Social suppo as a media o be ween
p oblem beha iou and gambling:
a c oss-sec ional s udy among
14–16-yea -old Finnish adolescen s
Tiina Räsänen,
1
Tomi Lin onen,
2
Asko Tol anen,
3
Anne Konu
1
To ci e: Räsänen T,
Lin onen T, Tol anen A, e al.
Social suppo as a media o
be ween p oblem beha iou
and gambling: a c oss-
sec ional s udy among
14–16-yea -old Finnish
adolescen s. BMJ Open
2016;6:e012468.
doi:10.1136/bmjopen-2016-
012468
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To iew hese iles please
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(h p://dx.doi.o g/10.1136/
bmjopen-2016-012468).
Recei ed 30 Ap il 2016
Re ised 3 No embe 2016
Accep ed 8 No embe 2016
Fo numbe ed a ilia ions see
end o a icle.
Co espondence o
D Tiina Räsänen; asanen.
iina.a@s uden .u a. i
ABSTRACT
Backg ound: Du ing he adolescen pe iod, isk-
aking beha iou inc eases. These beha iou s can
comp omise he success ul ansi ion om
adolescence o adul hood. The pu pose o his s udy
was o examine social suppo as a media o o he
ela ion be ween p oblem beha iou and gambling
equency among Finnish adolescen s.
Me hods: Da a we e ob ained om he na ional
School Heal h P omo ion S udy (SHPS) om he yea s
2010 and 2011 (N=102 545). Adolescen s we e
classi ied in he mos homogeneous g oups based on
hei p oblem beha iou ia la en class analysis.
Resul s: Pa h analysis indica ed ha social suppo
was nega i ely associa ed wi h p oblem beha iou , and
p oblem beha iou and social suppo we e nega i ely
ela ed (excep o social suppo om iends among
boys) o gambling. Social suppo om pa en s and
school media ed, albei weakly, he ela ions be ween
p oblem beha iou and gambling among gi ls and boys.
Conclusions: P oblem beha iou may a ec gambling
h ough social suppo om school and pa en s. Thus
p e en ion and in e en ion s a egies should ocus on
s eng hening adolescen s’social suppo . In addi ion,
because o he clus e ing o di e en p oblem
beha iou s ins ead o concen a ing on a single o m o
p oblem beha iou mul iple-beha iou in e en ions
may ha e a much g ea e impac on public heal h.
INTRODUCTION
Du ing he adolescen pe iod, isk- aking
beha iou inc eases.
1
Risk- aking includes
beha iou s ha a e done unde one’sown
oli ion, ha e unce ain ou comes and can
comp omise he success ul ansi ion om
adolescence o adul hood.
23
Risk- aking
beha iou s also mani es in he o m o
p oblem beha iou s, ac ions ha a e socially
disapp o ed and esul in social sanc ions.
These beha iou s can co-occu ; hus, in ol e-
men in one p oblem beha iou inc eases
he isk o in ol emen in o he p oblem
beha iou s, which is known as p oblem
beha iou synd ome.
45
Gambling may be a
componen o he p oblem beha iou syn-
d ome: p oblem gambling and egula gam-
bling (a leas once a week) a e associa ed
wi h conduc diso de , subs ance use and
delinquency.
6–9
Howe e , i is no known i
non-p oblem gambling and gambling ha is
no necessa ily egula is ela ed o he
p oblem beha iou synd ome. In Finland in
2010 gambling was allowed o adolescen s
aged 15 yea s and o e (excep In e ne and
casino gambling) and in 2011, 15-yea olds
could legally gamble a slo machines (all
o he gambling games had age limi o
18 yea s), which a e widely a ailable in
Finland. Adolescen s ha e also had posi i e
a i udes owa ds gambling in Finland.
10
Likewise, s udies ha e shown ha pa en s
and eache s do no hink ha gambling is a
g ea conce n among you h.
11 12
Acco ding o p oblem beha iou heo y, i
is he balance be ween p o ec i e and isk
S eng hs and limi a ions o his s udy
▪La ge scale, popula ion-based s udy explo ed he
ela ionship be ween gambling, p oblem beha -
iou and social suppo .
▪S udies ha e examined pa hways om social
suppo o bo h gambling and o he p oblem
beha iou s, bu esea ch ha ies o explain
how adolescen s’access o social suppo
accoun s o he associa ion be ween gambling
equency and p oblem beha iou , is lacking.
▪Tempo al ela ionship be ween hese ac o s
emains unclea , because o he c oss-sec ional
na u e o he s udy.
