Yarning about gambling in indigenous communities: an aboriginal and islander mental health initiative.
Abstract: Gambling impacts upon the health, wellbeing and finances of many people throughout Australia. This study aimed to explore the socioeconomic and cultural factors linked with gambling in urban and remote Indigenous settings in the Northern Territory to inform the development of a gambling public health strategy. The Aboriginal and Islander Mental Health Initiative developed a semi-structured questionnaire with Aboriginal partner organisations following consultation. Indigenous consumers of substance use treatment facilities participated in focus group discussions and key informant interviews were conducted with nine service providers at two time points, a year apart. Participants described key strengths in community as family, health and culture, while key worries included substance misuse, health concerns and family disharmony. Regulated gambling and card playing were also identified as important community worries. Financial and family concerns and addictive behaviour were seen as negative consequences of gambling. There was increasing concern linked with card playing and electronic gaming machines and an increased call for awareness campaigns, support from government for change and greater regulation. The findings of this study provide the most recent insight into attitudes, behaviours and consequences linked with Indigenous gambling in the Northern Territory.

Keywords: empowerment, gambling, Indigenous mental health, public health strategy, resilience
Article Type: Report
Subject: Australian aborigines (Social aspects)
Gambling (Influence)
Gambling (Social aspects)
Gambling industry (Management)
Gambling industry (Influence)
Gambling industry (Laws, regulations and rules)
Public health (Research)
Public health (Laws, regulations and rules)
Authors: Nagel, Tricia
Hinton, Rachael
Thompson, Valerie
Spencer, Neil
Pub Date: 06/22/2011
Publication: Name: Australian Journal of Social Issues Publisher: Australian Council of Social Service Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2011 Australian Council of Social Service ISSN: 0157-6321
Issue: Date: Summer, 2011 Source Volume: 46 Source Issue: 4
Topic: Event Code: 290 Public affairs; 200 Management dynamics; 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime; 310 Science & research Advertising Code: 94 Legal/Government Regulation Computer Subject: Company business management; Government regulation
Product: Product Code: 7760000 Legal Gambling; 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs NAICS Code: 7132 Gambling Industries; 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs SIC Code: 7999 Amusement and recreation, not elsewhere classified
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 301964265
Full Text: Introduction

National and international evidence suggests Indigenous gambling involvement, gambling expenditures and gambling-related problems are higher than that of non-Indigenous people (Raylu & Po Oei 2004; Delfabbro et al. 2005; Volberg & Wray 2007; Dyall 2010). Dyall argues that it is not only the availability of gambling, but also accompanying historical, economic and political changes that have led to increased gambling problems among Indigenous peoples in particular (Dyall 2007; Dyall 2010). Although the economic and societal implications of problem gambling are well understood (Brady 2004; Raytu & Po Oei 2004; Breen 2007; Dyall 2007), the potential threat of gambling to Indigenous social and cultural values has also been highlighted in the international literature (Dyall 2010).

Gambling is a big and rapidly growing business in Australia. It provides recreational pleasure, while also having adverse social consequences. The costs include financial and emotional impacts on gamblers and on others in their environment (Productivity Commission 2010). The challenge for policy makers and the gambling industry is to reduce the costs of problem gambling, through harm minimisation and prevention measures, while retaining as much of the entertainment benefit as possible (Productivity Commission 1999). Australian Indigenous people's gambling activity has, however, been influenced by distinct social, economic and historical factors. Understanding these influences and current attitudes to gambling is pivotal to the introduction of strategies to minimise gambling-related harm within Aboriginal and Torres Strait Islander communities. This study aimed to explore the socioeconomic and cultural factors linked with gambling in urban and remote Indigenous settings in the Northern Territory, to inform the development of a gambling public health strategy.

Gambling in the Northern Territory

It has been established that gambling activity in the Northern Territory (NT) began in the context of goods trading with the Macassans along the north coast, while modern card playing for money was likely introduced during European colonisation (Altman 1985; Brady 2004; Breen 2007; Christie et al. 2009). The introduction of unemployment benefits in remote communities in 1979 resulted in a rapid increase in access to cash. This was directly observed as leading to increased gambling in one remote community and supports the link between gambling and immediate surplus cash (Altman 1985). Indigenous gambling for money differs from non-Indigenous gambling in its use as a redistributive and accumulative mechanism (Altman 1985; Keen 2010). Research has shown that gambling can provide a means for people with no cash income to gain access to some cash. It also allows people to accumulate resources to purchase costly items, such as vehicles and white goods, for the extended family to use, but without incurring obligations. The emphasis is on the positive value of gambling as an expression of reciprocal social responsibility (Altman 1985; McMillan & Donnelly 2008).

