $5) 1 2 3 4 5

Large range between minimum and maximum betting amounts (e.g., 1¢ to $5) 1 2 3 4 5

Large number of lines to bet on in slots (e.g., 5 lines compared to 3 lines) 1 2 3 4 5

Prominent big prize advertising on machine 1 2 3 4 5

Frequent presentation of big prize symbols shown during play (e.g., reel placement) 1 2 3 4 5

Type of games available on one machine (e.g., poker, video slots, keno) 1 2 3 4 5

Multiple game possibilities on one machine (e.g., poker, video slots, keno) 1 2 3 4 5

Bonus round game features that reward players with further play on related game with different
1 2 3 4 5
features

Player controlled stop button 1 2 3 4 5

Display machine activity in credits instead of cash 1 2 3 4 5

Appearance of almost winning (i.e., near-miss) 1 2 3 4 5

Large mixture of small, medium, and large prize values, that increases the volatility of the game (i.e.
1 2 3 4 5
game is less predictable)

79
Electronic Gaming Machines and Problem Gambling

Moderately
Important

Important

Important

Important

Important
Extremely
Not at all

Slightly
In your opinion, how important are the following factors as contributors to EGM-

Very
related problem gambling?

EGM Features

Higher house advantage or edge (i.e., average amount per bet taken by gaming operator) 1 2 3 4 5

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 1 2 3 4 5

Offering winning outcomes more frequently through a higher “hit-rate” (i.e., higher chances of a win
1 2 3 4 5
occurring)
Offering winning outcomes less frequently through a lower “hit-rate” (i.e., lower chances of a win
1 2 3 4 5
occurring)
Offering small-win outcomes more frequently through a lower “hit-rate” (i.e., higher chances of a
1 2 3 4 5
small win occurring)

Wide variation in possible game outcomes (i.e., high outcome volatility) 1 2 3 4 5

EGM Venue Features

Large number of EGMs within venue 1 2 3 4 5

EGMs located in non-dedicated gaming venue (e.g., bar, hotel) 1 2 3 4 5

EGMs located in a dedicated gaming venue (e.g., EGM venue, racetrack) 1 2 3 4 5

Low visibility of the EGMs within the venue 1 2 3 4 5

No clocks in venue 1 2 3 4 5

No windows in venue 1 2 3 4 5

ATMs located on gaming floor or close to machines 1 2 3 4 5

ATMs located anywhere in the EGM venue 1 2 3 4 5

Frequent big prize advertising or promotion in the venue 1 2 3 4 5

Targeted player marketing for EGMs 1 2 3 4 5

General gambling marketing 1 2 3 4 5

Easy access to alcohol 1 2 3 4 5

24 hour access to EGMs in venue 1 2 3 4 5

Full access to EGMs for play in venue 1 2 3 4 5

80
 Electronic Gaming Machines and Problem Gambling

Very Important
Moderately
Important
important

important

important
Extremely
Not at all

Slightly
In your opinion, how important are the following factors as contributors to EGM-
related problem gambling?

Community Accessibility Features

Large number of community venues (bars, lounges, EGM venues, other) with EGMs 1 2 3 4 5

Wide dispersion of EGMs throughout community 1 2 3 4 5

Convenient location of EGMs sites (e.g., close proximity to high residential populations) 1 2 3 4 5

Large total number of EGMs in community 1 2 3 4 5

Large number of EGMs per capita in community 1 2 3 4 5

Overconcentration of EGMs in low income neighbourhoods 1 2 3 4 5

81
Electronic Gaming Machines and Problem Gambling

SECTION A: OPEN-ENDED QUESTIONS

Referring to Section A, please list the top three most important EGM features, EGM Venue features, and Community Accessi-
bility features that you think most likely contribute to problem gambling. For instance, if you think that sound effects are the
EGM feature that most likely contributes to problem gambling, indicate this as your first choice, and then please explain your
reasoning for your selection.

50) EGM Features

First

Second

Third

Please indicate any other EGM feature, not listed in Section A, that you think is an important contributor to problem gam-
bling. Please also explain your reasoning for specifying this additional feature.

51) EGM Venue Features

First

Second

Third

Please indicate any other EGM Venue feature, not listed in Section A, that you think is an important contributor to problem
gambling. Please also explain your reasoning for specifying this additional feature.

52) Community Accessibility Features

First

Second

Third

Please indicate any other Community Accessibility feature, not listed in Section A, that you think is an important contributor
to problem gambling. Please also explain your reasoning for specifying this additional feature.

82
 Electronic Gaming Machines and Problem Gambling

SECTION B: EGM/VENUE/ACCESSIBILITY MODIFICATIONS

It has been suggested that a number of modifications to EGMs, the venues that house them, and their overall accessibility in
the community may help reduce the risk of problem gambling. Using the 5-point scale provided, please indicate how effective
you think each modification would be in reducing this risk. Also, using the 3-point scale, please indicate your opinion of how
strong the evidence is to support the effectiveness of each modification in reducing this risk.

In your opinion, how strong

In your opinion, how effective would the is the evidence supporting
following modifications be in reducing the risk the effectiveness of each
EGM-related problem gambling? modification in reducing
problem gambling risk?