▪I may be ha he inal sample did no include
he adolescen s who we e engaging in he
highes le els o gambling and he highes le els
o p oblem beha iou .
▪Since his s udy was based solely on adolescen
sel - epo s, he e is he possibili y o o e o
unde - epo ing.
Räsänen T, e al.BMJ Open 2016;6:e012468. doi:10.1136/bmjopen-2016-012468 1
Open Access Resea ch
ac o s ha de e mines ones’in ol emen in p oblem
beha iou .
5
Social suppo p o ided by indi iduals and
ins i u ions can be desc ibed as in e pe sonal ela ion-
ships ha influence an indi idual’s unc ioning. Social
suppo is pa en s’closeness, moni o ing and ca ing,
eache s’in e es in hei s uden s, and iends’suppo -
i eness.
13
S udies ha e shown ha social suppo om
pa en s, iends and school all play a c ucial ole in ado-
lescen s’p oblem beha iou .
14–16
The e is also some e i-
dence indica ing ha amily cha ac e is ics influence
adolescen s’gambling.
17
Specifically, highe le els o
pa en al a achmen , moni o ing and supe ision a e
linked o dec eased gambling, while lowe le els o pa -
en al us and communica ion a e associa ed wi h
inc eased gambling.
18
Low le els o pa en al moni o ing
o adolescen s is also associa ed wi h p oblem gambling
du ing young adul hood.
19
Addi ionally, adolescen
p oblem gamble s end o pe cei e lowe le els o amil-
ial and pee suppo .
20
While p e ious s udies ha e
examined sha ed p edic o s be ween gambling, p oblem
beha iou s and pa en ing, he findings o hese s udies
do no p o ide e idence ha pa en al supe ision o
moni o ing a e ela ed o gambling as i is he case o
o he p oblem beha iou s.
21 22
Mo eo e , iends’
app o al o gambling, associa ing wi h de ian pee s,
associa ing wi h iends who gamble and ha ing iends
who ha e gambling p oblems a e associa ed wi h adoles-
cen gambling.
82324
Howe e , he only school cha ac e -
is ics ha ha e been s udied in he con ex o gambling
a e suspension a es, low school commi men and
schools’ ewa ds o p osocial in ol emen . These we e
ei he weakly o no a all associa ed wi h gambling.
25 26
S udies examining he associa ions be ween schools’
social suppo and gambling, a e lacking.
Ea lie s udies ha e demons a ed ha he e a e
gende di e ences in gambling as well as p oblem
beha iou . Fo example, gambling is mo e common
among men
27
and men also end o s a gambling a a
younge age.
28
Addi ionally, men ha e a highe isk o
hea y alcohol use and smoking.
29 30
Howe e , li le is
known abou gende di e ences in ela ion o
co-occu ence o gambling equency and p oblem
beha iou s. I is also unclea i he e a e gende di e -
ences in associa ions be ween gambling, p oblem beha -
iou and social suppo .
In s udies ha assess gambling, p oblem beha iou
and isk/p o ec i e ac o s, a limi ed numbe o
p oblem beha iou s (eg, gambling, subs ance use and
delinquency) a e examined and he ocus is on pa en al
moni o ing, indi idual ac o s (impulsi i y, mo al disen-
gagemen ) and pee delinquency,
21 22 31 32
he eby
excluding social suppo om impo an indi iduals and
ins i u ions, like iends and school. P e ious s udies
ha e examined pa hways om social suppo o bo h
gambling and o he p oblem beha iou s, bu esea ch
ha ies o explain how adolescen s’access o social
suppo accoun s o he associa ion be ween gambling
equency and p oblem beha iou , is lacking. Thus, he
ole o social suppo in he associa ion be ween
p oblem beha iou and gambling has no been in es i-
ga ed. As ea lie s udies ha e shown ha gambling is
associa ed wi h p oblem beha iou and he deg ee o
social suppo ha an adolescen ecei es is ela ed o
bo h gambling equency and p oblem beha iou ; i is
easonable o expec ha social suppo plays an impo -
an ole in he ex en o which p oblem beha iou s a e
ela ed o gambling equency. The e o e, using a
popula ion-based su ey o 8 h and 9 h g ade boys and
gi ls, he aim o his s udy was o in es iga e he ela ions
be ween p oblem beha iou and gambling equency,
and social suppo as a po en ial media o o his associ-
a ion (ie, se e as a p o ec i e ac o ). I is assumed ha
highe social suppo would be nega i ely associa ed
wi h p oblem beha iou and gambling.