The limited available research evidence on the role of unregulated gambling, such as card games, in remote communities suggests both positive (Christie et al. 2009) and negative impacts on individuals and the community (Stevens & Young 2009; Breen et al. 2010). Gambling provides opportunity to meet cultural needs for storytelling, sharing and socialising in communities and offers a relaxing, enjoyable leisure activity with potentially reduced alcohol consumption (Christie et al. 2009; Breen et al. 2010). However, these positive aspects of Indigenous gambling are increasingly outweighed by the negative impact of changes to the gambling landscape. Indigenous gambling has become widespread over the last three decades, not only in response to improved access to the cash economy, but also due to increased regulated gambling opportunities (Productivity Commission 1999). Unregulated gambling and community card games remain popular, but they are no longer the predominant form of gambling for Indigenous Australians in cities or country towns. Commercial forms of gambling such as TABs introduced in the 1970s and casinos and EGMs (electronic gaming machines, commonly called 'pokies') introduced in the 1980s and 1990s have proliferated (McMillen & Donnelly 2008). Regulated gambling venues are not only increasingly accessible but also particularly attractive and acceptable to Indigenous people (Christie et al. 2009). Venues are described as providing 'neutral' places to meet with others without cultural responsibility and protocol dominating behaviours. Furthermore, the increased adoption of urban lifestyles both exacerbates the need for money and increases access to regulated gambling (Christie et al. 2009). The potential risks of transition from community-based card games to electronic gaming machines include their potential to 'drain a substantial amount of money from communities that are already hurt by money spent on alcohol' (Brady 2004: 6).

There is increasing awareness of the negative consequences of Indigenous gambling. These include family and relationship disharmony, alcohol and other drug problems, mental illness, crime and personal financial concerns (Breen et al. 2010; Stevens & Young 2010). Stevens and Young (2010) have reported that Indigenous gambling problems correlate with overcrowded housing, low income and community disharmony. In rural areas the limited opportunities for alternative recreational activities accessible to Aboriginal people also contribute to high levels of problem gambling (Aboriginal Health & Medical Research Council of NSW 2007). In addition, one unintended consequence of the NT Emergency Response (NTER)--a Commonwealth intervention which includes the quarantining of income for specified purposes such as essential provisions --was that the diminished amount of money available in the community may have inadvertently increased the role of gambling in money-making activity (Christie et al. 2009). These Australian findings echo international research which links gambling with disempowerment and marginalisation (Volberg & Wray 2007; Dyall 2010) and the 'boredom, chaos and trauma' of everyday life (Dyall & Hand 2003: 325). Schissel ascribes the perpetuation of ethnic minority gambling problems to political influence such as the 'addiction' of governments to 'gaming-based revenue' (2001: 475).

The need for a culturally sensitive population health approach

Gambling was only identified as a public health issue relatively recently in Australia (Productivity Commission 1999). Research has found smoking, depression and problem drinking are common co-morbid disorders with problem gambling and highlights the importance of approaching gambling within a public health framework (Thomas et al. 2003). Such a framework would adopt the concept of a continuum from healthy to moderate to problem gambling, rather than only focusing on the measurement of problem gambling (Rodgers et al. 2009). It would also contribute to diminishing the shame and stigma which impede help-seeking behaviour (Christie et al. 2009). Australian researchers have therefore called for broad measures to address problem gambling as a public health issue that include population-based strategies and that adapt public health tools and processes (Breen et al. 2010). Similarly, in New Zealand, Dyall and Hand (2004) have called for a public health strategy to target problem gambling and have emphasised that its implications require a response no different to those for other health concerns, such as alcohol and smoking.

A public health approach would consider shifting the prevailing culture around gambling through the use of awareness campaigns, regulation and legislation, as well as promoting access to treatment. Mandatory pre-commitment strategies for EGMs, which are currently under debate in the Australian context, would be one strategy within a broader public health implementation plan. This framework could be modelled on the recommendations for alcohol within current health preventative strategies (National Preventative Health Taskforce by the Alcohol Working Group 2008). To be effective in remote Australia, such a framework would need to take into account Indigenous perspectives (Christie et al. 2009) and to ensure that tools for population screening, diagnosis, measurement of severity and treatment are culturally informed and appropriate. Yet there is little recent, published research reporting the first-hand perspectives of Northern Territory Indigenous people related to gambling. Christie and Young (2011) propose a revision of the approach to Indigenous gambling in the urban NT, which they suggest would be better aligned with local Aboriginal perspectives, needs and aspirations. A recent study by Lamb and Young (2011) also calls for locally-based responses to problematic forms of gambling in the NT. Given the heterogeneity of Indigenous peoples across Australia, incorporation of differences in perspectives, approaches and localities is pivotal for informed public debate. This article reports on the findings of an exploratory qualitative study of the socioeconomic and cultural factors linked with gambling among remote and urban Indigenous people in the Northern Territory. In using the term Indigenous in this article, we refer to Aboriginal and Torres Strait Islander people and acknowledge their diversity of language and culture.

