An analysis of Iowa gambling treatment completion and an exploration of disclosure among problem gamblers: an ecological approach

While a growing body of evidence suggests health-related behaviors, such as problem and pathological gambling, are affected by multiple levels of influence, gambling studies using an ecological approach have not been documented. This dissertation work, that contains three studies, contributes to fill such research gap by examining gamblers’ behaviors in formal treatment programs using an ecological approach. In study 1, the influences of the environmental and individual level factors on the treatment completion is examined. Previous studies have shown that treatment completion has a positive impact on the recovery path from gambling problems. In study 2 and study 3, interpersonal communication between gamblers and their social support networks is explored. More specifically, these two studies focus on understanding of the disclosure of gambling problems using the Integrated Model of Health Disclosure Decision-making. These two studies are significant because this may be the first attempt in gambling studies to explore disclosure of gambling problems. Disclosure may be a necessary step to ameliorate the negative consequences of gambling by creating or reinforcing gamblers’ social support network. Each of these studies uses a distinctive dataset and methodology. Study 1 uses the Iowa Gambling Treatment Outcome system data from 2005 to 2011 from the Iowa Department of Public Health. Study 2 uses the 2011 Iowa Gambling Attitude and Experiences survey data, which included questions designed specifically for gambling disclosure. Study 3 is based on qualitative data (interviews) collected from gamblers who disclosed their gambling problems within their social support network. Results from study 1 based on a generalized linear mixed model suggest that self-