Perceived Stress and Avoidant Coping Moderate Disordered Gambling Among Emerging Adults in Vietnam

Abstract

Gambling research conducted in Asia has been limited, despite a continued growth of the gambling industry within the region. Outside Asia, research suggests emerging adults have high rates of gambling behavior and experience serious consequences. The current study examines gambling behavior within an emerging adult (ages 16-24) population in Vietnam. The study evaluates gambling and tests a moderation model of stress and coping in relation to gambling. The rate of disordered gambling in this sample using the South Oaks Gambling Screen (SOGS, 3+) is 15%, slightly higher in comparison to samples of similar aged youth in other countries. Results also indicate avoidant coping moderated the relationship between gambling frequency and gambling problems, such that frequency was more strongly associated with gambling problems among individuals higher in avoidant coping. Etiological and epidemiological implications are discussed in the context of a developmental perspective on disordered gambling among Vietnamese emerging adults.

Keywords

gambling stress and coping Vietnamese emerging adults

Almost every culture from around the world engages in some form of gambling, with 149 countries currently having some form of government-sanctioned gambling. Gambling can be defined as placing something of value (e.g., money) at risk on an event that has an uncertain outcome, with the possibility of resulting in either a larger, more beneficial outcome (e.g., more money) or the loss of the thing of value. Research suggests that most people gamble either not at all or recreationally and experience little to no problems associated with their gambling (Shaffer & Korn, 2002). Despite relatively stringent criteria in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., 1994, American Psychiatric Association) for a diagnosis of pathological gambling, most clinicians and researchers recognize the existence of subclinical symptoms of pathological gambling and have used the terms problem, compulsive, or potential pathological gambling to refer to excessive gambling resulting in subclinical levels of symptomatology. Thus, gambling can be conceptualized as occurring along a continuum, ranging from no gambling or nonproblematic or social gambling (Level 1), to at-risk gambling (Level 2), to diagnosable pathological gambling (Level 3; Shaffer & Hall, 2001). The term “disordered gambling” was coined by Howard Shaffer and Hall to encompass both problematic and pathological gambling behaviors. Thus, disordered gambling refers to the problematic gambling spectrum from Level 2 (at-risk gambler) and includes those individuals meeting DSM-IV criteria for pathological gambling as typically assessed using the South Oaks Gambling Screen measure (SOGS; Lesieur & Blume, 1987).

Understanding the rates of gambling behavior and consequences that disordered gamblers face can be an important step in identifying a serious public health issue (Shaffer & Korn, 2002). For example, disordered gamblers have poor physical health outcomes and greater medical service utilization (Morasco et al., 2006). Disordered gamblers are also more likely to have comorbid substance use and mental health disorders (Johansson, Grant, Kim, Odlang, & Gotestam, 2009). Identifying the rate of disordered gambling within a population can provide policy makers information necessary for appropriate allocation of resources to address the problem (Shaffer & Korn, 2002). Although there is growing research on disordered gambling within industrialized countries such as the United States, there is as yet little research about gambling within Asia. Understanding the impact of disordered gambling among Asians could help in the development of effective prevention and treatments approaches that may be unique to this population.

Gambling in Asia

An understudied area of disordered gambling is the relationship between Asian ethnicity and gambling. Anecdotal reports and limited research have suggested that Asians have higher rates of disordered gambling than the general population (Neighbors, Lostutter, Larimer, & Takushi, 2002; Petry, Armentano, Kuoch, Norinth, & Smith, 2003). Most of the research on Asian gambling has been conducted with Asians residing outside Asia and has focused on immigrant populations or their descendants. Petry and colleagues assessed disordered gambling rates among Southeast Asian refugees (Laos, Cambodia, and Vietnam) attending community service organizations in Connecticut and found that 59% met criteria for disordered gambling in their lifetime. In addition, prevalence studies of youth and young adults (sometimes referred to as emerging adults; Arnett, 2002) suggest that this group may have higher rates of gambling problems compared to older adult populations (Winters, Stinchfield, Botzet, & Slutske, 2005). Cronce, Neighbors, Lostutter, and Larimer (2001) examined gambling behaviors among college students located in the United States with a large Asian and/or Asian American population. In this sample, 10.78% of students were identified through the SOGS as disordered gamblers, with Asian students nearly 3 times more likely to be to be identified as disordered gamblers than non-Asian students.

Besides racial identity, gender differences have also been found in disordered gambling, as males have been reported to have higher rates of disordered gambling than females do, regardless of nationality (Petry, 2004). The two most recent prevalence studies in Asian countries (Hong Kong and Singapore) concluded that men gamble more and have higher rates of disordered gambling compared to women (Teo, Mythily, Anantha, & Winslow, 2007; Wong & So, 2003). To date, no research in either English or Vietnamese publications has been conducted to examine the rate of disordered gambling in Vietnam.