Methodology

The study used a participatory action research (PAR) design. This type of research design made it possible for participants to discuss their attitudes and perceptions of gambling, reflect on gambling-related experiences, develop their own criteria of risks and benefits and elaborate on their own ideas about what appropriate interventions may look like for them. PAR was well suited to understanding the social contexts of problem gambling. A distinctive feature of the PAR design is its compatibility with research involving Indigenous peoples, as it emphasises respect and the facilitation of social change, and uses the language of participants to identify what needs to happen (Greenhill & Dix 2008). The design incorporated multiple methods and qualitative sampling techniques.

An initial phase of consultation and informal interviews informed the development of an interview and focus group discussion schedule to explore gambling attitudes, behaviours and consequences. Following this phase, key informant interviews (KIIs) were conducted with service providers who had particular knowledge about the subject and could give additional insight into the nature of problem gambling. Focus group discussions (FGDs) were held with Indigenous clients of substance use facilities. These discussions allowed sensitive issues to be explored by creating a safe and comfortable environment with opportunity for a range of opinions to be shared and heard (Liamputtong 2010). Interviews and FGDs were conducted at two different time points and with participants from three different organisations. By collecting data at different points in time and in different spaces we could be assured of the completeness of the data. We would have the opportunity to confirm findings as well as identify new themes. The use of different data collection techniques and multiple perspectives also reduced the chance of systematic bias and enhanced the trustworthiness of the findings (Flick 2009).

Initial consultation phase

From 2008 to 2009 the research team worked in collaboration with Waltja Tjutangku Palyapayi Aboriginal Corporation and Amity Community Services Inc. During this period both organisations were working in remote communities to address gambling-related harm. The research team held discussions with the Waltja executive in Alice Springs and reviewed findings from remote community 'wise spending' education workshops, including Indigenous paintings and written summaries. The majority of this material was gained from workshop participants who were local Aboriginal women within the communities. A research team member (an Aboriginal artist) was also engaged to draw pictorial representations of the positive and negative aspects of gambling. The drawings were discussed and revised according to feedback from both organisations. An interview schedule (see Appendix 1) was developed following the thematic analysis of Amity and Waltja workshop data. The schedule included closed-ended questions about the most common types of gambling (such as card playing, pokies, horses) and the types of gambling perceived to cause the most concern. Open-ended questions focused on the positive and negative aspects of gambling and the changes required in response to problem gambling in communities. The interview schedule also incorporated components of the Aboriginal and Islander Mental Health Initiative (AIMhi) 'Motivational Care Planning tool', developed in previous studies with Indigenous people in the NT (Nagel & Thompson 2007). It included open questions and pictorial prompts related to the spiritual and cultural, physical, social and family and mental and emotional spheres of life. The final draft of the interview schedule was presented for final review to Waltja Tjutangku Palyapayi Aboriginal Corporation and Amity Community, Services Inc. Ethical approval was granted by NT Central Australian and Top End Human Research Ethics Committees.

Participant recruitment

The research team consulted with a number of health boards and community-based organisations to purposively recruit relevant participants to the study and a partnership was formed with a residential substance misuse service in Darwin and a second Alice Springs-based service. The services offer a 12-week outpatient and eight-week residential program for Indigenous clients with substance use concerns. Service providers and clients in these settings were deemed likely to have high awareness of gambling problems, given the known high co-morbidity of gambling and substance misuse. Between 2010 and 2011 a total of 71 participants were recruited to the study. Twenty-six Indigenous consumers of the substance use facilities participated in an FGD in 2010 and 33 different consumers were interviewed within the same settings after 12 months. Nine key informant interviews (KIIs) were conducted with Alcohol and Other Drug (AOD) and mental health service providers in 2010, with an additional nine conducted with service providers after one year. Six key informants were involved in both stages of the study.

Key informant interviews

Two male and two female Indigenous researchers conducted key informant interviews with members of the NT government mental health workforce in Darwin and in two residential treatment services located in the Top End (Darwin) and Central Australia (Alice Springs). The researchers liaised with service staff to find times that aligned well with service and staffing programs and priorities. The interview schedule was used to guide key informant interviews in order to explore service provider perspectives of the role and impact of gambling in Indigenous communities. The researchers recorded the interviews in note form and participants self-completed the list of different forms of gambling. Key informant interviews were completed in 30 to 60 minutes and follow-up interviews were conducted one year later. These second-round interviews were conducted to gain additional insights into participants' attitudes and perspectives on gambling as well as to reinforce the data collected 12 months earlier.

