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Are Online Gamblers More At Risk Than Ofﬂine Gamblers?
1,2 Sylvia Kairouz, Ph.D., Catherine Paradis, Ph.D.,2,3 and Louise Nadeau, Ph.D. 2,4
Objectives: To characterize and compare sociodemographic proﬁles, game-play patterns, and level of addictive behaviors among adults who gamble online and those who do not, and to examine if, at the population level, online gambling is associated with more risky behaviors than ofﬂine gambling. Methods: Respondents were 8,456 ofﬂine gamblers and 111 online gamblers who participated in a population-based survey conducted in the ´ bec, in 2009. The study sample is representative of adult general population. Results: There is an province of Que unequal distribution of online gambling in the population. A disproportionate number of men, young people, and students say they participate in online gambling. Poker players are overrepresented among online gamblers and gambling behaviors tend to be more excessive on the Internet. Compared with ofﬂine gamblers, online gamblers report more co-occurring risky behaviors, namely alcohol and cannabis use. Conclusion: Those who gamble online appear to be more at risk for gambling-related problems, but the present ﬁndings alone cannot be used as evidence for that conclusion. Future research designs could combine longitudinal data collection and multilevel analyses to provide more insight into the causal mechanisms associated with online gambling.
Introduction hrough private Internet access and mobile technology, online gambling has become readily accessible. The gambling ﬁeld has thus seen dramatic changes over recent years. The number of gambling websites has grown from about 15 in 1995 to 2,358 in 2010. Global Internet gambling revenues have increased from $3 billion in 2000 to $24 billion in 2010.1 In this context, many worry about the possible effects of ´ bec, when the Crown this growth on public health. In Que corporation announced its decision to set up a gambling website in 2010, public health directors from across the province openly expressed concerns that those who gamble online could be more prone to an array of gambling-related problems.2 Theoretical research undertaken by Grifﬁths3–5 over the last decade has shed light on how the Internet in itself can be addictive and how online gambling can increase the potential for other gambling-related problems. Empirical studies have drawn similar conclusions. For example, using a self-selected sample of 1,920 American, Canadian, and international Internet gamblers, Woods and Williams6 found that, compared with ofﬂine gamblers, Internet gamblers were more likely to have a higher score on the Canadian Problem Gambling In-
dex (CPGI). In their study, 20.1 percent of Internet gamblers were classiﬁed as problem gamblers. Only a few empirical studies have speciﬁcally compared online and ofﬂine gamblers. An analysis of the British Gambling Prevalence Survey showed that online players were more likely to positively score on the DSM-IV pathological gambling criteria. Online gamblers were also more likely to be male, young, single, educated and working in managerial or professional occupations than ofﬂine players.7 In a clinical sample, Ladd and Petry8 found that online gamblers were more likely to have a higher score on the South Oaks Gambling Screen, more likely to be young and more likely to be non-Caucasian than ofﬂine gamblers. Using an opportunity sample of 38 participants, Cole et al.9 observed that those who gambled on online roulette placed more chips per bet and made riskier bets than those who gambled on roulette ofﬂine. Thus, empirical studies appear to support the idea that online gamblers are more at risk than their land-based counterparts. However, the majority of these ﬁndings are based on convenience samples that make it impossible to assess the extent to which they are representative of all online gamblers. Therefore, from an epidemiological perspective, very little is known about the characteristics of online gamblers compared to their ofﬂine counterparts.