MODIFICATIONS

Extremely effective
Not at all effective

Slightly effective

Very effective
Moderately

Moderate
effective

Strong
Weak
EGM
Increasing time elapsed between
initial bet and outcome (e.g., 2.5 to 1 2 3 4 5 1 2 3
5 sec. reel spin)

Increasing time between the

outcome of one bet and the next 1 2 3 4 5 1 2 3
bet (i.e., slowing play)
Reducing volume of sound effects
1 2 3 4 5 1 2 3
(e.g., music and ringing)
Eliminating sound effects and
1 2 3 4 5 1 2 3
music

Toning down lights and colours 1 2 3 4 5 1 2 3

Removing bill acceptors from

1 2 3 4 5 1 2 3
EGMs
Removing large bill acceptors
from EGMs (e.g., 20 or 50 1 2 3 4 5 1 2 3
denominations)

Eliminating electronic fund

transfers at the EGMs i.e., direct 1 2 3 4 5 1 2 3
debit

Delaying immediate access to

large wins (i.e., paying out large 1 2 3 4 5 1 2 3
wins in the form of cheques)

Paying out in cash instead of

1 2 3 4 5 1 2 3
tokens

Paying out in cash instead of tickets 1 2 3 4 5 1 2 3

83
Electronic Gaming Machines and Problem Gambling

In your opinion, how strong

In your opinion, how effective would the is the evidence supporting
following modifications be in reducing the risk the effectiveness of each
EGM-related problem gambling? modification in reducing
problem gambling risk?

MODIFICATIONS

Extremely effective
Not at all effective

Slightly effective

Very effective
Moderately

Moderate
effective

Strong
Weak
EGM

Reducing maximum bet size 1 2 3 4 5 1 2 3

Increasing minimum bet size 1 2 3 4 5 1 2 3

Reducing range between

minimum and maximum bet sizes 1 2 3 4 5 1 2 3
(e.g., 5¢-$1 versus 5¢-25¢)

Decreasing # of lines on which one

1 2 3 4 5 1 2 3
can bet (e.g., 5 to 3 lines)

Eliminating advertising of big

1 2 3 4 5 1 2 3
prizes on machines

Eliminating frequent presentation

of big prize symbols shown during 1 2 3 4 5 1 2 3
play (e.g., reel placement)

Removing some types of games

from EGMs altogether (e.g., poker, 1 2 3 4 5 1 2 3
video slots, keno)
Decreasing game variety on a
1 2 3 4 5 1 2 3
machine
Eliminating bonus rounds (e.g.,
further play on a different game 1 2 3 4 5 1 2 3
with different features)
Removing player controlled stop
1 2 3 4 5 1 2 3
button
Showing only the relevant
1 2 3 4 5 1 2 3
outcome combinations
Hiding spinning reels from player’s
1 2 3 4 5 1 2 3
view
Displaying simultaneous
(as opposed to sequential) 1 2 3 4 5 1 2 3
presentation of reel outcomes

84
 Electronic Gaming Machines and Problem Gambling

In your opinion, how strong

In your opinion, how effective would the is the evidence supporting
following modifications be in reducing the risk the effectiveness of each
EGM-related problem gambling? modification in reducing
problem gambling risk?

MODIFICATIONS

Extremely effective
Not at all effective

Slightly effective

Very effective
Moderately

Moderate
effective

Strong
Weak
EGM
Decreasing house advantage (i.e.,
average amount taken per bet by 1 2 3 4 5 1 2 3
gaming operator)

Increasing house advantage (i.e.,

average amount taken per bet by 1 2 3 4 5 1 2 3
gaming operator)
Decreasing the chances of a win
1 2 3 4 5 1 2 3
occurring (e.g., 25% to 5%)
Increasing the chances of a win
1 2 3 4 5 1 2 3
occurring (e.g., 8% to 30%)
Decreasing the chances of small
1 2 3 4 5 1 2 3
wins occurring

Reducing game volatility 1 2 3 4 5 1 2 3

Displaying total time of play on

1 2 3 4 5 1 2 3
screen

Displaying time of day on screen 1 2 3 4 5 1 2 3

Providing an option to set personal

1 2 3 4 5 1 2 3
pre-determined time limits
Requiring players to set a pre-
1 2 3 4 5 1 2 3
determined time limit

Adding countdown clock showing

1 2 3 4 5 1 2 3
time limit remaining

Enforcing play stoppage, break or

1 2 3 4 5 1 2 3
interruption

Providing running cash totals of

1 2 3 4 5 1 2 3
amount spent on screen

Displaying machine activity in cash

1 2 3 4 5 1 2 3
value instead of credits

85
Electronic Gaming Machines and Problem Gambling

In your opinion, how strong

In your opinion, how effective would the is the evidence supporting
following modifications be in reducing the risk the effectiveness of each
EGM-related problem gambling? modification in reducing
problem gambling risk?

MODIFICATIONS

Extremely effective
Not at all effective

Slightly effective

Very effective
Moderately

Moderate
effective

Strong
Weak
EGM

Providing an option to set personal

1 2 3 4 5 1 2 3
pre-determined spending limits

Requiring players to set pre-

1 2 3 4 5 1 2 3
determined spending limits

Displaying responsible gambling

1 2 3 4 5 1 2 3
messages during play

Providing general information

about responsible gambling on 1 2 3 4 5 1 2 3
welcome screen

Providing on-screen Helpline

1 2 3 4 5 1 2 3
number and message

Providing Helpline number and

message on the back of printed 1 2 3 4 5 1 2 3
payout ticket

Adding responsible gaming

button leading to gambling 1 2 3 4 5 1 2 3
information screens

Requiring mandatory registration

and use of smart card to begin 1 2 3 4 5 1 2 3
play

86
 Electronic Gaming Machines and Problem Gambling

In your opinion, how

strong is the evidence
In your opinion, how effective would the
supporting the
following modifications be in reducing the risk
effectiveness of each
EGM-related problem gambling?
modification in reducing
problem gambling risk?