Modern Vietnam

Vietnam is a country in economic and social flux. Economic reforms in the late 1980s called “Doi Moi” (renovation) moved the country from state-controlled industries to a more individually based, free market, globalized economy, which in turn led to greater contact and investment with Western countries. This economic prosperity has not only led to a larger middle class with more expendable income but has also widened the gap between the rich and the poor (King, Nguyen, & Minh, 2007). While economic prosperity has increased, so too have the country’s social problems, including increases in drug and alcohol use/abuse, prostitution, HIV/AIDS, other sexually transmitted diseases, and other social problems (Kaljee, Genberg, Minh, Tho, & Thoa, 2005). Gambling behavior and its associated negative consequences has yet to be empirically documented within a Vietnamese population.

Gambling in Vietnam, Emerging Adults, and Stress and Coping

There are varying types of legal and illegal gambling in Vietnam. Vietnamese citizens can participate in the government-sponsored lottery and limited pari-mutual betting on horse and dog racing located in Ho Chi Minh City and Ha Noi. Other popular but illegal forms of gambling include betting on professional and amateur sporting events, betting on animal fights (bird/dog/fish), playing cards or Chinese checkers, as well as a myriad of other games and activities. These gambling activities are common within the society, and prohibitions are not strongly enforced by government officials. Recently, the Vietnamese government has started examining ways to make sports betting legal in order to generate large tax revenues, given it is estimated that more than 1 billion U.S. dollars is illegally gambled annually on football games and other sporting events (“Vietnam Considers,” 2008). In hotels in large cities and resort areas, casinos cater to foreign visitors and are supposed to be accessed only by holders of a foreign passport. A recent news article reported, however, that several local Vietnamese nationals were found playing the slot machines at two separate “foreigners’ only” casinos, suggesting that local Vietnamese are willing to risk severe legal sanctions in order to gamble (“Illegal Hotel Gambling,” 2007).

Vietnam is also a country of young people. The mean age of the country is 26 years old, and 24% of the country is between the ages of 15-24 (U.S. Census Bureau, 2007). These emerging adults face a myriad of social and economic issues. Increased globalization in low-income and transitional countries has been implicated in changing the culture of adult roles, including longer periods of education, delayed marriage, and delayed familial caregiving responsibilities (Arnett, 2002). These evolving changes have been suggested to widen the generational gaps between parents and their children, leading to greater conflicts and perceived stress by young people (Anh, Duong, & Van, 2005). During this age period, young people face a myriad of stressful situations including poor identity/role development, academic stress, and high familial expectations that may increase the likelihood of emerging adults engaging in risky behaviors (Kaljee et al., 2009).

Gambling as Maladaptive Coping

The simplest explanatory model of stress and coping hypothesizes that an individual’s perceived environmental stressors lead a person to engage in coping behaviors in order to reduce or relieve their stress (Wills & Shiffman, 1985). Avoidant coping is usually considered maladaptive and is defined as engaging in distracting behaviors in order to avoid the stress. From a behavioral perspective avoidant coping works to relieve stress in the short run and, therefore, becomes both positively and negatively reinforcing, in that gambling wins or social interactions are viewed as positive and escaping one’s stressor as negatively reinforcing (Lightsey & Hulsey, 2002). However, over time if one continues to use gambling as a means of coping, subsequent financial problems or increasing amounts of time spent gambling can contribute to stress; thus, gambling to avoid stress may no longer function as an effective coping mechanism. Review of the psychological literature identified no currently published research on stress and coping in Vietnam. Logically, what is known is that emerging adults in Vietnam have access to gambling and are dealing with a stressful developmental period within a rapidly developing country, impacting traditional cultural and gender roles. Thus, we believe gambling may potentially be a serious problem for Vietnam’s emerging adults. Within this context, the use of avoidant coping strategies could lead to disordered gambling behaviors. Therefore, the purpose of the present research was twofold. The first aim was to document the rate of disordered gambling within an emerging adult population residing in Vietnam. Given lack of any country-specific disordered gambling prevalence studies for Vietnam, we expected the rates of disordered gambling in this population to be similar to those found in other countries for emerging adult populations (e.g., 9%-15%; Shaffer & Hall, 2001). The second aim was to test whether perceived stress and avoidant coping moderate the relationship between gambling behavior and gambling problems. We had the following hypotheses related to our research aims:

Hypothesis 1: Rates of disordered gambling would be higher for men than women.

Hypothesis 2: Individuals with higher disordered gambling problem severity, as measured by the SOGS, would also have higher levels of perceived stress and use more avoidant coping.

Hypothesis 3: Perceived stress and avoidant coping would moderate the relationship between gambling behavior and gambling problems, such that the relationship between gambling behavior and gambling problems would be stronger for those individuals who reported higher levels of both perceived stress and avoidant coping.