´ al, Canada. Department of Sociology and Anthropology, Concordia University, Montre ´ al, Canada. Lifestyle and Addiction Research Lab, Concordia University, Montre 3 Department of Political Studies, Bishop’s University, Lennoxville, Canada. 4 ´ de Montre ´ al, Montre ´ al, Canada. Department of Psychology, Universite
656 16.425 v2 42.6 7.3 7. A two-stage sampling design was used.4 17.01.1–9.0–14. Est.0 40.5 percent across regions.1 6.19 1.8–53.8 14.92 2. in which the administrative regions ´ bec deﬁned the ﬁrst stratum. never married Married De facto union Widowed.0 23.1 22.2 5.949 217.638 27.870 670.436.8 30.434 738.138 34.978 26.456) Percent Gender Male Female Age group 18 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 64 years 65 to 74 years 75 years and over Marital status Single. only individuals who reported having participated in any of the 12 listed gambling activities at least once during the last 12 months were considered.9–51.1 15.97*** 5.212 35.833 6. conﬁdence interval.7a 41. population estimates.4–18.4 7. ***pp0. Result nonpublishable.8 6.4 percent and ranged between 41.4 5. Que Methods Sample ´ bec gambling survey This study used data from the 2009 Que ´ BEC.5 10.517 963.2–16.8–22.4–6.7 32. Measures Game-play patterns. it excluded those individuals living on Indian Reserves or Crown KAIROUZ ET AL.4 2.7a 4.6a 40.1–26.2 4.896 7.3 percent and 60.1 11.5 28.8–11.7 3. living in private dwellings.5–23.3–4.7 1.3–43.7–24.656 4.6a 21.176 This article examines whether.3–18.7 9.682 943.199 1.627 306. Within each stratum.960 6. and level of addictive behaviors for adults who gamble online and ofﬂine in a representative.866 358.3 18.1 8.340 95% CI 73.1 4. 2.4 20.2 Pop.8 78. Current gamblers reported their gambling frequency in the past year. CI. The ﬁnal sample was composed of 8.7 3.902 2.8 5.8a 5. those who gamble online are more at risk than those who gamble ofﬂine.7 8.023 47.7 14.6–53.337 3.7–16.1a 24.2 8.006 18.2–10.05.7 48.9–41.395 1.1–2.526 4.0–91. or in institutions.9 4.337 683.0 5. The key objectives are to characterize and compare the sociodemographic proﬁles.6a 7.6–9.8 28.9a b 9. .6–21.2–16 50. one individual was selected in each selected dwelling.8–21.4 17. and associated substance use ´ bec population..151 627.1 21.149.499 979.970 528.8 17.7 36.2–23. The overall weighted response rate was 54.7 0.9 14.089. gambling problems.4 2.0 15.5 13.734.001 261.1–31.5–29.1–19.3 26.9–49.0 2.204 3.518 411.5–16.4 38.196 17.399.6–23. lands.148 15.4 1. in certain remote regions.8 10.9 4.599 164.5 22. 2009).8–41.5a 14.777 751.5 15.3 49.309 21.3a 85.001.5 20.7–33.2–17.5 2.8–67.6–15. At the second stage.4 25.6–55.1 52. game-play patterns.8 79.3–34.9–9.6 14.0 24. *pp0.5–12.655 1.9 16.337 29.1–33.0 77.8 15.9–15.5 30.5–5.0a 18. The survey targeted the behaviors in the Que population aged 18 and over. stay at home.932 1.797 4. at the population level.3a 19.456 ofﬂine gamblers and 111 online gamblers.227 5.4–6.1–37.886 1.6a 55.6 21.1–53. Est. which aimed to describe gambling (ENHJEU-QUE patterns.006 781. divorced Employment status Full-time Part-time Student Retired Unemployed On leave.1a 33.1 22.5 32.8 3.155.2 11.6 33.6–46.7 16.1 12.175.5–88.2 42.027 2.251.126 4.331 995.1–18.6a 4.400 256.7 24.752 11.8–26.3–51. Comparison of Ofﬂine and Online Gamblers on Major Sociodemographic Characteristics Ofﬂine gamblers (n = 8.1 21.5 2.04*** 12.075 650.850 21.2–80. we of Que selected a number of dwellings proportionate to the square root of the population effect. For this study.333 1.0–34. They were asked to Table 1. separated.379 74.35 Interpret with caution.2 8.902 1.5 27. **pp0.7a b b 95% CI 48.84*** 4.0 16.424.2 21.9 14.0 18.6 25.520 31. 71.5 19.096 900. population-based sample of ´ bec adults.2 22.6–28.1–8. Pop. Est.7a 31.9a 30.5 Pop.0 3.0–32.3a 13.9 42. other Education Some high school High school diploma College (CEGEP) degree University degree Household income Low income Lower middle income Upper middle income Higher income Other Geographic region Rural Urban a b Online gamblers (n = 111) Percent 82.240.2 24.4–10.9 31.183 7.02*** 50.4a 8.4–13.6 21.744 302 37.4 7.1 0.542 12.5–7.