METHOD
Se ing
In Finland, compulso y basic comp ehensi e school
s a s a age 7 (1s g ade) and ends a he age o 16 yea s
(9 h g ade). Du ing he 8 h and 9 h g ade boys and
gi ls a e be ween 14 and 16 yea s o age.
The Finnish gambling sys em is based on a s a e mon-
opoly; he p ofi s a e e u ned o socie y and used o
common good. In addi ion, he games a e widely a ail-
able in public places. The gambling age limi was se o
18 yea s in Oc obe 2010. The limi was also applied o
slo machines in July 2011, and p io o ha he age
limi was age 15 yea s. A he ime o su ey comple ion,
he age limi o gambling was 18 yea s and 15 yea s o
slo machines.
Da a
Da a we e ob ained om he na ional School Heal h
P omo ion S udy (SHPS) in 2010 and 2011, which
included ques ions on adolescen s’gambling, p oblem
beha iou and social suppo . In 2010, he s udy was
conduc ed in sou he n, eas e n and no he n Finland
and in wes e n and cen al Finland in 2011. Thus, he
2010 and 2011 su eys co e all o Finland, and in each
yea only a ew municipali ies e use o pa icipa e.
33
The municipali ies ha did no pa icipa e do no di e
om he o he s and his pa o he d op-ou is no
likely o pose a h ea o gene alisabili y. In 2010, 78% o
Finnish 8 h and 9 h g ade s we e su eyed, and in 2011
81% o Finnish 8 h and 9 h g ade s pa icipa ed in he
s udy. Responden s who had no answe ed o e hal o
he ques ions, o had no exp essed hei sex o g ade,
we e emo ed. Also hose who we e no in school when
su ey was conduc ed o could no answe independ-
en ly did no pa icipa e.
33
SHPS is a c oss-sec ional
su ey adminis e ed h oughou he school day in he
8 h and 9 h g ades o lowe seconda y schools.
Answe ing was olun a y. Pa en al consen was no
equi ed acco ding o e hical guidelines in Finland; gen-
e ally, su eys conduc ed du ing school days do no
2Räsänen T, e al.BMJ Open 2016;6:e012468. doi:10.1136/bmjopen-2016-012468
Open Access
need pa en al pe mission. In o al, 102 545 8 h (mean
age=14.9, SD=0.4) and 9 h (mean age=15.9, SD=0.4)
g ade s uden s pa icipa ed in he s udy. Fo y-nine pe
cen o su ey esponden s we e boys.
Measu es
P oblem beha iou
P oblem beha iou was measu ed h ough 11 di e en
o ms o p oblem beha iou s conce ning adolescen s’
uancy, bullying, delinquency, smoking, using snu ,
alcohol d inking, d unkenness- ela ed d inking, using
alcohol and medicine o in oxica ion, using medicine
o in oxica ion, glue-sni fing and d ug use. Mo e
de ailed in o ma ion abou ques ions ega ding p oblem
beha iou can be ound elsewhe e.
34
Since p oblem
beha iou indica o included measu es wi h mul iple
beha iou ypes and esponses, which we e no necessa -
ily iden ically scaled, la en classes we e es ima ed. Based
on la en class analysis (LCA) adolescen s we e di ided
in o ou g oups. F om hese g oups hose who pa ici-
pa ed in p oblem beha iou he mos and he leas we e
selec ed om he da a o s udy ex emi ies o he
p oblem beha iou phenomenon.
Social suppo om iends
Social suppo om iends was eques ed by ques ion:
Do you ha e a his momen any close iend whom you
can alk wi h confiden ially almos e e y hing?
Al e na i es we e I do no ha e any iends, one close
iend, wo close iends and se e al close iends.
Social suppo om school
Social suppo om school based on h ee s a emen s
and wo ques ions abou schools’and eache s’suppo .
S a emen s we e: eache s encou age me o imp ess my
own opinions a classes, eache s a e in e es ed abou
how I am doing and eache s a e ea ing s uden s ai ly.
The scale o hese was o ally ag ee, ag ee, disag ee and
o ally disag ee. S uden s we e also asked: do you ha e
oubles ge ing along wi h you eache s. Al e na i es
we e no a all, ai ly li le, ai ly much and e y much.
As well adolescen s we e eques ed i hey had oubles
wi h school wo k, how o en hey go help om school.
Al e na i es we e always when I need i , mos o he
ime, a ely and almos ne e . All o he s a emen s and
ques ions we e coded om one o ou , ou indica ing
good social suppo . F om hese fi e a iables he sum
a iable was c ea ed, which had one componen s uc-
u e wi h C onbach’sα alue o 0.7.