Method

Participants

Participants were recruited as part of a larger study focused on the relationship between alcohol use and risky sexual behaviors among emerging adults in Vietnam (see Kaljee et al., 2009, for details). Potential participants were stratified by gender for the purpose of the larger study and randomly selected based on census lists provided by six communes located in Nha Trang City, Khanh Hoa Province, Vietnam. The research team randomly selected 1,693 participants (846 men and 847 women) from the 14,554 names provided, with the expectation of successfully recruiting 50% of those selected (Kaljee et al., 2009) to have sufficient power to test the hypotheses. Commune Health Center workers from each commune, hired as research study recruiters, contacted potential participants to invite their participation and schedule them to complete an individual survey with a member of the trained local staff. A total of 951 participants (56%) were successfully contacted and agreed to participate, and 880 (93%) of those scheduled completed the gambling portion of the survey for a response rate of 51.97%. Of these respondents, 53.1% were female (468). Participants ranged in age from 16 to 24 with a mean age of 20.10 (SD = 2.63). The majority identified as Buddhist 56.8%, followed by no religion 18.3%, ancestor worship 14.5%, Catholic 9.7%, and Protestant 0.70%. Almost half (46.1%) were enrolled in school, with the majority of these currently attending high school (48.0%), college/university (32.7%), and the remainder attending technical or night school (17.3%). Of those participants not currently attending school, most had completed secondary school or high school (70.5%), followed by 15.6% completing primary school, 11.2% completing post–high school education, and 0.8% with no formal education. A total of 45.2% of respondents were recruited.

Assessment Procedures

Interested participants were scheduled for an assessment session conducted in private rooms at local Commune Health Centers. Participants who were aged 18 years and older provided written informed consent. Parental/guardian consent was obtained for 16- and 17-year-old participants, who also provided written assent. The survey took 1 to 2 hr to complete. To assure confidentiality and aid in the participants’ feeling comfortable answering sensitive questions honestly, interviewers read from their own copy of the survey while the participant marked his or her answers on a separate survey form. Participants were thanked and paid a small stipend of US$3.00. In addition, they were provided with a pamphlet with information about HIV/AIDS and available health resources within Nha Trang City. All procedures were reviewed and approved by two institutional review boards, one at the University of Maryland Baltimore School of Medicine Institutional Review Board and the other at Khanh Hoa Provincial Health Services Review Board.

Measures

All measures had been psychometrically validated in previous research studies based on U.S. populations. Bilingual Vietnamese-national staff translated the survey from English to Vietnamese and back-translated the survey. This method has been successfully used to ensure linguistic and construct comparability in other studies in Vietnam with similar health and risk behaviors (Kaljee et al., 2009).

South Oaks Gambling Screen-Revised (SOGS; Lesieur & Blume, 1987) is a widely used 20-item screening instrument for problem and pathological gambling. The SOGS has been translated into multiple languages and appears to be a reliable measure with a reported Cronbach’s alpha of .97 (Stinchfield, 2002). The SOGS highly correlates with other measures related to disordered gambling (Neighbors et al., 2002). In this study the SOGS was modified to account for the forms of gambling commonly available in Vietnam. Specifically, items related to casino gambling and slot machines were deleted from the survey, while cultural items such as cricket/fish/bird fighting and Internet gambling were added. Possible SOGS scores range from 0 to 20. Typically a score of 0 designates no gambling or nonproblematic gambling, 1 to 2 recreational gambling, 3 to 4 at-risk gambling, and 5 or more indicates probable pathological gambling Shaffer & Hall, 2001). The SOGS includes types of gambling, the frequency with which one gambles, the quantity of money wagered, and gambling symptoms based on the Diagnostic and Statistical Manual for Mental Disorders (3rd ed., American Psychiatric Association, 1980) criteria for pathological gambling. Specific items include, “Do you feel you ever had a problem with gambling?” and “When you gamble, how often do you go back another day to win back money you lost?” The current measure anchored all questions to the past 6 months. The Vietnamese version of the SOGS did not alter or delete items used in the scoring of the instrument. The Cronbach’s alpha for the revised measure was .81 indicating good internal reliability.

Gambling frequency (GFREQ) was created using a modified version of the SOGS frequency scale, which was comprised of 11 types of gambling and the amount of time the participant engaged in that particular gambling activity. Types of gambling included the following: played cards for money; bet on bird/chicken/cricket fights; bet on sports (e.g., football); played dice games for money; played the numbers (e.g. choi so de); bought lottery tickets; played slot machines, poker machines, or other gambling machines; played billiards or some other game of skill for money; played bingo (called lotto in Vietnamese) for money; gambled on the Internet; and any other gambling activity for money. The frequency-scale options for gambling in the past 6 months were 0 times, 1 to 10 times, more than 10 times but less than weekly, weekly or more than once a week but not daily, and daily. GFREQ scores were calculated by summing participant’s scores and treated as a continuous measure of gambling frequency for which the possible range was 0 to 44. Higher scores indicate more frequent gambling. GFREQ was evaluated for scale reliability, and the Cronbach’s alpha was.76 indicating good internal reliability.