2–86.470 6.7 35.9–73.’’ ‘‘monthly but not weekly.02 13.’’ ‘‘weekly but not daily.715 30.8b 20.4 0. household income (as measured by income adequacy).4b 7.5 1.4 3.799 26.001.6 93. Afterward.3–5.624 95% CI 64.494 16.8 4.35*** 33.4 20.9 6.609 11. we used the overall score on the Problem Gambling Severity Index (PGSI). or (d) problem gamblers (score = 8 and above).238 9. (b) low-risk gamblers (score = 1 or 2).8–1.75*** 130.8 38.1 37.10 The PGSI consists of nine items with answers reported on a 4-point scale (1 = ‘‘Never’’.’’ ‘‘daily and more’’).910 26. 4 = ‘‘Almost always’’).6–38.275 v2 20. 11 and over = ‘‘probable dependent drinkers’’).000 $1.910 57.018. employment status.4–35.5 14.775 228.8 12.0 31.8 5.5b 32. game-play patterns.8*** 44.1 3.759 1.8–7. or yearly.9–43.7b 66.5–45. marital status.12 The AUDIT scores were recoded into three categories (0 to 7 = ‘‘nonproblem drinkers’’.RISKS OF ONLINE GAMBLING estimate the number of times they gambled weekly.472 4.0 1.1 6. The total yearly spending was calculated by summing reported spending across all activities.3 41.5 32.194 25.7–4.6–33.235 35.4 3.9b 31.1b 19.94*** Differences were nonsigniﬁcant when exclusive lottery players had been removed from the analysis.3b 21.2 20. To assess the severity of gambling problems.4 31. Interpret with caution.5 13. ***pp0.4–43.6–43.9b c 5. Respondents were differentiated according to gender. or yearly basis. 66. Demographics.6 44.9b 13.6 8.5b c 95% CI 92.1 25.1–23.625 215. Respondents were asked about past-year frequency of alcohol consumption and problematic drinking using the Alcohol Use Diagnostic Identiﬁcation Test (AUDIT).196 35.9 9.6 23.079 2. We also measured the frequency of past-year cannabis use and past-year smoking.001 + Average play time per session Less than 1 hour Between 1 and 3 hours 3 hours + Gamblers proﬁle Nonproblem gamblers Low-risk gamblers Moderate-risk gamblers Problem gamblers a b Online gamblers (n = 111) Percent 77. The total number of times was summed across all activities and reported on a yearly basis.3–45. and marital status to the 2006 Census population using the direct method.01.76*** 50. monthly.6 34. Est.3 32.477 124.4–2.4 20.0 2.282 5.11.075. 3 = ‘‘Most of the time’’.9–10.0b 21.9–22.7–60. All estimates were weighted to represent the adult household population and were standardized by age.898 17. and prevalence of addictive behaviors.1–1.7–95.0–93.503 494.6 30.2 3. They were asked to estimate the time they spend gambling on a typical occasion for each reported activity and total yearly time spent on gambling was calculated by summing the typical gambling time per occasion across all activities.4 11.591 1.5b 22.1 21.1–15.435 233.2 6.2–36. scores were recoded into four categories (‘‘less than monthly.2–15.802 5. and geographic region. level of education.4–7. **pp0.7–47.0–39.0 6. 2 = ‘‘Sometimes’’.3–29.776 22. Statistical analysis We used v2 tests to assess associations between forms of gambling (online/ofﬂine) and demographic characteristics.629 1.4 13.6–55.6–1.38*** 56.25*** 450.5 7. 4.4 2.4–3.103 32.0 4.221 18.000 $5.3 2.5 8. The time frame was determined by the respondent’s spontaneous preference.2 Pop.5** 48.3 1.082 180.9 16.893 19. a modiﬁed version of the CPGI.359.168 1.3–10. Est.2b 11.5 10.3 3.227.3 42.5–30.8 52.9 55.8b 35.2 5. monthly. Current gamblers also reported their spending either per occasion or on a weekly.45*** 0. Comparison of Ofﬂine and Online Gamblers on Game-Play Patterns Ofﬂine gamblers (n = 8.7 50.85*** 31.435 607.409 16.7 Pop.2 5. STATA Table 2.1–31.820.4b 43.0–33.78*** 92. age.939 1.1 19.9b 4. To account for the complex survey design.823 4.634.4 63.502 279. *pp0.8 30.1 5.951 26.076 77.9 3.2 13.7 14. 8 to 10 = ‘‘problem drinkers’’.3b 30.309 54.8 19.6 36.5–48.1–37.595 129.7 0.662 36. 177 Other addictive behaviors.8 18.3–76.4b 46.1–4.2–15.2 0.7–6.201 364.2 2.5–3.469 266.6 1.6 4. (c) moderaterisk gamblers (score = 3 to 7).8 1.001 to $5.873 58.8 0.0 43.502 43. c Result nonpublishable. Respondents were categorized as (a) nonproblem gamblers (score = 0 on the PGSI).9 12.2–33.3–20.2 34.35*** 141. gender.0 2.896 385.0–31.0–9.1–14.9 28.122 440.456) Percent Gambling activities Lotterya Bingo Slot machinesa Video lottery terminalsa Poker Table games Sports betting Card games Skill games Annual frequency Less than monthly Monthly but not weekly Weekly but not daily Daily and more Annual spending 0 to $100 $101 to $500 $501 to $1.381 27.478.5–64.8–11.2 27.8 94.581 157. .05.