Focus group discussions

The research team held group information sessions for staff and consumers prior to seeking informed consent and conducting the group discussions. The Darwin-based FGDs were mixed gender while the Alice Springs service chose to run separate groups for men and women. The size of groups ranged from three to 11 people. All focus groups were conducted in a relaxed and informal setting, in lounge rooms, in a training room and, in one case, outside under awnings. Each focus group lasted between one and two hours. The research team used the interview schedule to guide the discussion, which focused on identifying strengths and worries and client's attitudes towards gambling, gambling behaviour and consequences. Although a few participants were initially shy and reserved, as the sessions progressed they relaxed and became well engaged in the process. One research officer recorded responses on the data sheet while the group moderator wrote responses on a whiteboard and participants self-completed the gambling checklist. Follow-up FGDs were conducted with a different cohort of Indigenous clients of the residential substance misuse facilities after 12 months. As with the KIIs, these FGDs were use for the purpose of data saturation and confirmation.

Data analysis

All interviews and focus groups were manually recorded using interview sheets and field notes, and were later transferred to an electronic Microsoft Access database. The responses to closed ended questions about the most common forms of gambling were analysed using descriptive statistics, while responses to open-ended questions were content-analysed by two researchers. This process involved the identification of emerging themes, unanticipated findings and gaps in the data and consensus themes were ranked according to their frequency (Johnson & Turner 2003; Rocco et al. 2003).

Results

At both interview points Indigenous client participants were a mix of remote and urban residents and the majority were unemployed. All key informants were employed within the AOD workforce or mental health service sector (Table I). Key informants tended to be older in age than focus group members and were more likely to be urban residents.

Prior to exploring sensitive issues of concern related to gambling within urban and remote Indigenous settings, the research team asked participants to reflect on the strengths within Indigenous communities. This question was used to encourage discussion of strength and resilience factors, promote engagement with the participants as well as provide a context within which to promote change and explore solutions. The most frequently mentioned strength overall was the support of family and friends, followed by living in community and maintaining and learning of culture and traditional ways. The second round group in 2011 also frequently mentioned work or leisure activities as an additional strength, with participants reflecting on the financial and social benefits of being in employment and in keeping occupied with a variety, of activities. Participants were also asked to reflect on current worries in Indigenous communities. Overall the most frequently mentioned stressors included substance misuse, poor health, family concerns and problem gambling. Other socioeconomic pressures cited included mental health and wellbeing concerns, such as 'feeling sad and shame which leads to humbug', violence, 'you get angry if you lose [money gambling] which can lead to domestic violence' and financial constraints, such as '[in general] not having money for bills or what you owe others'.

Gambling and its consequences

Participants were asked to identify the most common forms of gambling in their community and that which causes the greatest concern. Participants perceived the most popular form of gambling to be unregulated card playing, followed by regulated gambling at the casino and electronic gaming machines (pokies). Other regulated gambling activities identified were bets on football and horse racing. The gambling activity of most concern for participants in the first round of interviews in 2010 was the casino, followed by pokies. An important finding to emerge was the increasing number of respondents in the second round of interviews who identified card playing as of the most concern, whereas casinos were cited less frequently. Frequent comments from both consumers and service providers were that cards were more popular, widespread and of greater concern in remote communities, whereas pokies were a more pressing issue in town. Many participants felt people from outside the community, such as those living in other communities or urban areas, were visiting remote communities for the purpose of large unregulated card games and, as a result, money (winnings) was being extracted from the community rather than shared among its members.

Participants were asked to consider the good things about gambling as well as gambling concerns. Overall, participants frequently identified the social aspect of gambling as a positive, such as the incorporation of unregulated gambling activities into family visits and social gatherings, and the opportunity to 'catch up', 'tell stories' and relax with friends and family. The benefits that came from winning were frequently mentioned (such as having a surplus to pay bills, go shopping), as was sharing the proceeds of a win with friends and family. Several responses related to a reduction in money spent on alcohol or other drugs. In response to an open question about the 'not so good' things about gambling, over the course of the study participants frequently identified the financial burden of problem gambling and the wellbeing concerns and family problems that arose as a consequence (Figure 1). Being in debt, feelings of shame and stigma, addiction and constant family arguments were discussed as serious gambling-related consequences. The negative impact of gambling on family wellbeing and finances was a theme more frequently discussed by participants in the second round of interviews.

[FIGURE 1 OMITTED]

What change is needed around gambling?

The final questions explored what change was needed related to gambling and who was responsible for making the change. In terms of what changes were needed, the most common solutions identified related to the individual, such as limiting time and consumption on gambling and maintaining participation in education, work or other activities. Other themes to emerge were family focused, such as families spending more time together outside of the opportunities created by unregulated gambling. Participants identified government, services, individuals, families, and community, such as elders and leaders as agents of gambling change. One theme mentioned more often in the second round of interviews was the need for government to play an active role in gambling change, with increased regulation or legislation the most commonly identified solutions (Figure 2). Examples of responses included the removal of pokies from clubs and public bars, increased awareness and education about gambling and the continued quarantining of income as part of the NT intervention. One specific community-based strategy identified was to 'stop selling cards within the community'. Overall there was a marked decrease in the second round of interviews in the emphasis on community and family as important agents of change identification (Figure 3).