Social suppo om pa en s
Social suppo was examined by ou ques ions. S uden s
we e asked do hei pa en s know all o his/he iends.
This ques ion had al e na i es bo h pa en s do (coded
as h ee), only mo he / a he knows (coded as one)
and nei he o hem know (coded as ze o). Second
ques ion was, do you pa en s know whe e you spen
you F iday and Sa u day e enings, which had
al e na i es hey know always (coded as h ee), know
some imes (coded as one) and mos o he ime hey do
no know (coded as ze o). Adolescen s we e also asked
can hey alk wi h hei pa en s: almos ne e (coded as
ze o), some imes (coded as one), ai ly o en (coded as
wo) and o en (coded as h ee). The las ques ion was i
adolescen s had oubles wi h school wo k, how o en
hey go help om home. Al e na i es we e always when
I need i (coded as h ee), mos o he ime (coded as
wo), a ely (coded as one) and almos ne e (coded as
ze o). These ou ques ions measu ing he social
suppo om pa en s had one componen s uc u e,
which had C onbach’sα alue o 0.6.
Gambling
Gambling was eques ed by one ques ion: How o en do
you gamble? Al e na i es we e on 6–7 days pe week, on
3–5 days pe week, on 1–2 days pe week, less han once
a week, less han once a mon h, I ha e no gambled
du ing p e ious yea .
S a is ical analysis
Basic s a is ical analyses we e conduc ed wi h IBM SPSS
S a is ics V.22, and s uc u al equa ion modelling was
conduc ed wi h Mplus V.7.0.
35
Basic s a is ical analyses
included χ
2
- es ( o ca ego ical da a) and
Mann-Whi ney U es ( o con inuous da a), which a e
used o de ec s a is ically significan di e ence be ween
wo o mo e g oups. LCA was used o iden i y g oups o
adolescen s based on hei in ol emen in di e en
p oblem beha iou s. The pu pose was o iden i y he
mos homogeneous g oups ha include ex eme classes
o p oblem beha iou . LCA p o ides fi s a is ics and sig-
nificance es s o assess he numbe o classes ha bes
fi he da a.
36
To selec he numbe o classes o he
model, he analysis was fi s un wi h one class, hen
wi h wo and h ee classes and so on. This p ocedu e
was ollowed un il o he highes possible numbe o
classes we e un (which was in his case 11). Model solu-
ions we e assessed by examining he en opy alues
(nea 1.0), he Lo-Mendell-Rubin es (a p alue ha
p o ides in o ma ion abou s a is ically significan
imp o emen in fi o he inclusion o an addi ional
class) as well as he in e p e a ion o he esul s.
37
Fo
u he analysis, all indi iduals we e classified in o classes
whe e class membe ship was based on he highes pos-
e io p obabili ies.
Based on he LCA esul s, pa h analysis was conduc ed
o hose who pa icipa ed in he mos and he leas
p oblem beha iou s. The analysis was conduc ed o
examine i social suppo media es he associa ion
be ween p oblem beha iou and gambling. In his
model, gambling equency was eg essed on he h ee
o ms o social suppo , and o ms o social suppo
we e hen eg essed on p oblem beha iou (figu e 1).
Analyses we e un sepa a ely o 8 h and 9 h g ade gi ls
and boys gi en he possible di e ences in he ela ion
be ween gambling and p oblem beha iou . All he
Räsänen T, e al.BMJ Open 2016;6:e012468. doi:10.1136/bmjopen-2016-012468 3
Open Access
models we e sa u a ed, so he model fi s we e necessa ily
pe ec .
RESULTS
La en class analysis
Adolescen s who did no gamble du ing he p e ious
yea (37.3%) o had missing alues on he main
ou come a iable (1.3%) we e excluded. This was
ca ied ou because we we e only in e es ed in adoles-
cen s who we e gambling. Fo he emaining 62 956
indi iduals, LCA was conduc ed sepa a ely o 8 h and
9 h g ade gi ls and boys o iden i y g oups o adolescen s
based on hei p oblem beha iou s. Fo all 8 h and 9 h
g ade gi ls and boys, he op imal model had ou classes
wi h en opy alues anging om 0.88 o 0.83. The ea-
sonably high en opies and he Lo-Mendell-Rubin es p
alues sugges ed a good model fi o he ou class
model. Howe e , among 8 h g ade gi ls and 9 h g ade
boys, he p alues we e lowe han 0.05, indica ing ha
he fi e o mo e class model was a be e fi . Howe e ,
a e aking in o accoun he en opies and he in e -
p e a ion o he esul s, he ou class model was chosen
o all pa icipan s ( able 1).