Gambling Problem Index (GPI; Neighbors et al., 2002) is a 20-item scale designed to measure gambling-related consequences. Participants are asked whether they have experienced 20 gambling-related consequences using a 5-point Likert-type scale to indicate frequency of each consequence in the past 6 months: never, 1 to 2, 3 to 5, 6 to 10, and more than 10 times. The original scale demonstrated good reliability with a Cronbach’s alpha of .84. Specific items include “How often have you missed out on other things because you spent all your money gambling?” and “How often have you tried to quit gambling but weren’t able to do so?” All items were translated and back-translated following the previously described procedures, and no items were added or deleted from the original scale. The Cronbach’s alpha for the current study was .82.

Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983) is a widely used 14-item scale designed to measure the degree to which situations in one’s life are appraised as stressful. The measure uses a 5-point Likert-type scale ranging from never to very often; scores range from 0 to 70 with higher scores denoting higher levels of perceived stress. Sample items include “In the last month, how often have you felt nervous or ‘stressed?’” and “In the last month, how often have you found that you could not cope with all the things you had to do?” Norms for the original measure were established using two college student samples and one sample of smoking cessation group members, with alphas at .84, .85, and .86, respectively.

The PSS was translated and back-translated based on previously described procedures. After initial piloting of the measure, several items were deleted and revised. Items using colloquial English phrases such as “Felt that you were on top of things” were deleted, as they did not translate well. The assessment time frame was increased from 2 weeks to 1 month to coincide with the assessment period of interest for the larger study. Final sample items include “Felt stressed” and “Found that you could not cope with all the things that you had to do.” The final version of the PSS consisted of 6 items with scores ranging from 0 to 24, with higher scores indicating higher levels of perceived stress. The Cronbach’s alpha for the current study was .80.

Avoidant Coping Subscale (ACS; Patterson & McCubbie, 1987) was developed by using items from the seeking diversions and avoiding problems subscales of the Adolescent Coping Orientation for Problem Experiences (A-COPE), which assessed the use of nonsolution, focused distraction techniques as a way of escaping stress. The instructions acknowledge that people face problems in life, stating, “How often do you do the following things when you feel stressed?” The measure uses a 5-point Likert-type scale ranging from never to very often. Example items include “Blame others for what’s going on,” and “Ride around on a motorbike or bicycle.” The original measure reported good internal reliability for seeking diversions and avoiding problems, with Cronbach’s alphas of .75 and.71, respectively.

The finalized measure consisted of 11 items, was translated using the method described above, and culturally adapted to include and delete items relevant for Vietnamese culture. Items not applicable to Vietnamese culture such as “Get professional counselling” were removed from the questionnaire or culturally adapted; for example, the item “Ride around in the car” was altered to read “Ride around on the bike/motorbike” given that cars are a luxury item not owned by most Vietnamese. The scale ranged from 0 to 44, with high scores corresponding to higher utilization of avoidant coping strategies. The Cronbach’s alpha for the final survey was .69, demonstrating satisfactory internal reliability.

Results

Rate of Disordered Gambling

Seven volunteers did not complete the gambling measures and were excluded from analyses, leaving 873 respondents. According to the SOGS, 53% (n = 460) of participants had gambled in the past 6 months. Using the Shaffer and Hall (2001) categorization of disordered gambling, 15.7% of respondents were classified as social gamblers (SOGS = 1-2), 8.5% were at-risk gamblers (SOGS = 3-4), and 6.6% were classified as probable pathological gamblers (SOGS ≥ 5); thus, a total of 15.1% of the participants were engaging in disordered gambling (SOGS ≥ 3). Comparisons by gender indicated males were substantially more likely than females to meet criteria for disordered gambling using SOGS classification, χ²(12, 873) = 106.39, p <.001. Among men, 12.2% scored in the at-risk range and 13.4% scored in the probable pathological gambler range, whereas 5.2% of women scored in the at-risk range and 0.6% scored in the probable pathological gambler range. Descriptive statistics by SOGS categories are presented in Table 1.

Table 1.

Comparing Demographic and Psychological Measures Differences Between Non- or Infrequent Gamblers, Recreational Gamblers, At-Risk, and Probable Pathological Gamblers