MODIFICATIONS

Moderately effective

Extremely effective
Not at all effective

Slightly effective

Very effective

Moderate

Strong
Weak
EGM VENUE
Reducing the number of EGMs in
1 2 3 4 5 1 2 3
a facility
Capping the number of EGMs in
1 2 3 4 5 1 2 3
a facility
Providing non-gaming
1 2 3 4 5 1 2 3
entertainment on site
Restricting EGMs to dedicated
gaming venues (EGM site, 1 2 3 4 5 1 2 3
racetrack)
Placing EGMs in a highly visible
1 2 3 4 5 1 2 3
location in the facility
Displaying time of day in gaming
1 2 3 4 5 1 2 3
room
Providing windows in the gaming
1 2 3 4 5 1 2 3
room

Removing ATMs from the EGM site 1 2 3 4 5 1 2 3

Removing ATMs from the EGM site

1 2 3 4 5 1 2 3
gaming floor
Restricting daily ATM withdrawal
1 2 3 4 5 1 2 3
amount
Allowing only one ATM withdrawal
1 2 3 4 5 1 2 3
per venue visit
Prohibiting access to funds from
1 2 3 4 5 1 2 3
credit cards at ATMs
Prohibiting the cashing of cheques
1 2 3 4 5 1 2 3
at venue
Prohibiting prize advertising at
1 2 3 4 5 1 2 3
gaming venue
Eliminating targeted player
1 2 3 4 5 1 2 3
marketing for EGMs
Reducing targeted player
1 2 3 4 5 1 2 3
marketing for EGMs

87
Electronic Gaming Machines and Problem Gambling

In your opinion, how

strong is the evidence
In your opinion, how effective would the
supporting the
following modifications be in reducing the risk
effectiveness of each
EGM-related problem gambling?
modification in reducing
problem gambling risk?

MODIFICATIONS

Moderately effective

Extremely effective
Not at all effective

Slightly effective

Very effective

Moderate

Strong
Weak
EGM VENUE
Eliminating general gambling
1 2 3 4 5 1 2 3
marketing
Reducing general gambling
1 2 3 4 5 1 2 3
marketing

Prohibiting access to free alcohol 1 2 3 4 5 1 2 3

Prohibiting the service of alcohol

1 2 3 4 5 1 2 3
at the EGM
Prohibiting venues from being
1 2 3 4 5 1 2 3
open 24 hours/day
Restricting EGM play-time hours
1 2 3 4 5 1 2 3
in venue
Providing a self- exclusion
1 2 3 4 5 1 2 3
program
Establishing patron information &
1 2 3 4 5 1 2 3
education initiatives in venue

Conducting venue staff training 1 2 3 4 5 1 2 3

COMMUNITY ACCESSIBILITY
Reducing the number of EGM
1 2 3 4 5 1 2 3
facilities in a community
Capping the number of EGM
1 2 3 4 5 1 2 3
facilities in a community
Centralizing EGMs to one or a few
1 2 3 4 5 1 2 3
locations
Restricting EGMs to destination
style gaming facilities, away from 1 2 3 4 5 1 2 3
residential populations
Limiting concentration of EGMs in
1 2 3 4 5 1 2 3
low income neighbourhoods

88
 Electronic Gaming Machines and Problem Gambling

SECTION B: OPEN-ENDED QUESTIONS

Please list the top three modifications to EGMs, Venues, and Community Accessibility that you think would most likely
reduce problem gambling risk. For example, if you think that reducing speed of play is the most important EGM feature to
change, please indicate this as your first choice and then please explain your reasoning.

129) EGM Features

First

Second

Third

Please indicate any other EGM feature modification, not listed in Section B, that you think would most likely reduce EGM-
related problem gambling risk. Please also explain your reasoning for specifying this additional feature modification.

130) Venue Features

First

Second

Third

Please indicate any other EGM venue modification, not listed in Section B, that you think would most likely reduce EGM-re-
lated problem gambling risk. Please also explain your reasoning for specifying this additional venue modification.

131) Community Accessibility Features

First

Second

Third

Please indicate any other EGM accessibility modification, not listed in Section B, that you think would most likely reduce
EGM-related problem gambling risk. Please also explain your reasoning for specifying this additional modification.

89
Electronic Gaming Machines and Problem Gambling

Venue Specific Harm Minimization Strategies

In the space provided below, please describe your thoughts regarding any improvements you might make to the self-exclusion
program, patron information and education initiatives, and staff training programs. For example, you may want to describe
why you do not think that the advertising of the self-exclusion program is effective and what you would suggest to make
changes.

132) Self-exclusion program

133) Patron information and education initiatives

134) Staff training

135) Please indicate any other harm minimization strategy that you think would most likely reduce EGM-related problem
gambling risk. Please also explain your reasoning for specifying this strategy.

