Other key aspects of problem gambling are sex and age variables as risk factors for developing problematic online gambling. Just as it has been observed that adolescents are particularly vulnerable to developing offline gambling problems (American Psychiatric Association, 2013; Caillon, Grall-Bronnec, Bouju, Lagadec, & Vénisse, 2012; Calado, Alexandre, & Griffiths, 2017), they are also vulnerable to developing online gambling problems (Gainsbury, 2015; Hubert & Griffiths, 2018). This general vulnerability can be explained by the developmental characteristics of adolescence, which is a period of particular vulnerability to engage in multiple forms of risky behaviours (Jessor, 1991) and develop addiction problems due to its immature self-regulation capacity, impulsivity, external locus of control and susceptibility to contextual factors (Hollén et al., 2020). Adolescents' online vulnerability could be due to their overall increased use of the Internet for gambling (Chóliz et al., 2019; King et al., 2020) thanks to the fact that they have grown up in a society where gambling is generally accepted, heavily available, and widely promoted through Internet (Volberg, 2010). They may be lured by the pop up gambling advertisements, offers of gifts and free play, tempting easy win messages, thrill of many online games, and visually exciting graphics and photos presented with the games (Derevensky & Gupta, 2007). In addition, adolescents can gamble with a small cost per session, using prepaid debit cards issued more easily and with fewer safeguards than the credit cards, or online intermediaries like PayPal (Floros, Siomos, Fisoun, & Geroukalis, 2013; Wong, 2010). In sum, the accessibility, affordability, convenience and anonymity of internet gambling may serve as a good mean for young people to engage in gambling activities without age verification and parental supervision (Elton-Marshall, Leatherdale, & Turner, 2016). This fact is specially worrying since several studies show that the lower the age of online gambling onset, the higher the probability of developing problematic online gambling and the more severe the psychosocial consequences are (Potenza et al., 2011; Wong, 2010).
Studies had to meet five inclusion criteria: (C1) evaluates some level of problematic online gambling (problem, pathological or disordered) through psychometric instruments that allow to establish different groups of gamblers; (C2) includes a study sample consisting of adolescents between 11 and 21 years; (C3) is published in either English or Spanish; (C4) is a quantitative empirical study with original data; and (C5) provides results on the prevalence of problematic online gambling.
Offline Gambler System V 7 0l
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In general, the cut-off points in diagnostic and screening instruments were equal to 4 or more satisfied criteria to classify adolescents as probable pathological gamblers and three criteria generally classified them as exhibiting problem or at-risk gambling. However, it is worth noting that not all the instruments used include the same number of items. For example, while the OGD-Q includes 11 items, the DSM-IV-MR-J includes 9 and the SOGS-RA 12. Also, there were more particularities in each study (see Table 2), such as in one study, in addition to defining the cut-off point of 4 criteria, accounted for the duration of symptoms to determine the diagnosis of an online gambling disorder, differentiating it from problem gambling (González-Cabrera et al., 2020), while another study designates a participant as at-risk/problem gambling by fulfilling only one criterion of the DSM-IV (Potenza et al., 2011).
It is important to note that the group made up of online and offline gamblers is known as mixed gamblers and, according to different studies, mixed gambling predicts both at-risk gambling and problematic gambling better than pure online gambling does. This could be because, beyond the characteristics of the internet, mixed gambling implies greater engagement in the behaviour due to the diversity of games, access modes and time spent on them. González-Roz et al. (2017) and Olason et al. (2011) suggested that this could explain the higher prevalence of at-risk and problem gambling found among adolescents who gamble online (and are mixed gamblers) compared to those who gamble offline in numerous studies, including eleven studies of the present review (e.g. Brunelle et al., 2012; Griffiths & Parke, 2010; Griffiths & Wood, 2007; Mcbride & Derevensky, 2012; Olason et al., 2011). In line with this issue, Blaszczynski, Russell, Gainsbury, and Hing (2016) conclude that exclusive online gamblers represent a different subpopulation at lower risk of harm (problem gambling, gambling involvement and consumption of alcohol) compared to gamblers engaging in multiple forms of gambling. This discussion could be compared to that described in the scientific literature on substance abuse about "polydrugs users", that is those who use multiple substances at the same time, who have more negative and severe social and health consequences compared to monosubstance users (Steele & Peralta, 2020).