05*** Interpret with caution.304 6.54–2.2 7. 847.2a 11.50) had bet online at least once during the previous 12 months.3 Pop. Overall.2 1.363 respondents were ofﬂine gamblers who never played online.436 95% CI 17.2 0.3 87.178 10 was used to calculate all estimates and 95% conﬁdence intervals (CIs). more than 60 percent of ofﬂine gamblers played less than weekly.13 Coefﬁcients of variation (CV) were also used to evaluate estimate precision.3a 24.7–38.449 15. Conversely.4 14.6–43. More than 50 percent of online gamblers reported drinking on a weekly basis.3–37.0 11.8 percent (n = 103) of online gamblers reported that they also play ofﬂine. **pp0.1 15.4–8. the result is considered imprecise and has not been disclosed. Online gamblers also reported spending more time per gambling occasion compared with ofﬂine gamblers. largest category of ofﬂine gamblers. Level of education.1–24.4 1.01.680 58.078 3. With regard to marital status.6 percent and 33 percent. whereas retirees were the second KAIROUZ ET AL.1 19.503 57.581 9.2–3.456) Percent Tobacco use Daily smoker Occasional smoker Former smoker/nonsmoker Alcohol consumption Do not use Less than monthly Monthly but not weekly Two to three times per week Four times per week and more AUDIT score 0 to 7 8 to 10 11 + Cannabis consumption Do not use Less than monthly Monthly but not weekly Two to three times per week Four times per week and more a b Online gamblers (n = 111) Percent 26.451 200. a dagger symbol indicates that the result should be interpreted with caution.1 5.3 11.480 3. AUDIT. Est. Finally.8–26.7 4.4 3.0–5. 95% CI 1.5 12.6 4. online gamblers were more likely to report all types of gambling activities except for lottery.3–76.708 10.8–24.5 20. Results presented in Table 1 indicate that.7 74.5–31.3 3. Est.7 8. . Results Sociodemographic proﬁle Of the total sample (n = 8.695 309. the largest proportion of ofﬂine gamblers was found in the 45.199 660 v2 2. but gambling form was signiﬁcantly related to alcohol and cannabis use.8–7.816.1 28.2 6. Level of addictive behaviors The results presented in Table 3 indicate that the form of gambling was not related to tobacco use.1a b 95% CI 18. ***pp0. When they played.5 52.771 21. Where the CV is greater than 33 percent.7 7.6 88.7a 63. and region were not signiﬁcantly related to the form of gambling (online/ofﬂine).4 22.6a 21. the largest proportion of online gamblers reported spending between $1.015 308. whereas 111 players (1.863 56.121 1. income level.1 4. those working full time were the most likely to report gambling during the last year.509 18. online gamblers were more likely to be male and fall into one of the younger age categories. and signiﬁcant differences were determined from nonoverlapping 95% CIs.5–13.006.3 54.4–8.7a 12.1 18.772 2. with nearly 60 percent betting at least weekly. Game-play patterns Compared with ofﬂine gamblers.8–74.7–20. The greatest proportion of online gamblers was found among 25to 34-year-olds. online gamblers were signiﬁcantly more likely to report a higher score on the CPGI than ofﬂine gamblers.5a 30.8–21.1 22.637 21. which was more likely to be reported by ofﬂine gamblers (Table 2).9 75.277 26.8 23. For both online and ofﬂine gamblers.793 13. whereas the greatest proportion of ofﬂine gamblers reported spending less than $100 annually on gambling.553 212.97 percent.1–17.9 29.4 10.2–89.3 21.8–1.625 988.to 54year-old age category.000 annually.4–36.637 7. Students were the second largest category of online gamblers. online gamblers were more likely to report a higher frequency of alcohol consumption.6–20.05.001 and $5.4 1.121 45.259.411 54.8a 24.7–12.7–29.456).361 73.7 64. Analyses also revealed that online gamblers bet more frequently than ofﬂine gamblers. Conversely.198 3.8 6. the greatest proportion of online gamblers was found among single and cohabiting individuals.1 1.7–89.7 0.4a b b 4** 19.3–2. *pp0.1–1.285.831.9a 7. Comparison of Ofﬂine and Online Gamblers on Addictive Behaviors Ofﬂine gamblers (n = 8. Moreover. By contrast.6 11.3a 67. It is noteworthy that 92. Where the CV is between 16.5 87. 