136) Please indicate your general area of expertise

Health and Problem Gambling Specialist CDN INT

Problem Gambling Researcher CDN INT

Regulator CDN INT

Operator CDN INT

90

APPENDIX 3:
OPEN-ENDED RESPONSES
TO QUESTIONNAIRE
Key Informants who participated in this study (i.e., Re-
searchers, Specialists, Counsellors, and EGM Problem Gam-
blers) were asked to complete a comprehensive question-
naire regarding EGM-related problem gambling (Appendix
2). As part of the questionnaire, some Key Informants (i.e.,
Researchers and Specialists) were asked to answer supple-
mental, open-ended questions about the factors that could
either contribute to, or minimize, problem gambling. Topics
explored in these open-ended questions relevant to the pres-
ent report include:
• Additional features that might contribute to
problem gambling not already mentioned in
the questionnaire (i.e., EGM features, venue
features, community accessibility features),
and
• Additional modifications to the above fea-
tures that might reduce problem gambling
risk not already mentioned in the question-
naire.
The responses given by the Researchers (N = 13) and Spe-
cialists (N = 12) to the open-ended portion of the question-
naire are presented below.
Additional EGM Features That Contribute to
Problem Gambling
- Sound/visual effects tested on-site in venues, rather than
in laboratoriesRxx
- Continuous playR
- Linked jackpots can encourage a ‘feeding frenzy’ when
thought close to a payout levelR
xx R = Researchers; S = Specialists
Electronic Gaming Machines and Problem Gambling
- ‘Free spin’ features on Australian-style EGMs appear to be
strongly related to play patterns of problem gamblersR
- Features encouraging players to bet more, such as ‘buy’
features/bonuses, could lead players to increase bet size
-
especially if the option is presented during a gameS
Overall issue of game design, mapping, and display reels
needs to be evaluated closely by government regulatorsS
- Pop-up messages, the ability of players to set their own
time and money limits, machine setting time limits,
tracking spending/losses, easy access to on screen prob-
lem gambling/responsible choice messages, information
about cost per hourS
Additional Venue Features That Contribute to Problem
Gambling
- Gambling areas that can be accessed directly from car
parks and the street, as players can then access gambling
in secretS
- EGMs secluded in quiet corners of gaming establish-
ments limit interaction with others including staffS
- Venues with EGMs as a major facility, i.e., venues that
generate a high proportion of income from EGMs versus
other entertainment facilities and recreational optionsR
- Promotions that require the patron to wait a long time
in the venue before winners are announced encourages
longer gambling sessionsR
Additional Community Accessibility Features That
Contribute to Problem Gambling
- Over-concentration of EGM in low income neighbour-
hoods may be undesirable as this needs to be balanced
against the fact that low income earners may have limit-
ed opportunities for social interaction and having enter-
tainment facilities located in their neighbourhood may
be positive for that communityS
- Traditionally government would be responsible for
regulation, enforcement and consumer protection.
However, in most jurisdictions that have allowed EGMs,
the governments have either become the operator, pro-
moter, and a major beneficiary of gaming operations.
This appears to have compromised their previous roles.
The government promotion and sanctioning of gaming
has led to an increase in gaming activities that perhaps
would not have been there had the government taken
a more enforcement role and a more public safety ap-
proach.S
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Electronic Gaming Machines and Problem Gambling

- ‘Fit’ between communities and accessibility to EGMs. We
have evidence that some communities are more resilient
than others, with greater capacity to minimise gambling
harm. Conventional socio-demographic-economic in-
dicators are not predictors.R
- Free buses to gambling venues which increase accessR
- There is not terribly strong evidence that problem gam-
bling is more so an issue for low income individuals.
Stats I am familiar with note moderate to higher income
persons with problem gambling behaviour.S
Additional EGM Modifications to Reduce Problem
Gambling
- Control over loss limits by calibrating the central system
so that players could lose no more than $50 in a 48 hour
periodR
- Modifications to make the game unappealing, e.g., an
inter-trial interval of greater than 15 seconds (average
reel spin speed 3.5 - 5.0 seconds; players play at a rate of
one spin per 10 seconds)R
- Some of the feature modifications identified in this sur-
vey have interactions, e.g., increasing speed of play by
itself may have minimal effect if number of lines and
bet levels are kept at existing levels. However, if they are
raised at the same time, the combination could lead to
problematic behavioursS
- Remove or restrict linked jackpotsR
- Elimination of free spin featuresR
- Photo-recognition imbedded in machines to enforce
voluntary self-exclusionS
Additional Venue Modifications to Reduce Problem
Gambling
I-care system, which is a responsible gaming tracking
system based on player wagering behaviour. This system
which is transferable to all EGM systems and venues, if
combined with a smart card system, would appear to be
a highly effective system in reducing risksS
- Reducing ATM access might have unpredictable re-
sults. It might cause people to access more money ahead
of time because they know they can’t access it at the
casinoR
- Eliminating targeted advertisements is a bit of a problem
because it would be possible to avoid marketing to prob-
lem playersS
Additional Community Accessibility Modifications to
Reduce Problem Gambling
- The issue of accessibility will differ from community to
community and it is necessary to understand the dy-
namics of individual communities to be truly effective.S
- If the emphasis is on prevention I think you need to
provide information and messaging outside of gaming
venues. By the time people have decided to play they
are not interested in RG or PG messages. Don’t confuse
responsible gambling messages with problem gambling
messages. Give people some guidelines by which to as-
sess their play. Work done by David Hodgins is very in-
teresting in this regard. Work on early education with
youth about dangers of over gambling.S
- Prohibition may be worth thinking about - particularly
if there are numerous other less risky gambling options
available. EGMs are clearly the most dangerous gam-
bling mode!R
- reducing the number of EGMs in a communityS

- Gaming areas should be fully integrated into the facility

and located prominently in venues so gamblers cannot
hide away and gamble in secretS
- No credit or cheque-cashing privilegesR
- Using smart cards with pre-set limits and no play until
debt is paidS
- Encourage operators to be receptive and involved in
player information/protection measures. Setting an ex-
ample at the top makes it easier for employees to em-
brace and implement soft intervention techniques. This
could be accomplished via regulatory intervention if op-
erators are not receptive.S
- Saskatchewan Gaming Corporation has developed the

92
 Electronic Gaming Machines and Problem Gambling

APPENDIX 4: COMPLETE
RANKINGS OF CONTRIBUTORS
AND MODIFICATIONS
TABLE A1. Rank Order of Mean Importance Scores: EGM Contributors (Researchers and Specialists)

Item Rank Order

EGM Contributor
Researchers Specialists
Fast speed of play (e.g., shorter time between initial bet and outcome) 1 3

Direct electronic fund transfers at machine (e.g., direct debit) 2 1

Appearance of almost winning (i.e., near-miss) 3 2

Bill acceptors 4 4.5

Machines that accept high bill/note denominations (e.g., 20 or 50 bill/note acceptors) 6 7

Player controlled stop button 6 7

Large mixture of small, medium, and large prize values, that increases the volatility of the game (i.e. game is
6 15
less predictable)
Prominent big prize advertising on machine 8 15

Frequent presentation of big prize symbols shown during play (e.g., reel placement) 9.5 4.5

Bonus round game features that reward players with further play on related game with different features 9.5 11

Large denomination minimum betting amounts (e.g., $1, $5) 11 9

Large denomination maximum betting amounts (e.g., $5, $10) 12 7

Large number of lines to bet on in slots (e.g., 5 lines compared to 3 lines) 13.5 11