	Non- or infrequent gambler, SOGS = 0	Recreational gambler, SOGS = 1-2	At-risk gambler, SOGS = 3-4	Probable pathological gambler, SOGS ≥ 5	Total	Statistic (df)	p Value
N (%)	604 (69.2)	137 (15.7)	74 (8.5)	58 (6.6)	873
Mean age (SD)	20.18 (2.64)	19.84 (2.67)	19.93 (2.74)	19.95 (2.40)	20.10 (2.63)	F(3, 869) = 0.81	p = .49
Gender (%)
Male	222 (54.0)	84 (20.4)	50 (12.2)	55 (13.4)	411 (47.1)	χ²(1, 3) = 102.53	p < .001
Female	382 (82.7)	53 (11.5)	24 (5.2)	3 (0.6)	462 (52.9)
Educational level (%)
Primary school	52 (72.2)	9 (12.5)	4 (5.6)	7 (9.7)	72 (8.3)	χ²(18, 3) = 19.89	p = .33
Secondary school	108 (66.3)	24 (14.7)	20 (12.3)	11 (6.7)	163 (18.7)
High school	235 (64.7)	68 (18.7)	35 (9.6)	25 (6.9)	363 (41.7)
College/university	124 (76.1)	24 (14.7)	6 (3.7)	9 (5.5)	163 (18.7)
Technical school	62 (75.6)	8 (9.8)	4 (4.9)	8 (9.8)	82 (9.4)
Night school	18 (75.0)	3 (12.5)	2 (8.3)	1 (4.2)	24 (2.8)
No formal education	3 (75.0)	1 (25.0)	0 (0.0)	0 (0.0)	4 (0.5)
Employment status (%)
Yes	275 (70.0)	57 (14.5)	34 (8.7)	27 (7.9)	393 (45.1)	χ²(1, 3) = 0.81	p = .85
No	328 (68.5)	80 (16.7)	40 (8.4)	31 (6.5)	479 (54.9)
Measures mean score (SD)
Gambling frequency	0.69 (1.40)*****	3.03 (2.43)*****	4.43 (3.84)*****	6.52 (4.59)*****	1.76 (2.83)	F(3, 869) = 187.16	p < .001
Gambling problems	0.41 (1.69)*****	4.02 (4.15)****	6.93 (5.59)*	11.67 (8.19)***	2.21 (4.66)	F(3,846) = 257.47	p < .001
Perceived stress	5.66 (4.13)***,	6.28 (4.57)	7.51 (4.07)****	7.13 (3.80)*	6.01 (4.21)	F(3, 869) = 6.17	p < .001
Avoidant coping	18.40 (5.89)****	18.66 (6.08)***	18.57 (5.80)**	21.32 (5.78)**,,*	18.65 (5.94)	F(3, 869) = 4.33	p <. 005

Note: SOGS = South Oaks Gambling Screen. Post hoc Tukey’s HSD tests compared differences among groups on frequency, problems, stress, and coping. For each measure, same superscripts represent significant differences between groups at the p values provided below.

p = .05. **p = .04. ***p = .02. ****p = .002. *****p < .001.

Differences Between SOGS Categorization and Gambling Frequency, Gambling Problems, Perceived Stress, and Avoidant Coping

One-way analysis of variance (ANOVA) procedures were performed to examine mean differences between the four different SOGS categorization groups (SOGS = 0, no gambling; SOGS = 1-2, recreational gambler; SOGS 3-4, at-risk gambler; SOGS ≥ 5, probable pathological gambler) and four dependent variables of interest (gambling frequency, gambling problems, perceived stress, and avoidant coping). ANOVA results revealed significant differences between SOGS categorization and all four outcome variables. Tukey’s post hoc tests were performed to examine specific differences among SOGS groups. Results for overall ANOVA and post hoc tests are reported in Table 1.

Gambling Frequency and Gambling Problems

Tukey’s post hoc analyses revealed significant differences in gambling frequency between all four levels of gambling severity based on SOGS categories, such that gambling frequency increased as SOGS severity score increased. The most frequent type of gambling, as measured by the SOGS, was purchasing lottery tickets (34%), which is a legal form of gambling in Vietnam. Respondents engaged in a variety of illegal gambling activities, including playing cards for money 29%, lotto 15%, sports betting 14%, playing numbers 13%, billiards 8%, betting on animal fights 4%, machine gambling and dice 2% each, and other gambling 6%. Types of gambling were not mutually exclusive, and some individuals engaged in multiple forms of gambling.

As expected, post hoc test revealed significant differences in Gambling Problem Index (GPI) consequences between each of the SOGS categorizations. As severity of gambling based on SOGS category increased, scores on the GPI increased. Vietnamese gamblers reported a myriad of negative consequences related to their gambling. Among respondents reporting gambling in the past 6 months, the most frequently reported consequence was having a bad time when gambling (33%). However, a high percentage of individuals also reported unsuccessfully trying to quit gambling (33%), unsuccessfully trying to control their gambling (23%), and/or being told by family or friends to stop gambling (23%). Participants also reported missing out on other activities (21%) and/or neglecting their responsibilities (20%) or schoolwork (15%) due to gambling.

Analysing the items from the SOGS, 23.8% of participants reported chasing their losses at least half of the time, and 1.7% reported chasing their losses most of the time, and 1.5% all of the time. In addition, 25% of participants reported feeling guilty because of their gambling; 12% of participants claimed to be winning, when in fact they had actually lost money gambling at least half of the time when they gambled, whereas 0.6% reported this occurred all the time. Approximately, 9% of participants reported hiding their gambling behaviors from others, 4.5% reported arguing with others about their gambling, and 1.1% reported stealing money from parents to gamble.