8.2 16.2 Pop.7–34.7 6.247 500.5*** 19. with more than 83 percent of online gamblers falling under the age of 45. 22.9 0.7–77. Result nonpublishable. 96 percent of online gamblers reported spending at least 1 hour gambling compared with 79 percent of ofﬂine gamblers.791 1. the greatest proportion of ofﬂine gamblers Table 3.001. compared with ofﬂine gamblers. and the greatest proportion reported drinking two to three times a week.303 533.3–5.3 49.7–75.2–23.5 10.6 88. whereas the largest proportion of ofﬂine gamblers was found among married individuals.1 1.0 4. Alcohol Use Diagnostic Identiﬁcation Test.
Internet gambling: issues. Ladd G. In accordance with other studies. 13.com/primary%20navigation/ online%20data%20store/internet_gambling_data. From a lifestyle perspective. Wood RT. Proﬁling online gamblers: an exploratory study. ´ publique s’inquie ` te 2. Orford J. (2007) Stata statistical software. 9. 12. compared with ofﬂine gamblers. Our ﬁndings also suggest that gambling behaviors tend to be more excessive on the Internet. http://www. $M. 14. Problem gambling on the internet: implications for Internet gambling policy in North America. Disordered gambling among universitybased medical and dental patients: a focus on Internet gambling. (accessed November 17. 3. From a psychological perspective. We cannot determine. CyberPsychology & Behavior 2003. observed associations between individual characteristics (the set). whether gambling on the Internet creates problems in and of itself. Parke J. College Station: StataCorp LP. concerns. Higgins-Biddle JC. www. Wynne HJ. This study was conducted while Sylvia Kairouz and Louise ´ be ´ cois de la reNadeau were supported by the Fonds que ´ sur la socie ´ te ´ et la culture (FQRSC) operation grant. CCA’s Global Internet Gambling Revenue Estimates and Projections (2001–2010.ccai.9 percent vs.3 percent) was signiﬁcantly higher than the proportion observed among ofﬂine gamblers (4. Moreover. for example. Grifﬁths M. Ottawa. Saunders JB. Wardle H. Geneva: World Health Organization. We found an overrepresentation of poker players among online gamblers. the proportion of online gamblers who were identiﬁed as problem drinkers on the AUDIT (21. we ran all the analyses after removing this particular group from the sample. 16: 76–79. CyberPsychology & Behavior 2009. References 1. 7. the same vulnerability factors that contribute to gambling may contribute to other risk-taking behaviors. La Presse Canadienne. Report to the Canadian Inter-Provincial Committee. Parke A. 2011). International Journal of Business Research 2007. a signiﬁcantly greater proportion of online gamblers reported using cannabis during the last 12 months (32. or whether those who are already experiencing problems are more likely to be enticed to gamble on the Internet. 2008 (ENHJEU-QUE Disclosure Statement No competing ﬁnancial interests exist. 8:1–8. Likewise. 2010. et al. cherche ´ bec survey Source of work: Portrait of Gambling in Que ´ BEC). Development of the alcohol use disorders identiﬁcation test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption—II. Given that a large majority of ofﬂine gamblers (70 percent) were exclusively lottery players. Williams RJ. Grifﬁths M. Wood R. 4. with online gambling. (2010) La sante ` mes associe ´s aux jeux en ligne: UN moratoire est des proble ´ sur le projet de Loto-Que ´ bec. UNLV Gaming Research and Review Journal 2006. 10. 11.14–16 observed that gambling problems are more severe among online gamblers. Saunders JB. Frequency of play.17. our results indicate higher co-occurrence of other risky behaviors. 