Display machine activity in credits instead of cash 13.5 18.5

Wide variation in possible game outcomes (i.e., high outcome volatility) 15 15

Offering winning outcomes more frequently through a higher “hit-rate” (i.e., higher chances of a win
16 11
occurring)
Large range between minimum and maximum betting amounts (e.g., 1¢ to $5) 17.5 13

Sound effects (i.e., music, buzzing and ringing) 17.5 24

Visual effects (i.e., lights, colours) 19.5 21

Small denomination minimum betting amounts (e.g., 5¢, 10 ¢) 19.5 26

Payout in tickets instead of cash 21.5 17

Type of games available on one machine (e.g., poker, video slots, keno) 21.5 24

Payout in tokens instead of cash 23.5 18.5

Multiple game possibilities on one machine (e.g., poker, video slots, keno) 23.5 27

Higher house advantage or edge (i.e., average amount per bet taken by gaming operator) 26 20

Offering winning outcomes less frequently through a lower “hit-rate” (i.e., lower chances of a win occurring) 26 22

Lower house advantage or edge (i.e., average amount per bet taken by gaming operator) 26 24

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Electronic Gaming Machines and Problem Gambling

TABLE A2. Rank Order of Mean Importance Scores: Venue Contributors (Researchers and Specialists)

Item Rank Order

Venue Contributor
Researchers Specialists
ATMs located on gaming floor or close to machines 1.5 1

24 hour access to EGMs in venue 1.5 3

Targeted player marketing for EGMs 3.5 2

EGMs located in non-dedicated gaming venue (e.g., bar, hotel) 3.5 4

ATMs located anywhere in the EGM venue 5.5 5

Easy access to alcohol 5.5 8

Full access to EGMs for play in venue 7 6.5

Frequent big prize advertising or promotion in the venue 8 6.5

Large number of EGMs within venue 9 11

General gambling marketing 10 9

EGMs located in a dedicated gaming venue (e.g., casino, racetrack) 11 10

No windows in venue 12 13

Low visibility of the EGMs within the venue 13 12

No clocks in venue 14 14

TABLE A3. Rank Order of Mean Importance Scores: Community Accessibility Contributors
(Researchers and Specialists)

Item Rank Order

Community Accessibility Contributor
Researchers Specialists
Large number of community venues (bars, lounges, casinos, other) with EGMs 1 2

Wide dispersion of EGMs throughout community 3 1

Convenient location of EGMs sites (e.g., close proximity to high residential populations) 3 3

Overconcentration of EGMs in low income neighbourhoods 3 6

Large number of EGMs per capita in community 5 4

Large total number of EGMs in community 6 5

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 Electronic Gaming Machines and Problem Gambling

TABLE A4. Rank Order of Mean Effectiveness Scores: EGM Modifications by Key Informant Group

Item Rank Order by Key Informant Group

EGM Modification Problem
Researchers Specialists Counsellors
Gamblers
Eliminating electronic fund transfers at the EGMs i.e.,
1 2 5 1
direct debit

Removing bill acceptors from EGMs 2 4 14.5 9

Removing large bill acceptors from EGMs (e.g., 20 or

3.5 1 1 2
50 denominations)
Require mandatory registration and use of smart card
3.5 7 14.5 16
to begin play
Requiring players to set pre-determined spending
5 3 2.5 7
limits

Requiring players to set a pre-determined time limit 6.5 5.5 5 6

Providing running cash totals of amount spent on

6.5 5.5 10.5 12
screen
Providing an option to set personal pre-determined
8.5 8.5 2.5 5
time limits
Providing an option to set personal pre-determined
8.5 12 10.5 21.5
spending limits
Increasing time elapsed between initial bet and
11.5 12 5 4
outcome (e.g., 2.5 to 5 sec. reel spin)

Reducing maximum bet size 11.5 18 19.5 9

Eliminating bonus rounds (e.g., further play on a

11.5 17 36.5 21.5
different game with different features)

Enforcing play stoppage, break or interruption 11.5 10 27 23.5

Displaying machine activity in cash value instead of

14 14.5 10.5 9
credits
Delaying immediate access to large wins (i.e., paying
15 24 10.5 3
out large wins in the form of cheques)

Hiding spinning reels from player’s view 16 16 19.5 23.5

Removing player controlled stop button 17 8.5 19.5 27.5

Displaying total time of play on screen 18 19.5 7.5 17.5

Eliminating advertising of big prizes on machines 19 27 27 12

Decreasing the chances of small wins occurring 20 25.5 14.5 35

Decreasing # of lines on which one can bet (e.g., 5 to

21 23 24 14.5
3 lines)

Eliminating sound effects and music 22.5 28.5 27 14.5

Decreasing the chances of a win occurring (e.g., 25%

22.5 30 34 20
to 5%)

95
Electronic Gaming Machines and Problem Gambling

(Table A4 continued from previous page)

Item Rank Order by Key Informant Group

EGM Modification Problem
Researchers Specialists Counsellors
Gamblers

Toning down lights and colours 25 33 27 12

Increasing the chances of a win occurring (e.g., 8% to

25 25.5 7.5 19
30%)

Displaying time of day on screen 25 34 40 37

Reducing volume of sound effects (e.g., music and

27.5 28.5 32.5 27.5
ringing)

Provide on-screen Helpline number and message 27.5 14.5 19.5 29

Paying out in cash instead of tickets 30.5 31.5 23 17.5

Add countdown clock showing time limit remaining 30.5 12 14.5 25.5

Displaying responsible gambling messages during

30.5 21.5 27 33
play
Add responsible gaming button leading to gambling
30.5 39.5 36.5 37
information screens

Paying out in cash instead of tokens 34.5 19.5 27 25.5

Removing some types of games from EGMs

34.5 36.5 32.5 30
altogether (e.g., poker, video slots, keno)