Perceived Stress and Avoidant Coping

In addition to securing descriptive information regarding gambling behavior and related problems among Vietnamese adolescents, we were interested in evaluating the roles of perceived stress and avoidant coping in the relationship between gambling behavior and related problems. Perceived stress and avoidant coping varied as a function of SOGS classification with those individuals reporting higher levels of stress and avoidant coping also reporting more gambling problems.

Specifically, the post hoc tests revealed that perceived stress was significantly higher for both at-risk gamblers and probable pathological gamblers compared to nongamblers but not significantly higher than recreational Gamblers. Avoidant coping was only significantly different for probable pathological gamblers compared to the other three groups. Results generally supported the hypothesis that disordered gamblers had higher rates of perceived stress and (for the most severe gamblers) higher avoidant coping compared to those individuals who did not meet disordered gambling criteria. Thus, the results supported a closer examination of the relationship between gambling behavior, perceived stress, avoidant coping, and gambling problems.

Moderation Analyses

To evaluate whether the relationship between gambling frequency and problems varied as a function of perceived stress and avoidant coping, we used multiple regression analyses. Gambling problems were regressed on gambling frequency, perceived stress, and avoidant coping at Step 1. Two-way product terms were added at Step 2 to evaluate whether the relationship between gambling frequency and problems varied as a function of perceived stress and/or avoidant coping. The three-way product was added at Step 3 to test the full stress and coping model. All predictors were mean-centered to facilitate interpretation of interactions and reduce multicollinearity (Aiken & West, 1991). Effect sizes (d) for all analyses were calculated using the formula d = 2t/√df. By convention, small, medium, and large effects are typically considered to be in the range of .2, .5, and. 8, respectively (Rosenthal & Rosnow, 1991). Regression results and effects sizes are presented in Table 2.

Table 2.

Regression Results for Composite Score for Gambling Frequency, Perceived Stress, and Avoidant Coping on Gambling Problems

Predictor	B	SE B	β	t	d
Step 1: R²
Gambling frequency	0.993	0.046	0.594	21.808***	1.499
Perceived stress	0.075	0.031	0.067	2.379*	0.164
Avoidant coping	0.058	0.022	0.074	2.615**	0.180
Step 2: R²
Gambling Frequency X Perceived Stress	0.017	0.012	0.045	1.395	0.096
Gambling Frequency X Avoidant Coping	0.025	0.008	0.107	3.335***	0.230
Perceived Stress X Avoidant Coping	−0.001	0.005	−0.003	−0.128	−0.009
Step 3: R²
Gambling Frequency X Perceived Stress X Avoidant Coping	−0.004	0.002	−0.091	−2.460***	−0.169

p < .02. **p < .01. ***p < .001.

Results at Step 1 were consistent with the descriptive results and revealed that gambling frequency, perceived stress, and avoidant coping were each uniquely and positively associated with gambling-related problems. Results at Step 2, which evaluated the two-way interactions, revealed that the only significant interaction was between avoidant coping and gambling frequency on gambling problems. The significant two-way interaction is presented in Figure 1 and indicates that the relationship between gambling frequency and related problems was stronger among participants who were higher in avoidant coping. Results at Step 3, however, indicated that the two-way interaction was qualified by a significant three-way interaction among frequency, avoidant coping, and perceived stress. Thus, the interaction between gambling frequency and avoidant coping in predicting gambling problems varied as a function of perceived stress. Specifically, for individuals who are low on perceived stress, the relationship between gambling frequency and gambling problems is stronger for those who are higher in avoidant coping as compared to those lower in avoidant coping. However, higher levels of perceived stress appear to diminish the influence of avoidant coping on the relationship between gambling frequency and related problems. The significant three-way interactions are presented in Figure 2.

Figure 1.

Avoidant coping moderates relationship between scores on Gambling Frequency and Gambling Problems Index

Figure 2.

Three-way interaction between perceived stress and avoidant coping moderated the relationship between Gambling Frequency and Gambling Problem Index scores

Discussion

The current study was the first of its kind to examine gambling behavior of emerging adults in Vietnam. Slightly more than half of the sample had engaged in gambling activities in the past 6 months, and a considerable proportion of those young people who had recently gambled were also experiencing some negative consequences related to their gambling. The current study found 15.1% of the sample met criteria for disordered gambling (SOGS ≥ 3), including 6.6% who met probable pathological gambling criteria (SOGS ≥ 5). This study also tested a theoretically derived model of stress and coping in order to examine how these variables interact with gambling frequency and associated gambling problems in this sample. Results showed significant main effects for gambling frequency, perceived stress, and avoidant coping, a significant two-way interaction between avoidant coping and gambling frequency, and significant three-way interaction between perceived stress, avoidant coping, and gambling frequency in predicting gambling problems.