10:27–39.3 percent for ofﬂine gamblers).19 The present ﬁndings alone cannot be used as evidence that those who gamble online are more at risk for gamblingrelated problems. Internet Gambling: an overview of psychosocial impacts. and the object of addiction (mostly poker gambling) lead us to conclude that future research will need to expand to more comprehensive multilevel models. February demande 18. (2001) A U D I T—The alcohol use disorders identiﬁcation test. Acknowledgments 179 The authors are very thankful to Elyse Picard and Lina Mihaylova for their valuable contribution to this article. Babor TF. Only a longitudinal research design would permit the careful examination of gambling trajectories and associated problems among online gamblers.htm. New Media & Society 2007. Finally. Ferris J. Christiansen Capital Advisors (2004). Aasland OG. Pearce G. and environmental conditions. et al. spending. . Social Science Computer Review 2002. US). Sociodemographic correlates of Internet gambling: ﬁndings from the 2007 British Gambling Prevalence Survey. and recommendations. collective life conditions largely determine a series of health-related behaviors through combinations of chances and choices.18 Cooccurrence ought to be thought of as the result of multiple common biological. Lee G. 6: 557–568. The cross-sectional nature of this study makes it impossible to infer directionality in the association between the Internet setting for gambling and the occurrence or exacerbation of gambling-related problems.6 percent). et al. 12:199–202. 10th ed.14–16 we found a disproportionate number of men. Research designs combining longitudinal data collection and multilevel analyses could provide more insight into the causal mechanisms associated with online gambling. Social facilitation in online and ofﬂine gambling: a pilot study. The Social impact of Internet gambling. and gambling time are signiﬁcantly greater among online gamblers.com/politique/quebec/283354/ la-sante-publique-s-inquiete-des-problemes-associes-aux-jeuxen-ligne (accessed February 15. Grifﬁths M. Grifﬁths M. Babor TF. 8. International Journal of Mental Health and Addiction 2010. There was an association between gambling form and game-play patterns. young people. Addiction 1993.RISKS OF ONLINE GAMBLING was found among those who drink less than weekly. 20:312–320. We. namely alcohol and cannabis use. 5. Discussion The analyses presented in this article show an unequal distribution of online gambling in the population. like others. StataCorp. 6.ledevoir. Psychology of Addictive Behaviours 2002. Cole T. Petry N. 2011). 9:520–542. 11. Le Devoir. (2001) The Canadian problem gambling index: ﬁnal report. Canada: Canadian Centre on Substance Abuse. 7:109–118. social. Finally. 88:791–804. This result should not be surprising. et al. Barrett D. and students among online gamblers. Grifﬁths M. All the results remained unchanged except three: (a) higher participation in lottery playing among ofﬂine gamblers became nonsigniﬁcant (b) higher prevalence of betting on slot machines among online gamblers became nonsigniﬁcant (c) higher prevalence of betting on video lottery terminals among online gamblers became nonsigniﬁcant. environmental conditions (the online setting).
UNLV Gaming Research & Review Journal 2005. Potvin L. Guelph. Address correspondence to: Dr. Gregory S. problems. Frohlich KL. and policy options. 23:776–797. Conceptualizing contemporary health lifestyles: moving beyond Weber. patterns. Final Report prepared for the Ontario Problem Gambling Research Centre. A theoretical proposal for the relationship between context and disease. M. Montreal. 16. A ‘‘components’’ model of addiction within a biopsychosocial framework. Sylvia Kairouz Department of Sociology and Anthropology Concordia University 1455 de Maisonneuve Blvd. 38:321–342. Williams RJ. (2009) Internet gambling: prevalence. 17. Proﬁle of Internet gamblers: betting on the future. Wood RT. Woodruff C.ca . 19. 18. 10:191–197. Ontario.180 15. Canada. Journal of Substance Use 2005. Corin E. The Sociological Quarterly 1997. Sociology of Health & Illness 2001. Cockerham WC. Grifﬁths. Rutten A. 9:1–14. Abel T. Quebec. KAIROUZ ET AL. H3G 1M8 Canada E-mail: skairouz@alcor. West.concordia.
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