Decreasing game variety on a machine 34.5 36.5 19.5 31

Provide general information about responsible

34.5 38 39 37
gambling on welcome screen
Decreasing house advantage (i.e., average amount
37.5 33 36.5 34
taken per bet by gaming operator)
Provide Helpline number and message on the back of
37.5 21.5 27 39
printed payout ticket

Increasing minimum bet size 39 39.5 36.5 40

Increasing house advantage (i.e., average amount

40 31.5 19.5 32
taken per bet by gaming operator)

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 Electronic Gaming Machines and Problem Gambling

TABLE A5. Rank Order of Mean Effectiveness Scores Venue Modifications by Key Informant Group

Item Rank Order by Key Informant Group

Venue Modification Problem
Researchers Specialists Counsellors
Gamblers

Prohibiting access to funds from credit cards at ATMs 1 1 3 5

Removing ATMs from the casino gaming floor 2.5 2.5 10 1

Prohibiting the cashing of cheques at venue 2.5 2.5 10 6

Removing ATMs from the casino 4 4.5 6.5 4

Prohibiting access to free alcohol 5.5 8 12.5 8

Prohibiting the service of alcohol at the EGM 5.5 14 12.5 12.5

Restricting EGMs to dedicated gaming venues

7 12 3 18.5
(casino, racetrack)

Restricting daily ATM withdrawal amount 8 9 3 2.5

Allowing only one ATM withdrawal per venue visit 9 10.5 5 2.5

Prohibiting venues from being open 24 hours/day 10 10.5 6.5 7

Prohibiting prize advertising at gaming venue 11 18 17 10

Reducing the number of EGMs in a facility 12.5 6.5 8 12.5

Conducting venue staff training 12.5 19.5 17 14

Capping the number of EGMs in a facility 14.5 19.5 17 11

Providing a self-exclusion program 14.5 4.5 1 17

Establishing patron information & education

16 6.5 10 9
initiatives in venue

Place EGMs in a highly visible location in the facility 17 13 14 20

Providing windows in the gaming room 18 16.5 17 16

Providing non-gaming entertainment on site 19 15 20 18.5

Displaying time of day in gaming room 20 16.5 17 15

97
Electronic Gaming Machines and Problem Gambling
APPENDIX 5:
FOCUS GROUP SCRIPT
Two focus groups with EGM problem gamblers were con-
ducted for this study: One in Regina, Saskatchewan (N = 4),
the other in Ajax, Ontario (N = 8). A description of the focus
groups’ methodology and results are presented in Chapter 3.
Below is the script that was used by the moderator to guide
the focus group discussions.
INTRODUCTION
Thank you very much for agreeing to participate in this study.
Your input will be of great value to the research. The purpose
of the focus group is to get your opinion on problem gam-
bling and electronic gaming machines. By electronic gaming
machines, I mean slot machines and VLTs. During the focus
group, you will be asked to give your opinion on different
issues related to EGMs, the venues that offer them, and the
machines’ accessibility in the community overall. You’ll also
be asked to give your opinion on what you think it is about
these things that increase the risk of problem gambling, and
what you think might help reduce this risk. The focus group
should take no more than one and a half hours. When pro-
viding your answers during the focus group, please try to be
as open, frank, and detailed as you can.
WARM UP QUESTIONS
1. Can you tell me a bit about your gambling history?
a. How long have you been gambling?
b. Why did you start gambling?
c. How long were you playing EGMs before you felt
that you had developed a problem?
d.. When you first started gambling, what form of
gambling did you do?
e. Are you currently gambling?
98
MAIN QUESTIONS
2. Can you tell me a bit about your experience with VLTs
and slot machines?
a. Why are you drawn to these machines over other
forms of gambling? What is it about the machines
that appeals to you?
b. What is it about VLTs and slot machines that make
them so problematic? Why do you think this? For
example, some people think that their speed of
play is problematic. <<Can PROMPT with other
examples (see questionnaire)>>
c. If you could change anything about VLTs or slot
machines to make them less problematic, what
would you change?
d. Do you think that VLTs and slot machines are
more problematic than other forms of gambling?
If so, how would you describe the difference?
3. Can you tell me about the gaming venues you’ve at-
tended?
a. Why are you drawn to them? What is it about the
venues that make gambling more appealing to
you?
b. Is there anything about the gaming venue that
makes gambling more of a problem for you? If so,
what is it? For example, some people think that
having a large number of EGMs at a site plays a
large role. <<Can PROMPT with more examples
(see questionnaire)>>
c. If you could change anything about the gaming
site to make gambling less of a problem for you,
what would you change and how would you do
this?
4. Can you tell me a bit about the availability of VLTs
and slot machines in the community?
a. How do you think the availability of the machines
affects your gambling? Why do you think this? For
example, some people believe that having VLTs
and slot machines located close to residential areas
can be a problem.
<<Can PROMPT with more examples (see
questionnaire)>>
 Electronic Gaming Machines and Problem Gambling

b. If you could change anything about the availabil-

ity of VLTs or slot machines in your community,
what would you change?

5. What do you think gaming venues could do to effec-

tively address EGM-related problem gambling?

6. What is the one thing that you think would be most

effective in reducing the risk of EGM-related problem
gambling? <<If they suggest things that are unrealistic
or impractical, PROMPT for next best option>>

7. Have you ever self-excluded from a gaming venue?

a. Describe the effectiveness of the program. Can

you identify any successes you’ve had or challenges
that you’ve faced?
b. Overall, did it help you ad-
dress your gambling problems?
<<Can PROMPT: Why or why not? >>

8. When you first started using VLTs or slot machines,

did you know about the risk of problem gambling?

9. Do you feel that if you had been aware of risk, it

would have reduced the likelihood of you developing
gambling-related problems?