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

Participants were also asked to reflect on how it could be determined whether change related to gambling within the community has happened, and how people might behave and feel after change occurred. The most common changes described by participants related to improved family harmony due to reduced financial pressures and families spending more time together away from gambling. Financial stability and 'spending wisely' were therefore also frequently mentioned as indicators of change, as was improved social and emotional wellbeing, such as increased self-respect and less 'humbug' of family and friends. In terms of feelings linked with the change, the overwhelming feelings were of happiness, less anxiety, more pride and less shame, and more motivation. Additional evidence of improvement was described as improved knowledge and understanding of gambling-related problems, and feeling more connected to culture, family and community.

Request for more information

At the end of each interview and FGD, the researchers inquired about interest in receiving education about gambling. Participants were unanimous in their interest in receiving information about community-based services related to wise spending, mental health and/or gambling, and in receiving support for a community-based intervention related to making change. In addition, most were also interested in receiving information about gambling and/or mental health workshops.

Discussion

The findings related to perceived community strengths and concerns support those of recent studies suggesting that family, culture and community are central values across different Indigenous communities (Nagel & Thompson 2007; Christie et al. 2009). These were the most highly valued strengths identified throughout the study. Such community strengths and worries are also reflected in the specific gambling concerns reported, such as family disputes and community disharmony intensified by substance misuse and violence. As well as indicating protective and resilience factors, these findings support the proposition that community-wide as well as individual approaches to treatment are relevant for remote NT Indigenous peoples (Christie et al. 2009).

The participants in this study perceived an increased engagement of Indigenous people with regulated forms of gambling. In line with previous research (McMillen & Donnelly 2008), our study showed regulated gambling was identified as a pressing concern. There was a difference at 12 months, however, with a reported increased concern linked with larger unregulated card games in remote communities and money being extracted from, rather than redistributed within, the community. This is in keeping with the findings at consultation, which led to development of the study.

This study provides relevant insights into the role of gambling in Indigenous communities. Gambling is recognised as a recreational activity. It is strongly linked with socialising, fun and relaxation. This study supports other research findings that gambling allows opportunity for sharing and socialising, with the potential for reduced spending on alcohol (Christie et al. 2009; Breen et al. 2010). On the other hand, these findings also support the proposition that limited opportunities for alternative recreational activities contribute to high levels of problem gambling (Aboriginal Health & Medical Research Council of NSW 2007). There were many distressing and disturbing aspects of gambling reported by participants. Financial, social and emotional wellbeing concerns (such as shame, stigma, substance misuse) and family problems (such as arguments, violence, financial constraints) were frequent responses, while improved financial stability., family support and integration, and improved wellbeing were reported as the strongest evidence of positive change around gambling activity. Thus the responses also support the findings of Stevens and Young (2010), which show that Indigenous gambling problems correlate with community disharmony, including violence and alcohol misuse.

Gambling and mental health

Our study finds that respondents link gambling with shame, unhappiness and anxiety. These feelings, characteristic of high emotional distress, are likely to link with vulnerability to mental illness. Mental disorders are a leading contributor to the disease burden in Indigenous Australians (Begg et al. 2007; Vos et al. 2008). Between 2004-05 and 2008-09 hospitalisation rates for mental and behavioural disorders were around 1.7 times higher for Indigenous persons than for non-Indigenous persons across all years (Productivity Commission 2011: 7.53). Our findings contrast somewhat with a previous report (Hunter 1993) that, unlike non-Indigenous gamblers, card players in Indigenous communities do not experience distress at large gambling losses or have higher rates of depression, although they do have anxiety.

Strategies for change: government and regulation

Participants identified a number of strategies for gambling-related change: increased work and activities, education of gamblers, raised awareness and regulation, and legislation. There was a difference in participants' responses in the 2010 and 2011 groups regarding the use of regulation and legislation strategies as proposed solutions to gambling concerns, and a related difference of emphasis on the agents of change. While the community was mentioned as the lead change agent by participants in the first round of interviews, participants in the second round were more likely to see government in this role and to see regulation and legislation as solutions. The findings suggest that although family, community and culture are the most frequently identified community strengths, there appears to be reduced confidence in these institutions as agents of change. One possibility is that the NT Emergency Response has brought a greater assumption or expectation of intervention from outside the community itself.

