Health Survey for England, 2021 part 2

This report includes results from the 2021 Health Survey for England describing gambling participation and the prevalence of at-risk and problem gambling.

Detailed tables accompanying this report can be accessed here.
 

• In 2021, 50% of adults had participated in a gambling activity in the last 12 months. Men (55%) were more likely than women (45%) to take part in any gambling activity.
• 10% of adults had participated in any online gambling (excluding National Lottery and other lotteries) in the last 12 months.
• According to their Problem Gambling Severity Index (PGSI) scores, 2.8% of adults were identified as engaging in at-risk or problem gambling and 0.3% as engaging in problem gambling.
• Men were more likely to be identified as engaging in at-risk or problem gambling than women (4.4% of men and 1.1% of women).
• People who had gambled and spent money on four or more different gambling activities in the last 12 months were more likely to engage in at-risk or problem gambling (27.8%) than those who gambled on two or three different activities (4.6%) or only one activity (1.6%).
• Among adults who had gambled in the last 12 months, their PGSI scores identified 5.8% as engaging in at-risk or problem gambling compared with 18.2% of those who had gambled online.

Great Britain has one of the most accessible gambling markets in the world. Opportunities to gamble exist on most high streets and, with access to the internet, in virtually every home. Concerns regarding the harms associated with gambling have been increasing in the UK in recent years and gambling is viewed as a public health issue.

This chapter looks at the types of gambling activities that all adults, aged 16 and over, have taken part in in the last 12 months. Taking part in a gambling activity was defined as having spent money on a gambling activity in the last 12 months. Prevalence of gambling is compared across different groups, including by region, household income and Index of Multiple Deprivation (IMD). Validated scales are used to estimate the prevalence of at-risk and problem gambling.

As data collection took place during the COVID-19 pandemic some gambling activities, such as those done in-person (e.g. at a bookmaker, casino, bingo hall) were not always available during the 12 months prior to participants completing the questionnaire. For this reason, along with those outlined elsewhere about methodology, comparisons between 2021 findings those from earlier HSE surveys have not been made.

The full questionnaires, including self-completion booklets, can be found within the Survey Documentation.

Questions about gambling were included in the self-completion booklet to ensure that they could be answered in confidence.

The questionnaire asked about participation in the past 12 months in 19 different types of gambling.

For those who had participated in any type of gambling in the past 12 months, there was a summary question about how often participants had spent money on gambling. Finally, there were questions asking about experiences connected with gambling: the Problem Gambling Severity Index and a screening instrument taken from the Diagnostic and Statistical Manual of Mental Disorders.

Problem Gambling Severity Index (PGSI)

The PGSI was designed for use among the general population rather than within a clinical context. It was developed, tested and validated within a general population survey of over 3,000 Canadian residents (Ferris and Wynne, 2001).

The instrument itself has been subject to critical evaluation and was revised in 2003. The PGSI consists of nine items ranging from ‘chasing losses’ to ‘gambling causing health problems’ to ‘feeling guilty about gambling’. Each item is assessed on a four-point scale: never, sometimes, most of the time, almost always.

Responses to each item are given the following scores: never = 0; sometimes = 1; most of the time = 2; almost always = 3. When scores to each item are summed, a total score can range from 0 to 27. The PGSI was also developed to give additional information on sub-threshold problem gamblers.

Diagnostic and Statistical Manual of Mental Disorders, fourth version (DSM-IV)

The DSM-IV screening instrument is based on criteria from the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) (APA, 1993). It was originally created as a clinical diagnostic tool and was not intended for use as a screening instrument among the general population.

An adapted version of the DSM-IV for use in a survey setting was developed for the British Gambling Prevalence Survey (BGPS) series and was subject to a rigorous development and testing process, including cognitive testing and piloting.

The DSM-IV contains ten diagnostic criteria ranging from ‘chasing losses’ to ‘committing a crime to fund gambling’. Each item is assessed on a four-point scale, ranging from ‘never’ to ‘very often’.

This report follows the scoring method used by the BGPS. Each item is coded according to whether the participant had a positive score, resulting in a total score between 0 and 10. Among clinicians, a diagnosis of pathological gambling is made if a person meets five out of the ten criteria. Many surveys, when adapting the DSM-IV criteria into a screening instrument for use within a general population survey, have included a category of “problem gambler” for those who meet at least three of the DSM-IV criteria (Fisher, 1996, Productivity Commission, 1999, Clarke et al, 2006, NGISC, 1999).

Types of gambling

As well as individual types of gambling, activities are summarised in four main ways within this publication.