Class 1 included adolescen s who pa icipa ed in all
o ms o p oblem beha iou s a he highes equency
(see e . 33). Fo example, adolescen in class 1 smoked
a leas daily, d ank alcohol on a weekly basis and had
ied d ugs a leas once. You h in class 2 also pa ici-
pa ed in p oblem beha iou , bu hei pa icipa ion in
p oblem beha iou s was mo e expe imen al. In addi ion,
mos o he you h in class 2 did no use alcohol wi h
medicine o in oxica ion, use medicine o in oxica ion
and did no pa icipa e in glue sni fing. In class 3, ado-
lescen s smoked obacco less o en han once a week
and consumed alcohol only a couple o imes a mon h.
The you hs in class 4 did no pa icipa e in any o m o
p oblem beha iou . F om hese g oups, class 1 and class
4 we e selec ed, including adolescen s pa icipa ing
egula ly in all examined p oblem beha iou s and hose
no pa icipa ing in any, which allowed o he s udy o
he ex emes o p oblem beha iou (N=29 870).
Gambling, p oblem beha iou and social suppo
The nex se o analyses compa ed he adolescen s who
pa icipa ed in he mos p oblem beha iou and he
adolescen s ha pa icipa ed in he leas p oblem beha -
iou . Boys gambled mo e han gi ls did (χ
2
(4)
=3280.182, p<0.001); howe e , pa icipa ion in p oblem
beha iou was mo e common among gi ls (χ
2
(1)
=1313.636, p<0.001) ( able 2). Gi ls expe ienced mo e
social suppo om iends (χ
2
(4)=553.19, p<0.001),
and boys ecei ed mo e suppo om school
(U=88080721, p<0.001) and om pa en s (U=84026360,
p<0.001) ( able 2). 9 h g ade s gambled (boys: χ
2
(4)
=11 395 p=0.022), (gi ls: χ
2
(4)=25.416, p<0.001) and
pa icipa ed in p oblem beha iou (boys: χ
2
(1)
=126.024, p<0.001), (gi ls: χ
2
(1)=367.030, p<0.001)
mo e o en han 8 h g ade s. Eigh h g ade boys also
expe ienced mo e social suppo om iends (χ
2
(3)
=25.933), p<0.001), school (U=52467017.0, p<0.01), and
pa en s (51780278.5, p<0.001) han 9 h g ade boys.
Eigh h g ade gi ls expe ienced mo e social suppo
om school (U=9696512.5, p<0.001) and pa en s
(U=9817557.0, p<0.01), bu he e we e no s a is ical di -
e ences in social suppo om iends ( able 2). Among
gi ls who gambled on weekly basis, 50% o 8 h g ade s
and 74% o 9 h g ade s also pa icipa ed in p oblem
beha iou . Among he boys, he pe cen age was 14% o
8 h g ade s and 22% o 9 h g ade s.
Pa h analysis
The s anda dised pa ame e es ima es (β) shown in
able 3 indica ed ha p oblem beha iou was signifi-
can ly and posi i ely ela ed o adolescen s’gambling
equency (pa h c). The βindices also showed ha
he e was a significan nega i e associa ion be ween
p oblem beha iou and he di e en ypes o social
suppo ; howe e , among 9 h g ade gi ls, social suppo
om iends was no s a is ically significan (pa hs d– ).
Social suppo om pa en s and school we e nega i ely
ela ed wi h gambling (pa hs g and i). Among boys,
social suppo om iends was significan and posi i ely
associa ed wi h gambling; howe e , among gi ls social
suppo om iends was significan ly and nega i ely
associa ed wi h gambling (pa h h) ( able 3; also see
figu e 1).
The s a is ically significan albei e y small indi ec
e ec s indica ed ha social suppo media ed he ela-
ionship be ween p oblem beha iou and gambling e-
quency, bu social suppo om iends did no media e
his associa ion. The o al e ec o p oblem beha iou
Figu e 1 Pa h model o he
associa ions be ween he social
suppo om iends (SSF), social
suppo om school (SSS), social
suppo om pa en s (SSP),
p oblem beha iou and gambling
equency among 8 h and 9 h
g ade boys and gi ls.