These findings raise concern about the decrease in empowerment and community efficacy over time within these communities. Health of communities has been linked with social capital and empowerment, and the belief that communities can make change from within (Kawachi & Kennedy 1997; Baum 1999). The reduction in participant confidence in the community's capacity, to make change and take action is particularly important given that international studies link increased gambling with disempowerment and marginalisation (Volberg & Wray 2007; Dyall, 2010) and suicide risk of Indigenous peoples with lack of cultural continuity (Chandler & Proulx 2006). Studies among First Nations peoples have established that when a community takes active steps to preserve and rehabilitate its own culture, there is a reduction in overall suicide rate (Chandler & Lalonde 1998). Chandler and Lalonde (1998; 2008) have shown 'protective factors', such as securing native title, taking back from government agencies certain rights of self-government, community control over social and community services and communal cultural activities and facilities, need to be present in a community in order to build cultural continuity. Regeneration of this capacity and confidence in Indigenous Australian communities will be an important component of improved outcomes related to gambling. This is especially relevant in the current context of the NTER. The Human Rights Commission has argued that Indigenous Australians will be re-traumatised if the Intervention results in further disempowerment or a sense of extreme powerlessness, with negative mental health, social and emotional and physical consequences (HREOC 2008).

Study limitations

The information obtained in this study was limited by the choice of a small, non-random sample (Indigenous clients and service providers in mental health and treatment services) and thus does not necessarily generalise to the broader Indigenous population. The majority of participants in this setting were also adult males and the participation of more women and younger people in the study might have increased the diversity of perspectives and attitudes about Indigenous gambling. In addition it is not clear how far the interview and focus group findings are reported from first or second-hand experience. Despite these limitations, the study provides useful insight into perceptions of gambling in these settings.

Conclusions

Decreasing the health gap between Indigenous and non-Indigenous Australians involves promotion of resilience as well as targeting specific health concerns. Gambling is linked with socialising and sharing in Indigenous communities, but more importantly is associated with financial difficulties, emotional distress and family disharmony. Indigenous people are especially concerned about card playing in remote communities and electronic gaining machines in town. Promoting community strengths will be key to public health strategies to minimise gambling-related harm. In addition, participants recommended a number of strategies for gambling change, including more employment and recreational activities, education of gamblers, raised community awareness, and increased regulation and legislation.

Community awareness and education programs which promote resilience factors, such as cultural identity and values of Indigenous peoples, will be important for sustained change and improved health outcomes (Kirmayer et al. 2003). Regulation (and legislative) change, which engages with community leadership and control, will concurrently enhance community efficacy. Our findings lead to the specific recommendation that government adopts a preventive public health approach to Indigenous gambling similar to that recommended for alcohol use (National Preventative Health Taskforce 2009). This would aim to change the culture of gambling through a multi-pronged approach. Regulation and legislation, community awareness and education campaigns, and provision of a broader base of culturally-appropriate treatment services tailored to different communities, will be important components of the approach. Given the heterogeneity of Indigenous peoples across Australia, the incorporation of differences in perspectives, approaches and localities is critical. Heightened awareness of the link between gambling and emotional distress is also essential, while encouraging further research to examine protective and risk factors, responses to treatment and the outcome of preventive strategies.

Appendix 1: Topic guide for key informant interviews and consumer focus groups

1. Community strengths (Show Grow Strong Tree from flip chart)

a. What do you see as the five most important things that keep people strong in this community?

2. Community worries (Show Worries Tree from flip chart)

a. What do you see as the five biggest worries for people in this community?

3. Gambling in this community

Gambling is when you play cards or other games for money or pokies or other games in casinos pubs and clubs (betting on footy, horse racing etc)

a. What types of gambling do people do in this community? (Place ticks in column k next to those you see/know about)

b. What is the most popular type? (Place one tick in Column B)

c. What type causes the most worry and trouble for people? (Place one tick in Column C)

4. Good things about gambling in this community

a. What do you see are the good things about gambling in this community?

5. Not so good things about gambling in this community

a. What do you see are the not so good things about gambling in this community?

6. Making Changes

a. What do you think needs to change about gambling in this community?

b. Who do you think can help to make that change in this community?

c. How will people know if that change has happened?

d. What will people be doing differently?

e. How will they be feeling differently?

7. Information and support

Would you be interested in:

a. information about Amity Community Services gambling workshops and their community development approach?

b. information about AIMhi workshops related to mental health and/or gambling?

c. information about other community based services related to wise spending, mental health and/or gambling?

d. Support for a community based intervention related to making change?

Acknowledgements

The Foundation of Rehabilitation with Alcohol Related Difficulties Aboriginal Corporation (FORWAARD), Central Australian Aboriginal Alcohol Programs Unit Aboriginal Corporation (CAAAPU) Waltja Tjutangku Palyapayi Aboriginal Corporation and Amity Community Services Inc. supported this research study, in collaboration with Cowdy Aboriginal Mental Health Workers and members of the Menzies Aboriginal and Islander Mental health initiative (AIMhi) research team (especially John Cusack and Leigh-Ann Onnis). Financial support was provided by a Community Benefit Fund Amelioration grant (2009-2011).

References

Aboriginal Health & Medical Research Council of NSW (2007) Pressing Problems: Gambling Issues and Responses for NSW Aboriginal Communities, Sydney, NSW Office of Liquor Gaming and Racing, Department of Arts, Sport and Recreation.