• Any gambling refers to all types of gambling reported.
• Any gambling excluding the National Lottery includes all activities except the National Lottery draws. This category excludes those whose only gambling activity was playing the National Lottery.
• Any gambling excluding lotteries and scratchcards includes all activities except the National Lottery, other lotteries or scratchcards. This category excludes those who did not do any gambling activity other than lotteries or scratchcards.
• Online gambling refers to any gambling online, apart from National Lottery draws, for example online poker, bingo instant win/scratchcards games, slot machine style games or casino games for money and online betting with a bookmaker. Questions about participation in lotteries did not specify whether participation was online or offline, so these are excluded from the online category.

Problem gambling

The HSE uses two screening tools to identify at risk or problematic gambling: the DSM-IV criteria and the Problem Gambling Severity Index (PGSI) (Ferris and Wynne, 2001). A score of 3 or more for DSM-IV or a score of 8 or more for PGSI is indicative of problem gambling.

At-risk gambling

A score of 1 or more for PGSI is indicative of at-risk gambling. A score of 1 to 2 is considered low risk and a score of 3 to 7 is considered moderate risk.

In 2021, 50% of adults aged 16 and over had participated in some form of gambling in the last 12 months. A proportion of this is accounted for by the National Lottery: 36% had participated in gambling other than the National Lottery. When any lotteries or scratchcards are excluded, 18% of adults had participated in other types of gambling in the last 12 months.

The most popular gambling activities were:

• Tickets for National Lottery Draw (34%)
• Tickets for other lotteries (15%)
• Scratchcards (14%)
• Online betting with a bookmaker (8%)
• Betting on horse races at a bookmaker, by phone or at a racecourse (5%).

All other gambling activities had participation rates below 5%.

One in ten adults had participated in any online gambling in the last 12 months.

Men (55%) were more likely than women (45%) to take part in any gambling activity.

For more information: Table 1

The proportion of adults aged 16 and over who took part in gambling activities increased with age, with the highest gambling participation in those aged 45 to 54 (61%) before gradually decreasing with age to 45% in those aged 75 and over.

Gambling participation was lowest in those aged 16 to 34 (39%). In the UK, all types of gambling, including lotteries and scratchcards, are illegal for under 18s.

For more information: Table 2

Men were more likely than women to take part in gambling activities other than the National Lottery (39% and 33% respectively). The proportion of all adults aged 16 and over who took part in gambling activities excluding the National Lottery varied between age groups, following a similar pattern to that of all gambling activities.

When scratchcards and all lotteries were excluded, participation was also higher among men than women. Similar proportions of adults aged under 54 took part (between 22% of 16 to 34 year olds and 20% of 45 to 54 year olds), but participation declined with age thereafter.

Men were more likely than women to take part in online gambling activities excluding lotteries (14% and 5% respectively). The proportion of adults who took part in an online gambling activity decreased with age from 14% of those aged between 16 and 44, to 1% of those aged 75 and over.

For more information: Tables 1 and 2

Regional estimates are shown as observed and age-standardised estimates. Observed data show the actual prevalence rate. Age-standardised data take into account the different age profiles within regions enabling comparisons between regions. 

There were differences between regions in gambling participation rates. The proportion of adults who took part in any gambling activity in the last 12 months was highest in the North East (59%) and lowest in the South West (41%).

For more information: Table 3

There were also regional variations in the proportion of adults who participated in gambling activities other than the National Lottery and in those who participated in online gambling. Although the patterns of variation were not consistent, both types of gambling were highest in the North East, where 43% of adults participated in gambling other than the National Lottery and 15% participated in online gambling.

Participation in gambling activities other than the National Lottery was lowest in the South West, 27%, and online gambling was also lowest in the South West, 4%. 

For more information: Table 3

The HSE uses the measure of equivalised household income, which accounts for the number of adults and dependent children in the household as well as overall household income. Households are divided into quintiles (fifths) based on this measure. The age profile of the income quintiles has been age-standardised to account for differences in age profiles between households. For information about how equivalised income is calculated, see the HSE 2021 Methods report.

The proportion of adults who had participated in any type of gambling activity in the last 12 months was similar across household income levels. This was also the case for participation in any gambling activity excluding the National Lottery and for online gambling.

For more information: Table 4

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2021 Methods report.

The proportion of adults who had participated in any type of gambling activity in the last 12 months was similar across area deprivation levels. This was also the case for participation in any gambling activity (apart from the National Lottery) and in any online gambling.

For more information: Table 5

Adults who had gambled at least once in the past 12 months were asked how often they spent money on any gambling activities. The question did not distinguish the frequency of taking part in specific activities or types of activity.