4Räsänen T, e al.BMJ Open 2016;6:e012468. doi:10.1136/bmjopen-2016-012468
Open Access
on p oblem gambling equency consis ed o a di ec
e ec and an indi ec e ec h ough social suppo
( able 3). Fo y- wo pe cen and 49% o he a iance
(R
2
) was explained by he associa ion be ween gambling
and social suppo o 8 h g ade and 9 h g ade boys,
espec i ely. Fo 8 h g ade gi ls, 63% o he a iance was
explained and 69% o he a iance was explained o
9 h g ade s.
DISCUSSION
This la ge scale, popula ion-based s udy explo ed he
ela ionship be ween p oblem beha iou , gambling and
social suppo among 14–16-yea -old adolescen s. The
main pu pose o he s udy was o examine whe he
social suppo would media e his associa ion. Social
suppo om pa en s and school media ed weakly he
ela ions be ween p oblem beha iou and gambling
among gi ls and boys. Social suppo om iends did
no media e his associa ion. Thus, he da a sugges ha
he ela ion be ween p oblem beha iou and gambling
can be explained only by he deg ee o social suppo
ecei ed om school and pa en s; he e may be o he
issues o phenomena ha a e mo e impo an in media -
ing his associa ion.
In acco dance wi h he Mun e al
38
esea ch, his s udy
indica ed ha p oblem beha iou did clus e a he bo h
ends o he li es yle spec um (ie, ‘p oblem’o ‘non-
p oblem’beha iou pa e ns among adolescen s).
Wi hin hese wo classes, he e we e adolescen s who
pa icipa ed egula ly in all o ms o p oblem beha iou s
and hose who did no pa icipa e in any p oblem beha-
iou s. Addi ionally, his s udy ound ha p oblem
beha iou and gambling we e associa ed, wi h p oblem
beha iou inc easing as he equency o gambling
inc eased. This is simila o p e ious s udies.
72232
These
esul s may indica e ha in ol emen in one p oblem
beha iou also inc eases he isk o in ol emen in o he
p oblem beha iou s, as demons a ed by p oblem beha -
iou heo y.
413
To he bes o ou knowledge, his is he fi s s udy o
examine whe he social suppo om school is asso-
cia ed wi h gambling equency. Ea lie s udies ha e
assessed school cha ac e is ics, such as suspension a es,
school commi men and schools’ ewa ds o p osocial
in ol emen .
25 26
In he cu en s udy, social suppo
om school was significan ly ela ed o gambling e-
quency, wi h lowe suppo ela ed o highe gambling
pa icipa ion. In addi ion, low social suppo om
pa en s and iends was ela ed o inc eased gambling,
which is consis en wi h he findings o Ha doon e al.
20
In hei s udy, hey epo ed significan di e ences
be ween gambling se e i y g oups in hei le els o
amily and pee suppo . Specifically, hei esul s indi-
ca ed ha non-gamble s and social gamble s expe i-
enced mo e social suppo han a - isk and pa hological
gamble s. Howe e , in he cu en s udy, his pa e n was
ound only o emale adolescen gamble s. Fo boys,
Table 1 Resul s o he LCA
8 h g ade boys 9 h g ade boys 8 h g ade gi ls 9 h g ade gi ls
n o classes en opy
Lo-Mendell-
Rubin n o classes en opy
Lo-Mendell-
Rubin n o classes en opy
Lo-Mendell-
Rubin n o classes en opy
Lo-Mendell-
Rubin
1 class model 19 471 NA NA 21 711 NA NA 9432 NA NA 12 342 NA NA
2 class model c1=6805
c2=12 666
0.86 0.00 c1=25 768
c2=37 188
0.85 0.00 c1=3591
c2=5841
0.86 0.00 c1=5445
c2=6897
0.82 0.00
3 class model c1=1975
c2=6813
c3=10 683
0.90 0.00 c1=9482
c2=26 304
c3=27 170
0.89 0.00 c1=1734
c2=3706
c3=3992
0.88 0.00 c1=2645
c2=3707
c3=5990
0.88 0.00
4 class model c1=586
c2=5377
c3=3065
c4=10 443
0.88 0.04 c1=911
c2=4734
c3=7233
c4=8833
0.86 0.00 c1=513
c2=2123
c3=3240
c4=3556
0.86 0.00 c1=1473
c2=4145
c3=3169
c4=3555
0.83 0.00
5 class model c1=567
c2=2829
c3=4543
c4=2956
c5=8576
0.81 0.70 c1=503
c2=2290
c3=6086
c4=4142
c5=8690
0.85 0.00 c1=138
c2=1165
c3=1641
c4=3013
c5=3475
0.86 0.00 c1=159
c2=1910
c3=2865
c4=3543
c5=3865
0.84 0.76
Bold cha ac e s ep esen hose pa icipa ing in p oblem beha iou he mos and he leas .