Altman, J. (1985) 'Gambling as a mode of redistributing and accumulating cash among Aborigines: a case study from Arnhem Land'. In G. Caldwell, B. Haig & L. Sylvan (eds), Gambling in Australia, Sydney, Croom Helm.

Baum, F. (1999) 'Social capital: is it good for your health? Issues for a public health agenda', Journal of Epidemiology and Community Health, 53 (4), 195-196.

Begg, Stephen. Vos, T. Barker, B. Stevenson, C. Stanley, L. & Lopez, A. (2007) The Burden of Disease and Injury in Australia 2003, Canberra, AIHW

Brady, M. (2004) Regulating social problems: the pokies, the Productivity Commission and an Aboriginal community, Discussion Paper 269, Centre for Aboriginal Economic Policy Research, Canberra, Australian National University.

Breen, H. (2007) 'Visitors to Northern Australia: debating the history of Indigenous gambling'. In I. McDonnell, S. Grabowski & R. March (eds) CAUTHE 2007: Tourism--Past Achievements, Future Challenges, Manly, NSW, 11-14 February, Sydney, University of Technology.

Breen, H. Hing, N. & Gordon, A. (2010) Exploring Indigenous gambling, understanding Indigenous gambling behaviour, consequences, risk factors and potential interventions, final report for Gambling Research Australia, Centre for Gambling Education and Research, School of Tourism and Hospitality Management, Lismore, Southern Cross University.

Chandler, M. & Lalonde, C. (1998) 'Cultural continuity as a hedge against suicide in Canada's First Nations', Transcultural Psychiatry, 35 (2), 191-219.

Chandler, M.J. & Lalonde, C.E. (2008) 'Cultural continuity as a moderator of suicide risk among Canada's First Nations'. In L. Kirmayer & G. Valaskakis (eds) Healing Traditions: The Mental Health of Aboriginal Peoples in Canada, Vancouver, University of British Columbia Press.

Chandler, M. & Proulx, T. (2006) 'Changing selves in changing worlds: youth suicide on the fault-lines of colliding cultures', Archives of Suicide Research, 10 (2), 125-140.

Christie, M. & Young, M (2011) 'The public problem of "Aboriginal gambling": winning the struggle for an urban space', Australian Journal of Social Issues, 46 (3), 253-272.

Christie, M. Greatorex, J. Gurruwiw, D. Djirrimbilipilwuy, F. Galathi, J. Gapany, D., Garrjgulkpuy, E., Guthadjaka, K., Gurrumuwuy, C., Gumbula, I., Lawurrpa, E., Dhamarrandji, M., Gumbula, M., Nyununyunu, M., Gaykamanu, W. & Guyula, Y. (2009) Regulated gambling and problem gambling among Aborigines from remote Northern Territory communities: a Yolnu case study, workshop report, Darwin, Charles Darwin University http://www.nt.gov.au/justice/licenreg/documents/media/Gambling%20in%20 Yolngu%20Communities%20-%20Workshop%20Report.pdf

Delfabbro, P. Lahn, J. & Grabosky, P. (2005) Adolescent gambling in the ACT, report to the ACT Gambling and Racing Commission, ANU Centre for Gambling Research, Canberra, Australian National University.

Dyall, L. (2007) 'Gambling, social disorganisation and deprivation', International Journal of Mental Health and Addiction, 5 (4), 320-330.

Dyall, L. (2010) 'Gambling: a poison chalice for Indigenous peoples', International Journal of Mental Health and Addiction, 8 (2), 205-213.

Dyall, L. & Hand, J. (2004) 'Maori and gambling: a comprehensive Maori public-health response required in New Zealand', International Journal of Mental Health & Addiction, 1 (1), 1-17.

Flick, U. (2009) An Introduction to Qualitative Research, (4 ed.), London, Sage.

Greenhill, J. & Dix, K. (2008) 'Respecting culture: research with rural Aboriginal community'. In P. Liamputtong (ed.) Doing Cross-Cultural Research: Ethical and Methodological Perspectives, Dordrecht, Springer.

HREOC (Human Rights and Equal Opportunity Commission) (2008) Submission of the Human Rights And Equal Opportunity Commission (HREOC) to the Northern Territory Emergency Response Review Board, Canberra, Commonwealth of Australia.

Hunter, E. (1993) Aboriginal Health and History: Power and Prejudice m Remote Australia, Melbourne, Cambridge University Press.

Johnson, B. & Turner, L. (2003) 'Data collection strategies in mixed methods research'. In A. Tashakkorie & C. Teddue (eds) Handbook of Mixed Methods in Social and Behavioural Research, London, Sage Publications.

Kawachi, I. & Kennedy, B. (1997) 'Socioeconomic determinants of health: health and social cohesion: why care about income inequality'? BMJ, 314 (7086), 1037.