The majority of adults who gambled in the past year reported spending money on gambling once a month or less (53%). 47% of adults who gambled did so more than once a month, including 22% who reported gambling once a week and 12% who reported gambling two or more times a week. There was a similar pattern for those who gambled on activities other than the National Lottery.

Adults who gambled online participated in gambling activities more often. 58% of those who gambled online spent money on all gambling activities, online or offline, more than once a month. This includes 21% who reported gambling once a week and 20% who reported gambling two or more times a week.

For more information: Table 6

From their responses to the PGSI questions, 2.8% of adults were identified as engaging in at-risk or problem gambling (score 1+).

Men were more likely to be identified as engaging in at-risk or problem gambling than women. 4.4% of men and 1.1% of women were identified as engaging in at-risk or problem gambling according to their PGSI scores.

The proportion of adults identified as engaging in at-risk or problem gambling was highest amongst those aged 35 to 44 (4.5%) and 45 to 54 (3.7%).

For more information: Table 7

Using PGSI scores, 0.3% of adults were identified as engaging in problem gambling (score 8+).  Using DSM-IV scores, 0.4% of adults were identified as engaging in problem gambling, defined as having a DSM-IV score of 3+.

For more information: Table 7

Among adults who gambled at all in the last 12 months, PGSI scores identified 5.8% as engaging in at-risk or problem gambling (score 1+).

The prevalence of at-risk and problem gambling was higher amongst gamblers when those gambling on the National Lottery only were excluded: 7.9% of individuals who gambled on any gambling activity apart from the National Lottery were identified as engaging in at-risk or problem gambling (PGSI score 1+).

The prevalence of at-risk and problem gambling was higher still amongst gamblers who gambled online. 18.2% of individuals who participated in online gambling activities were identified as engaging in at-risk or problem gambling.

For more information: Table 8

Among those who had gambled in the last year, 0.5% were identified as engaging in problem gambling according to their PGSI scores (8+) and 0.8% were identified as engaging in problem gambling according to their DSM-IV scores (3+).

For more information: Table 8

According to PGSI scores, the proportion of gamblers engaging in at-risk or problem gambling increased with the number of gambling activities gamblers spent money on.

• 1.6% of gamblers who spent money on only one gambling activity were identified as engaging in at-risk or problem gambling
• 4.6% of gamblers who spent money on two or three gambling activities were identified as engaging in at-risk or problem gambling
• 27.8% of gamblers who spent money on four or more gambling activities were identified as engaging in at-risk or problem gambling.

For more information: Table 9

The prevalence of problem gambling amongst gamblers increased with the number of gambling activities undertaken. Using DSM-IV scores, gamblers who spent money on four or more gambling activities in the last 12 months were more likely to engage in problem gambling (5.6%) than those who gambled on two or three activities (0.1%) or only one activity (0.2%). Similarly, using PGSI scores, gamblers who spent money on four or more gambling activities in the last 12 months were more likely to engage in problem gambling (3.6%) than those who gambled on two or three activities (0.1%) or only one activity (0.2%).

For more information: Table 9

American Psychiatric Association (1993). Diagnostic and statistical manual of mental disorders, 4^th edition. Washington DC: American Psychiatric Association. https://doi.org/10.1176/ajp.152.8.1228

Clarke D., Abbott M., Tse S., Townsend S. (2006). Gender, Age, Ethnic and Occupational Associations with Pathological Gambling in a New Zealand Urban Sample. New Zealand Journal of Psychology, 35(2), 84-91.https://mro.massey.ac.nz/bitstream/handle/10179/6163/NZJP-Vol352-2006-4-Clarke2.pdf

Ferris, J., Wynne, H. (2001). The Canadian Problem Gambling Index: Final Report. Canada: The Canadian Centre on Substance Abuse.

Fisher, S.E. (1996). Gambling and problem gambling among casino patrons, Report to the British Casino Industry Consortium, Plymouth UK.

National Gambling Impact Study Commission (NGISC) (1999). [USA] Final Report. http://govinfo.library.unt.edu/ngisc/reports/fullrpt.html

Productivity Commission, (1999). Australia’s gambling industries: Report no. 10. Canberra: AusInfo.

Wynn, H. (2003). Introducing the Canadian Problem Gambling Index. Wynne Resources: Canada. https://www.researchgate.net/profile/Harold_Wynne/publication/228460062_Introducing_the_Canadian_problem_gambling_index/links/0046351472fee04668000000/Introducing-the-Canadian-problem-gambling-index.pd