The rate of disordered gambling among emerging adults in Vietnam within the study can be difficult to put into perspective, given the lack of a directly comparable sample. In comparison to the pathological gambling prevalence studies that have been conducted within other Asian countries, the 6.6% rate in the current study is higher than rates of 5% and 1% found in Hong Kong (Wong & So, 2003) and Singapore (Teo et al., 2007), respectively. These studies, however, used different recruitment methodologies, measures of gambling, and surveyed the general adult population rather than emerging adults, which limits the direct comparison. The current study found that 15.1% met disordered gambling criteria (SOGS 3+), which is higher than that of the Asian American college sample reported (11.7%) by Cronce and colleagues (2001) but lower than the 59% reported by Petry et al. (2003). However, both of those studies used different time frames for their SOGS measure of past year and lifetime, respectively, whereas the current study used the past 6-month timeframe for the SOGS. Also both of those studies had populations of immigrant or second-generation Vietnamese as well as other Asian ethnicities included in their samples, whereas the current study had solely Vietnamese emerging adults. More research is needed to assess gambling prevalence within Vietnam, and more stringent cross-cultural studies are required to accurately evaluate the similarities and differences between these emerging adult populations in their gambling behaviors and problems.

As hypothesized, the current study found significant gender differences in gambling behaviors and disordered gambling. Men gambled more and had more problems associated with their gambling than woman did. This finding is consistent with other studies that have found men gamble more and have higher rates of disordered gambling (Blanco, Hasin, Petry, Stinson, & Grant, 2006). This fairly consistent finding has been hypothesized to be biologically based, with men exhibiting greater risk-taking behaviors and more impulsivity than women did (Lightsey & Hulsey, 2002). Although the current study does not address the potential for the biological underpinnings of disordered gambling, it does provide further evidence that gambling behavior in general, and disordered gambling specifically, occurs more frequently among men than women in Vietnamese society. In recent work (Kaljee et al., 2005) it has been suggested that gender differences in other risky health behaviors, such as heavy alcohol consumption and unprotected sex, could also be explained by cultural variables as well as differences in socialization patterns of men and women. They suggest that distinct societal gender norms may account for their findings that men associate more closely with peers, have more expendable money, consume more alcohol, and engage in riskier sexual behaviors. Men may also perceive having fewer alternative ways to deal with stress in comparison to women. In Vietnamese culture, a common belief is that men are naturally prone to gambling problems. Due to this cultural expectation, men may be more apt to participate in gambling activities and less concerned when their gambling gets out of control. An alternative explanation could be that the developmental period of emerging adulthood may not be as risky time for gambling among Vietnamese women, who may develop more problematic gambling behaviors later in life as suggested in research focusing on women in other countries (Blanco et al., 2006). Further research is needed to better understand the impact of gender roles on gambling behavior and trajectories of gambling among Vietnamese.

One of the explanatory models for problematic gambling is the stress and coping model (Lightsey & Hulsey, 2002). The model suggests that as individuals experience a stressful life situation they attempt to manage their stress by engaging in behaviors that might reduce feelings of stress, some of which may be maladaptive. In the current study, those individuals who scored higher on perceived stress and higher on avoidant coping had more problems associated with their gambling. The model suggests as stress increases an individual’s inclination to indulge in gambling as a coping mechanism, it leads to more gambling problems, which should be particularly true among individuals who are prone to use more avoidant coping strategies rather than solution-focused ones. However, in the current study, at higher stress levels avoidant coping no longer moderated the relationship between gambling frequency, perceived stress, and gambling problems. One possible explanation for these results could be that at higher levels of stress, gambling no longer serves as a functioning coping strategy, given that the most likely outcome will lead to more losses and increased perceived stress. Although there is limited research regarding the role stress and coping play in gambling within which to contextualize our results, some studies have found support for stress and avoidant coping as both the cause and maintainer of disordered gambling. Our results stand in contrast to the most recent findings of Lightsey and Hulsey, who did not find a linear relationship between gambling and stress-coping in a predominantly Caucasian, U.S. college student population. Rather, they found an interaction effect for men only, with low impulsivity and high stress interacting with emotional coping in predicting gambling. Our results support a possible developmental hypothesis in which stress may change as a function of one’s coping and amount of gambling behavior. A desire for stress reduction might lead one to initiate gambling, but, over time, if serious gambling problems develop, the stress-relieving benefits of gambling dissipate and no longer provide the coping relief once received from this behavior.

A number of limitations to the current study should be recognized. These include measurement and cultural issues. Most of the measures used in the study where developed in the United States and then translated into Vietnamese. Given the cultural and language differences, it is possible that the psychological constructs of the measures used may not capture the Vietnamese phenomena for disordered gambling, perceived stress, and/or avoidant coping (Sanchez, Spector, & Cooper, 2005). In order to mitigate these limitation we utilized several methods outlined by Sanchez et al., including bilingual input on the Vietnamese modifications to the measures of interest to correct for language and cultural issues. We also utilized back-translation by an independent expert in order to maintain the fidelity of the original constructs of interest. Overall, the measures appear to have face validity and internal reliability for measuring the proposed constructs. Nonetheless, further research is warranted to evaluate measurement invariance cross-culturally.