Furthermore, as noted, the diagnostic criteria on which these tools were based have not been clinically tested on the adolescent population, which calls into question their validity for this population (Edgren et al., 2016; King et al., 2020; Stinchfield, 2010; Volberg et al., 2010). For some instruments, such as the MAGS or SOGS-RA, it has even been suggested that the criterion validity is not equivalent for boys and girls (Edgren et al., 2016). Moreover, none but one of the reviewed instruments has been validated in adolescent online gamblers (González-Cabrera et al., 2020), which could present a validity issue when assessing problematic online gambling in adolescents and in the highest-risk population: online gamblers. In general, there is limited assessment of the psychometric properties of the measurement instruments used in the studies and several authors recommended further research in this regard (Derevensky & Gupta, 2006; Edgren et al., 2016; King et al., 2020; Potenza et al., 2019; Stinchfield, 2010). In this review, only seven studies provided information on reliability using Cronbach's alpha, but it was insufficient (Edgren et al., 2016).
Regarding the differences found in prevalence according to sex, although only six studies analysed this issue, all of them indicated that boys have more problems related to online gambling than girls do, in line with findings on offline gambling (Calado et al., 2017). These results may have been skewed by the type of gambling included in each study and, therefore, cannot be considered conclusive. For example, boys place more online sports bets than girls do (Hollén et al., 2020; McCormack et al., 2014), which has been significantly associated with problematic online gambling (Olason et al., 2011; Potenza et al., 2011). However, recent studies have seen significant growth in online gambling behaviour in women and some trend changes in the development of online gambling problems (Hollén et al., 2020; McCormack et al., 2014; Volberg et al., 2018), which points to the need for further analysis on gender related differences in online gambling.
Regarding age, only three studies analysed its relationship with problem, pathological or disordered online gambling. As the results were contradictory, a firm conclusion cannot be established. For example, Potenza et al. (2019) and Floros et al. (2013) found no significant differences in age, whereas Andrie et al. (2019) observed a higher proportion of ARPG among older adolescents. In line with this, studies such as that of Hubert and Griffiths (2018), which included adolescents and adults, found that almost half of the pathological online gamblers were between the ages of 16 and 20.
Gambling has become an increasingly popular leisure activity throughout Europe (Calado and Griffiths 2016). New technologies have significantly facilitated this growth in the form of remote gambling including Internet gambling, mobile phone gambling, and interactive television gambling (Kuss and Griffiths 2012). Research examining Internet gambling suggests it may be more likely to contribute to problem gambling than gambling in offline environments among vulnerable individuals such as problem gamblers (Griffiths et al. 2009; Kuss and Griffiths 2012). There have been claims that increasing gambling opportunities via remote gambling have resulted in an increasing number of gamblers and that the problem is likely to get worse (Barrault and Varescon 2012). Identifying the specific characteristics of online and offline problem gamblers in specific cultures and/or jurisdictions may help in the development of culturally relevant prevention and treatment programs for gambling-related harm. Furthermore, variables such as cultural values and beliefs, the process of acculturation, and the influence of culturally determined help-seeking behaviors also need to be examined in relation to the role they could play in the initiation of and maintenance of gambling (Raylu and Oei 2004).
As Internet gambling has become more widespread, some studies have claimed that Internet gambling may be more problematic for vulnerable individuals because of its situational and structural properties such as availability, accessibility, affordability, anonymity, and convenience (McCormack and Griffiths 2013). Studies have also shown that gamblers themselves believe online gambling is more addictive than offline gambling and that online gambling will exacerbate gambling problems in society (e.g., McCormack and Griffiths 2012). Researchers have also attempted to establish whether offline problem gamblers differ from online problem gamblers (Griffiths 2010) and whether online gambling is more dangerous than offline gambling (Shaffer 2009). Despite the many European studies that have reported data on various aspects of gambling, data concerning online and offline gambling addiction in Portugal is almost non-existent. Based on the few studies carried out, the prevalence of gambling and problem gambling in Portugal appears to be similar to the corresponding figures in other European countries (Calado and Griffiths 2016). Gambling in Portugal has traditionally been confined to offline social gambling (e.g., EuroMillions and other lottery games, large land-based casinos, etc.). However, more recently, online betting has become more popular. In 2015, new gambling legislation was introduced regulating the industry in different areas both online and offline. 2ff7e9595c
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