99
Electronic Gaming Machines and Problem Gambling
APPENDIX 6:
COUNSELLOR
INTERVIEWS
METHODOLOGY
Eight problem gambling counsellors from addiction agen-
cies participated in interviews for this study: five from
Saskatchewan, three from Ontario. Interviews were con-
ducted in-person or over the telephone by Dr. Jamie Wiebe
and lasted approximately one hour. Some of the topics cov-
ered during the interviews of relevance to the present report
include:
• Counselling experience and clientele,
• Perceived EGM features, EGM venue features,
and community accessibility features that
contribute to problem gambling,
• Perceived modifications to the above features
that might reduce EGM-related problem
gambling risk, and
• Prevention strategies.
The script that was used by the interviewer to guide the in-
terviews is presented in Appendix 7. The names of the coun-
sellors who participated in the interviews are presented in
Appendix 1.
100
RESULTS
Counselling Experience and Clientele
Counsellors had been involved in addictions counselling in
general for 7 to 32 years, and problem gambling counselling
in particular for 2 to 12 years. All were currently providing
problem gambling counselling exclusively. All counsellors
said that the large majority of their clients had problems re-
lated to EGMs, with five counsellors indicating that at least
80% of their clients had such problems. All but one counsel-
lor felt that the proportion of clients with EGM-related prob-
lems had stayed stable over the years; the remaining coun-
sellor felt that the proportion of clients with EGM-related
problems had increased.
EGM Features That Contribute to Problem Gambling
Many counsellors said that the fast and continuous speed of
play of EGMs, coupled with their sights and sounds (which
create a “numbing or intoxicating effect”) contribute to EGM-
related problems. Some mentioned the machines’ varied
schedule of reinforcement, which makes people more likely
to chase losses because they believe a win is more likely to oc-
cur. Also mentioned was increased betting lines, which give
the perception that there is a greater chance of winning (with
“people getting betting tolerance”). The machines’ graphics,
interactive touch screen, and bonus rounds were also men-
tioned as contributors. Finally, some counsellors said that
their clients were attracted to the machines’ ease of play, and
the lack of social interaction required.
Venue Features That Contribute to Problem Gambling
Most counsellors felt that access to cash through automated
teller machines (ATMs) in the gaming venue made it too
easy for people to exceed limits and spend additional money.
Some talked about the customer-service focus, in that play-
ers are called by name and made to feel important. Others
described the comfort and safety element, that there are no
set rules with EGM play—players can choose to interact or
be autonomous. One counsellor felt that the spacing of ma-
chines was a factor, noting that clients tend to have a prefer-
ence for where they want to play. Another felt that venue staff
increase beliefs that machines are due for a win by making
comments on which machines have, and have not, paid out
recently.

Community Accessibility Features That Contribute to
Problem Gambling
All counsellors felt strongly that increased accessibility to
EGMs in the community increased problems, stating that
most of their clients would not have problems if the ma-
chines were not in their community. In describing her clients,
one counsellor noted, “many clients talk about developing
problems by happenchance. They went to have a drink and
the machines were there.” Others talked about the problem
of having access to EGMs in small communities, where there
are few socializing and entertainment options.
EGM Modifications to Reduce Problem Gambling
A frequent suggestion to reduce EGM problem gambling
related to the machines themselves was to have smart cards
which include maximum spending limits or allow players
to set their own limit. One counsellor noted, “Clients often
say that they start with a limit but that they don’t stick to it.
A preset limit would work for some.” The counsellors from
Saskatchewan specifically noted the need for a card that ap-
plied to both casinos and VLT sites. Another common sug-
gestion was to display machine activity in dollars or cents,
rather than in credits, that it is easier to devalue the amount
being spent and to lose track of expenditures with the latter.
To help reduce the amount of money spent, a few counsellors
recommended reducing maximum bets, number of betting
lines, and near misses (which increase the belief that a win
is imminent).
Many counsellors noted that there were minimal changes that
could be done to EGMs to assist their clients. As one counsel-
lor noted, “People with problems will play the machines no
matter how much they can bet.” Some counsellors felt that
pop-up messages that inform players of the amount of time
and money they have spent are a nuisance; two counsellors
described players with problems as being in the “zone,” such
that it is easy for them to disconnect from pop-up messages.
Slowing down machines was not viewed as an effective mea-
sure, with one participant stating “you would have to slow it
down so much that it is not an option.”
Venue Modifications to Reduce Problem Gambling
The most commonly suggested venue modification to reduce
EGM-related problem gambling was to remove ATMs from
gaming venues, with many noting that their clients wanted
Electronic Gaming Machines and Problem Gambling
this change. One counsellor described the issue as follows:
“If we consider this an impulse control disorder, then the
more time that you can put between the impulses, the bet-
ter…the more time to have a sober second thought.” Some
felt that more could be done to intervene with the gambler at
the gaming venue by encouraging players to take a break or
by approaching those who are visibly upset. One counsellor
felt that an intervention would be helpful if the person was
contemplative, but that it would annoy those who were pre-
contemplative. A few felt that players should not be allowed
to save machines, that some get attached to particular ones
and will save them if they need to go away for some reason
(e.g., to obtain more money). Some counsellors felt that a
“no save” rule would reduce the amount of time spent gam-
bling. A number of participants recommended that venues
provide information on the odds of winning, how the games
work, cost of playing, return rates, and the likelihood of win-
ning large prizes. As one participant explained, “People don’t
understand how the machines work. They believe that their
odds of winning are higher. They don’t realize that the ma-
jority of prizes are small. They don’t understand the slippery
slope of not winning over time. They believe that some skill
is involved.” One counsellor suggested that this information
be made available to all players when signing up for a player’s
card.
There were several venue modifications that counsellors be-
lieved would not affect problem gambling risk. Most, for in-
stance, felt that changing the hours of operation of a gaming
venue would not have an impact. As one participant stated,
“They tend to set a time when they gamble. It’s not about time
but about loss of control.” Reducing the number of machines
at a venue was also seen by some as ineffective, as it “would
have to be so pronounced and only make a difference if ma-
chines are fully utilized all the time and this is not the case.”
Others noted that those with problems will wait in line for
a machine. Serving alcohol wasn’t seen as making much of
a difference, “for most clients, it is not about the alcohol.”
Banning prize ads was not viewed as having an impact be-
cause clients know all about the prizes. Finally, although pro-
viding information about the signs of a gambling problem
was not seen as impacting those with problems, many noted
that it may be important for preventing problems.
101
Electronic Gaming Machines and Problem Gambling