The rate of disordered gambling in the current sample should be interpreted with caution, given that those meeting SOGS criteria were not followed up for further clinical interviews to accurately diagnose those with subclinical or clinical levels of disordered gambling. Due to funding and time constraints, formal diagnostic interviewing was beyond the scope of the current study. The SOGS was developed for a treatment-seeking population, and the original authors and others have cautioned against the use of this screening instrument for independently diagnosing gambling problems. Despite some limitations of the measure, it has been translated into 36 languages, shown to be internally reliable, has strong construct validity, and highly correlates with DSM-IV pathological gambling diagnosis (Gambino & Lesieur, 2006). Another limitation is the cross-sectional nature of the current data set and the nonexperimental nature of the study, which prevents causal directions of the relationships from being inferred. Although it is impossible to unravel the causality of the relationships among the current data the interpretations offered are based on the theoretical and empirical evidence to date. Further longitudinal research is needed to investigate the temporal relationship between perceived stress and avoidant coping in regard to substance use and gambling problems.

There is reason to believe that disordered gambling could be on the rise throughout Asia and especially within Vietnam, given the increasingly expanding casino industry throughout Asia and the Vietnamese government’s interest in legalizing sports betting in the country. A recent report referred to the expansion of gambling markets in Asia as “the Holy Grail” and to Vietnam in particular as “the cherry on top” (Champion, 2007). This expansion of legalized gambling is likely to lead to more Vietnamese gambling, which may lead to an increase in the number of disordered gamblers. Other addictive behaviors have been shown to increase in transitional stages of economic growth. Research on alcohol use in economically developing Asian countries has identified increases in alcohol consumption and the social acceptance of excessive drinking behaviors (Kaljee et al., 2005). Further research is warranted investigating the potential societal harms, which could occur if sport betting is legalized in the country.

Whereas the current study suggests further research in the area of disordered gambling within Vietnam is warranted, we recognize that given Vietnam’s current state of health care, especially in the area of mental health services, the country lacks the infrastructure and public health resources to prevent and treat disordered gambling. Currently, gambling is predominantly viewed as a social vice within Vietnam. This translates to a moral model perspective, which views the gambler as a weak individual who lacks the willpower to control his or her behavior. These cultural and systematic barriers will need to be overcome if efficacious prevention and treatment efforts are to be implemented within the country. The current study is the first step in documenting the need for the development of effective prevention and treatment of disordered gambling in Vietnam. Recent studies suggesting the use of motivational and cognitive behavioral techniques in reducing gambling frequency and problems (Petry, 2004) offer hope that these same techniques could be translated and culturally adapted to work in Vietnam.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by National Institute for Alcohol Abuse and Alcoholism Grants 5R21AA014774 (PI: Kaljee, L.) and T32AA07455 (PI: Larimer, M.) and by the National Institute on Drug Abuse Grant 1F31DA023634 (PI: Lostutter, T.).

Bios

Ty W. Lostutter, PhD, is a senior research fellow at the Center for the Study of Health and Risk Behaviors in the Department of Psychiatry & Behavioral Sciences at the University of Washington. He is trained in clinical psychology and has worked in the areas of prevention and treatment of substance use disorders and comorbid mental health disorders for the past 10 years. He has been conducting research in Viet Nam since 2005.

Mary E. Larimer, PhD, is professor and director of the Center for the Study of Health and Risk Behaviors in the Department of Psychiatry & Behavioral Sciences at the University of Washington. She is a clinical psychologist. Her research and clinical interests include (a) prevention and treatment of alcohol problems among adolescents and college students; (b) prediction of initiation of drinking and maintenance of low- or high-risk drinking patterns during college; (c) comorbidity of substance use with depression, disordered eating, and gambling problems; and (d) dissemination of evidence-based prevention and treatment approaches into clinical, school, and work-site settings.

Clayton Neighbors, PhD, is a professor and the director of the social psychology program at the University of Houston. His work focuses on social, motivational, and spiritual influences in etiology, prevention, and treatment of health and risk behaviors. He has applied his research toward better understanding and alleviating problems related to alcohol and substance abuse, intimate partner violence, problem gambling, body image and eating disorders, and aggressive driving.

Linda M. Kaljee, PhD, is associate professor at the Pediatric Prevention Research Center, Wayne State University. She is trained in anthropology and has worked in adolescent reproductive health and HIV/AIDS prevention for the past 20 years. Her work has included HIV/AIDS prevention program development and evaluation in the United States, China, the Bahamas, and India. She has been conducting research in Viet Nam since 1997.

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