LCA, la en class analysis; NA, no applicable.
Räsänen T, e al.BMJ Open 2016;6:e012468. doi:10.1136/bmjopen-2016-012468 5
Open Access

social suppo om iends was posi i ely ela ed o gam-
bling equency. I migh be ha gambling is social ac i -
i y o boys, bu o gi ls gambling may be an ac i i y
ha subs i u es no mal social con ac s. P oblem gam-
bling may occu in he absence o iends, whe eas non-
p oblema ic gambling may be pa o a social pas ime.
20
Gambling was mo e common among boys, which is con-
sis en wi h p e ious s udies;
623
howe e , o e 50% o
8 h g ade and 74% o 9 h g ade gi ls who gambled on a
weekly basis pa icipa ed in p oblem beha iou . This
indica es ha ac i e gambling among gi ls is s ongly
linked o p oblem beha iou and hus a phenomenon
ha should be s udied mo e ex ensi ely.
Al hough he findings o his s udy indica ed ha
social suppo media ed he associa ion be ween
p oblem beha iou and gambling equency, he
Table 2 Adolescen s’in ol emen in gambling and p oblem beha iou , and expe iencing SSF, SSS and SSP based on hei
sex and g ade
8 h g ade
boys
9 h g ade
boys
8 h g ade
gi ls
9 h g ade
gi ls
Boys s
gi ls
8 s9
g ade
Pe cen
Gambling p<0.001
e a:0.278
p=0.022
e a:0.01
Less han once a mon h 38.4 34.1 73.7 69.9
Less han once a week 28.8 30.3 15.7 18.1
1–2 days pe week 18.7 19.6 5.0 6.2
3–5 days pe week 8.1 9.3 2.2 3.0
6–7 days pe week 6.1 6.8 3.4 2.8
Pa icipa ing in p oblem
beha iou
5.3 9.3 12.6 29.3 p<0.001
e a: 0.210
p<0.001
e a: 0,14
SSF p<0.001
e a: 0.101
p=0.029
e a:0.015
Do no ha e any iends 13.7 15.3 7.1 6.7
One close iend 24.1 26.0 20.7 21.6
Two close iends 20.5 19.1 27.5 27.2
Se e al close iends 40.9 39.0 44.5 44.3
Missing alues 0.8 0.7 0.2 0.3
x (SD)
SSS 2.8 (0.5) 2.7 (0.6) 2.7 (0.5) 2.7 (0.6) p<0.001
e a: 0.003
p<0.001
e a: 0.002
SSP 2.2 (0.6) 2.2 (1.2) 2.1 (0.7) 2.0 (0.7) p<0.001
e a: 0.005
p<0.001
e a: 0.001
n 11 029 9744 4069 5028 29 870 29 870
E a alues indica e he s eng h o associa ions.
ss , social suppo om iends; ssp, social suppo om pa en s; sss, social suppo om school.
Table 3 Pa h model o he di ec and indi ec e ec s be ween he ss , sss, ssp, pb and gambling equency (gb) among 8 h
and 9 h g ade boys and gi ls
8
h
g ade boys 9
h
g ade boys 8
h
g ade gi ls 9
h
g ade gi ls
ββββ
Di ec e ec c (pb o gb) 0.35*** 0.36*** 0.34*** 0.36***
Pa h om pb o sss (pa h e) -0.30*** -0.36*** -0.43*** -0.46***
Pa h om pb o ss (pa h d) -0.09*** -0.07*** -0.08*** -0.01
Pa h om pb o ssp (pa h ) -0.37*** -0.39*** -0.19*** -0.50***
Pa h om sss o gb (pa h h) -0.11*** -0.13*** -0.06** -0.11***
Pa h om ss o gb (pa h g) 0.07*** 0.04*** -0.08*** -0.09***
Pa h om ssp o gb (pa h i) -0.09*** -0.08*** -0.10*** -0.06***
To al e ec c' (pb o gb) 0.41*** 0.43*** 0.42*** 0.44***
To al indi ec e ec c-c' 0.06*** 0.07*** 0.08*** 0.08***
Pa h om pb o sss o gb 0.03*** 0.05*** 0.03** 0.05***
Pa h om pb o ss o gb -0.01*** -0.00*** 0.01*** 0.00
Pa h om pb o ssp o gb 0.03*** 0.03*** 0.05*** 0.03***
** p<0.01, ***p<0.001
6Räsänen T, e al.BMJ Open 2016;6:e012468. doi:10.1136/bmjopen-2016-012468
Open Access
empo al ela ionship be ween hese ac o s emains
unclea . Thus, addi ional esea ch is needed using longi-
udinal da a. Addi ionally, i is impo an o no e ha
while social suppo om iends, pa en s and school
we e significan ly associa ed wi h gambling, he pa h
coe ficien s we e low among boys and gi ls and may due
o la ge sample size. Fu he mo e, pa h coe ficien s o
he indi ec e ec s we e low. This may indica e ha
social suppo does no play a la ge in he associa ion
be ween p oblem beha iou and gambling. The e may
be addi ional ac o s ha play a mo e impo an ole in
his associa ion, such as ha ing iends o pa en s who:
gamble, ha e a gambling p oblem o pa icipa e in
o he p oblem beha iou s o indi idual ac o s such as
low sel -con ol o conduc diso de . These ypes o
ac o s ha e been examined in p e ious
s udies.