Keen, I. (ed.) (2010) Indigenous Participation in Australian Economies: Historical and Anthropological Perspectives, Canberra, ANU E-Press http:// epress.anu.edu.au?p=122571

Kirmayer, L. Simpson, C. & Cargo, M. (2003) 'Healing traditions: culture, community and mental health promotion with Canadian Aboriginal peoples', Australasian Psychiatry, 11 (Supplement), 15-23.

Lamb, D. & Young, M. (2011) '"Pushing buttons": an evaluation of the effect of Aboriginal income management on commercial gambling expenditure', Australian Journal of Social Issues, 46 (2), 119-140.

Liamputtong, P. (2010) Performing Qualitative Cross-Cultural Research, Cambridge, Cambridge University Press.

McMillen, J. & Donnelly, K. (2008) 'Gambling in Australian Indigenous communities: the state of play', Australian Journal of Social Issues, 43 (3), 397-426.

Nagel, T. & Thompson, C. (2007) 'AIMhi NT "Mental Health Story Teller Mob": developing stories in mental health', Australian e-Journal for the Advancement of Mental Health (AeJAMH), 6 (2), 1-6.

National Preventative Health Taskforce (2009) Australia: The Healthiest Country by 2020, Barton, Commonwealth of Australia.

National Preventative Health Taskforce by the Alcohol Working Group (2008) National Preventative Health Task force Technical Report No 3 Preventing Alcohol-related Harm in Australia: A Window of Opportunity, Canberra, Commonwealth of Australia.

Productivity Commission (1999) Australia's Gambling Industries, Summary, Report No. 10, Canberra, Ausinfo.

Productivity Commission (2010) Gambling: Inquiry Report, Report No. 50, Canberra, Productivity Commission.

Productivity Commission (2011) Overcoming Indigenous Disadvantage, Canberra, Productivity Commission.

Raylu, N. & Po Oei, T. (2004) 'Role of culture in gambling and problem gambling', Clinical Psychology Review, 23 (8), 1087-1114.

Rocco, T., Bliss, L., Gallagher, S., Perez-Prado, A., Alacaci, C., Dwyer, E., Fine, J.C. & Pappamihiel, N.E. (2003) 'The pragmatic and dialectical lenses: two views of mixed methods use in education'. In A. Tashakkorie & C. Teddue (eds) Handbook of Mixed Methods in Social and Behavioural Research, London, Sage Publications.

Rodgers, B. Caldwell, T. & Butterworth, P. (2009) 'Measuring gambling participation', Addiction, 104 (7), 1065-1069.

Schissel, B. (2001) 'Betting against youth: the effects of socioeconomic marginality on gambling among young people', Youth Society, 32 (4), 473-491.

Stevens, M. & Young, M. (2010) 'Independent correlates of reported gambling problems amongst Indigenous Australians', Social Indicators Research, 98 (1), 147-166.

Stevens, M. & Young, M. (2009) Gambling problems amongst the Indigenous population of the Northern Territory, Darwin, Charles Darwin University.

Thomas, S. Jackson, A. & Blasczcynski, A. (2003) Measuring problem gambling --evaluation of the Victorian Gambling Screen, Gambling Research Panel Report No. 4, Melbourne, Government of Victoria, Community Support Fund.

Volberg, R. & Wray, M. (2007) 'Some considerations for future research: legal gambling and problem gambling as mechanisms of social domination?', American Behavioral Scientist, 51 (1), 56-85.

Vos, T. Barker, B. Begg, S. Stanley, L. & Lopez, A. (2008) 'Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: the Indigenous health gap', International Journal of Epidemiology, 38 (2), 470-477.
A. Gambling types in   B. Most popular   C. Causes most
                 this community                           worries

1. Cards
2 Pokies
3. Casino
4. Footy
5. Horses
6. Other


Table 1: Participant characteristics

                                               2010
                                               (n)

                                  Consumers    Service    Total
                                              providers

Total Participants                   26           9        34
Male                                 25           7        31
Median age range (years)            30-35       40-45
Remote resident                      19           0        19

Employment

Full-time                             0           8         7
Part-time                             0           1         1
CDEP                                  5           0         5
Benefits                             21           0        21

Service Role

ACID worker                                       2
Aboriginal mental health worker                   2
Manager                                           2
Community worker                                  1
Client liaison officer                            1
Administrative officer                            1

                                               2011
                                               (n)

                                  Consumers    Service    Total
                                              providers

Total Participants                   33           9        42
Male                                 28           6        34
Median age range (years)            30-35       40-45
Remote resident                      15           0        15

Employment

Full-time                             0           8         8
Part-time                             0           1         1
CDEP                                  0           0         0
Benefits                             33           0        33

Service Role

ACID worker                                       4
Aboriginal mental health worker                   2
Manager                                           2
Community worker                                  0
Client liaison officer                            1
Administrative officer                            0
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.