Community Accessibility Modifications to Reduce - Decrease government involvement: A couple of re-

Problem Gambling
All participants recommended the removal of VLTs
(Saskatchewan) and EGMs in residential areas (Ontario).
Overall, participants felt that EGMs should only be available
in gambling destination facilities.
spondents felt that government should not be in the
gambling business; that it sends mixed messages and
facilitates the belief that gambling must be safe.
- Increase non-gambling options: Have more social al-
ternatives so that people don’t view gambling as the
only option for socializing and excitement.

Prevention Strategies
All of the counsellors felt that it is very difficult to reach those
who already have gambling-related problems, but that things
could be done to prevent problems from developing in the
first place. Suggestions of how best to prevent problems were
quite varied and included the following:
- Decrease access to EGMs: Remove VLTs from bars
and restaurants; remove EGMs from residential
areas.
- Decrease access to money: Remove ATMs from gam-
ing venues.
- Increase control over money spent: Provide smart
cards that specify maximum amounts that can be
spent; decrease maximum bets.
- Increase honesty and transparency: Inform consum-
ers of the risks, expected losses per hour, and odds
of winning; display machine activity in dollars or
cents rather than credits.
- Reduce gambling advertising: Many called for a re-
duction in gambling advertising, with one par-
ticipant stating that the “product is marketed to a
point where we think that gambling circumvents
problems.”
- Raise public awareness of the problems associated
with gambling: One participant noted that it is still
“not okay to talk about problem gambling publicly.
People suffer alone. Society needs more normaliz-
ing that problems do occur.” Another felt that it is
important to let people know that gambling can be
controlled, that you don’t have to quit in order to
get help.
- Intervene early: Provide on-site professionals who
can approach players displaying distress or who
have been gambling for extended periods of time.
- Target youth: Participants noted the importance of
early education and informing youth of the risks as-
sociated with gambling before they reach legal age.

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APPENDIX 7:
COUNSELLOR
INTERVIEW SCRIPT
INTRODUCTION
Thank you very much for agreeing to participate in this study.
Your input will be of great value to the research. The purpose
of the interview is to get your opinion, as a counsellor work-
ing in the field, on the relationship between electronic gaming
machines and problem gambling. As you know, by electronic
gaming machines, I mean slot machines and VLTs. During the
interview, you will be asked to give your opinion on different
issues related to EGMs, the venues that offer them, and the
machines’ accessibility in the community overall. You’ll also
be asked what you think it is about these things that increase
the risk of problem gambling, and what you think might help
reduce this risk.
When providing your answers during the interview, please try
to be as open, frank, and detailed as you can. I anticipate that
the interview will last about one hour. Before we begin, I just
want to inform you that by participating in the interview, you
are consenting to be involved in the research. Is that alright?
Great, let’s begin.
WARM UP QUESTIONS
1. Can you tell me a bit about your background as an ad-
dictions counsellor?
a. How long have you been an addictions counsellor?
b. How long have you specialized in problem
gambling?
c. Is your counselling practice exclusively for problem
gambling?
Electronic Gaming Machines and Problem Gambling
2. Can you tell me about your clientele?
a. What proportion of your clientele present with
gambling problems?
b. What proportion of this group are EGM users?
c. Has the proportion of EGM users changed over
time, if so, has it increased or decreased? How do
you account for the change?
MAIN QUESTIONS
Based on your experience and what you have learned
through counselling problem gamblers…
3. Can you tell me a bit about EGMs?
a. What is it about the machines that make them
problematic? Why do you think this? For exam-
ple, some people think that their speed of play is a
problem. << Can prompt with other examples (see
questionnaire)>>
b. If you could change anything about EGMs to make
them less problematic for your clients, what would
you change and how would you do this?
c. Do you think that EGMs are more problematic
than other forms of gambling, such as casino table
games? If so, what makes you think this?
d. Do you think your clients would share these views
with you?
4. Can you tell me a bit about the gambling venue (i.e.,
casino, bars with EGMs)?
a. Is there anything about the venue that makes gam-
bling more of a problem for your clients? If so, what?
For example, some people think that having a large
number of EGMs at a site plays a large role. << Can
prompt with other examples (see questionnaire)>>
b. If you could change anything about the gaming site
to make gambling less of a problem for your cli-
ents, what would you change and how would you
do this?
c. Do you think your clients would share these views
with you?
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Electronic Gaming Machines and Problem Gambling

5. Can you tell me a bit about the availability of EGMs in

the community?

a. How do you think the availability of EGMs in your

community plays a role in problem gambling for
your clients? Why do you think this? For example,
some people believe that having EGMs located
close to residential areas is problematic.
<< Can prompt with other examples (see
questionnaire)>>
b. If you could change anything about the availabil-
ity of EGMs in your community, what would you
change?
c. Do you think your clients would share this view
with you?

6. What do you think is the best thing a gaming venue

could do to effectively address EGM-related problem
gambling?

a. What do you think is the BEST thing a gaming ven-

ue can do?

7. What are your thoughts on the role that self-exclusion

plays in helping people with their gambling problems?

a. In your experience, has this type of program helped

your clients? If so, how?
b. Can you think of any benefits and/or limitations to
the self-exclusion program?
c. What do you think your clients would say about
the usefulness of self-exclusion as a way to recover
from problem gambling?

8. Do you think that if your clients had been aware of the

increased risk of problem gambling related to EGMs,
it would have reduced their likelihood of developing
problems?

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Electronic Gaming Machines and Problem Gambling

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