7 8 18 21 23 24
Fu he mo e, gambling equency was assessed by a
single i em, and he e was no alida ed p oblem gam-
bling sc een used he ein. Howe e , he goal o he s udy
was o s udy gambling in ol emen and i s associa ions
wi h p oblem beha iou s and social suppo , no o iden-
i y p oblem gamble s. The su ey did no collec add-
i ional in o ma ion on gambling beha iou (eg, how
much money is spen on gambling), no was in o ma-
ion abou gambling ypes. Addi ionally, he defini ion
o gambling was no gi en in he ques ionnai e, so ado-
lescen s could in e p e gambling in many ways.
34 39
Also we did no use a alida ed measu e o social
suppo . The in e nal consis ency o he scale o ‘social
suppo om pa en s’was no op imal as indica ed by
he low alue o C onbach’sα. Howe e , alidi y is sup-
po ed by he ac ha he p incipal componen analysis
indica ed one componen s uc u e.
In addi ion, da a we e collec ed om 78% o Finnish
8 h and 9 h g ade s in 2010 and om 81% o Finnish
8 h and 9 h g ade s in 2011. Howe e , i may be ha he
final sample did no include he adolescen s who we e
engaging in he highes le els o gambling and he
highes le els o p oblem beha iou . Mo eo e , since his
s udy was based solely on adolescen sel - epo s, he e is
he possibili y o o e o unde - epo ing.
Despi e he limi a ions, media ion e ec s we e
de ec ed, which ha e heo e ical impo ance as well as
significan implica ions o in e en ion. Specifically, p e-
en ion and in e en ion s a egies should ocus on
s eng hening adolescen s’social suppo om pa en s
and school. In addi ion, because o he clus e ing o di -
e en p oblem beha iou s and he ac ha p oblem
beha iou was linked o gambling, ins ead o concen a -
ing on a single o m o p oblem beha iou mul iple-
beha iou in e en ions may ha e a much g ea e
impac on public heal h.
40
Au ho a ilia ions
1
School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland
2
Finnish Founda ion o Alcohol S udies, Helsinki, Finland
3
Depa men o Psychology, Uni e si y o Jy äskylä, Jy äskylä, Finland
Con ibu o s TR, AT, TL and AK we e in ol ed in s udy concep ion and
design. TR, AT, TL and AK analysed and in e p e ed he da a. TR d a ed he
manusc ip . AT, TL and AK c i ically e ised he manusc ip .
Funding This s udy was inancially suppo ed by he Finnish Founda ion o
Alcohol S udies. The Finnish Founda ion o Alcohol S udies had no
in ol emen in he s udy design, da a handling, w i ing o submission o he
manusc ip . The g an s awa ded by he Finnish Founda ion o Alcohol
S udies o gambling esea ch a e based on a go e nmen con ac o
s udying gambling- ela ed ha m.
Compe ing in e es s None decla ed.
E hics app o al The e hical commi ee o Tampe e Uni e si y Hospi al.
P o enance and pee e iew No commissioned; ex e nally pee e iewed.
Da a sha ing s a emen No addi ional da a a e a ailable.
Open Access This is an Open Access a icle dis ibu ed in acco dance wi h
he C ea i e Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license,
which pe mi s o he s o dis ibu e, emix, adap , build upon his wo k non-
comme cially, and license hei de i a i e wo ks on di e en e ms, p o ided
he o iginal wo k is p ope ly ci ed and he use is non-comme cial. See: h p://
c ea i ecommons.o g/licenses/by-nc/4.0/
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