Environmental Determinants of Health: A study of problem gambling in Montreal

Social and physical environments provide settings that can be more or less supportive of risky behaviours. The form of gambling linked most strongly to problem gambling, video lottery terminal (VLT) use, is used to study the link between environment and behaviour. First, people living closer to VLTs were hypothesized to be more likely to gamble due to greater accessibility. Second, social mechanisms, such as social norms, were hypothesized to cause spatial clustering of gambling prevalence rates. Data from a telephone survey of Montreal residents (Ladouceur 2004) were modeled hierarchically in a logistic multilevel model with 2007 individuals in 49 residential areas. Results show that respondents living in the bottom tertile of physical accessibility are almost half as likely to use VLTs as the remaining respondents. Also, VLT use prevalence rates show spatial clustering, even after controlling for compositional characteristics and physical accessibility. Environmental factors, both physical and social, are deemed to be intrinsic to problem gambling etiology and to health in general.