Social Science & Medicine 272 (2021) 113674Available online 2 January 20210277-9536/© 2021 Published by Elsevier Ltd.“You don’t really see the dangers of it at the time.” Risk perceptions andbehaviours of older female gamblersSimone McCarthy a,*, Samantha L. Thomas a, Hannah Pitt a, Maria E. Bellringer ba Institute of Health Transformation, School of Health and Social … Continue reading “Risk perceptions and behaviours | My Assignment Tutor”
Social Science & Medicine 272 (2021) 113674Available online 2 January 20210277-9536/© 2021 Published by Elsevier Ltd.“You don’t really see the dangers of it at the time.” Risk perceptions andbehaviours of older female gamblersSimone McCarthy a,*, Samantha L. Thomas a, Hannah Pitt a, Maria E. Bellringer ba Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australiab Gambling and Addictions Research Centre, School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, Auckland University ofTechnology, Auckland, New ZealandA R T I C L E I N F OKeywords:riskolder womengamblinggambling harmpublic healthA B S T R A C TOlder women are vulnerable to the risks associated with some forms of gambling. While research has examinedhow individuals functionally interact with gambling products, very limited research has investigated how individuals conceptualise and interpret the risks associated with these products. Theorists suggest that risk-takingis not based on a lack of knowledge but on the different ways people make sense of their lives. As such, this studyaimed to understand the factors that may influence how older women who gamble on electronic gamblingmachines (EGMs) perceive the risks associated with gambling on these products. It examined how risk perceptions interacted with a range of complex social factors in women’s everyday lives to influence their risk behaviours. Semi-structured interviews were conducted with 20 Australian women aged 55 and over who had beennegatively impacted by EGM gambling. This study found that older women’s risk perceptions of gambling wereshaped by their early recreational experiences with gambling, rather than their current regular and harmfulgambling behaviours. Risk perceptions of EGMs were often downplayed or ignored as women sought to maintainvalued social identities within the venues. Women went through a process of risk negotiation whereby thebenefits of this social interaction outweighed the potential harms associated with the machines. This also ledthem to deflect or ignore risk minimisation messaging which was completely focused on individual behaviours.This study signals the importance of moving away from individualised responsible gambling messages towardsrisk information about gambling products. This research also provides evidence of the need for regulationaddressing the design features of EGMs that ultimately may make products safer and protect the most vulnerablefrom gambling harm.1. IntroductionGambling-related harm is a significant public health issue. There iswidely recognised inequality in the distribution of gambling harm[Goyder et al., 2020; Markham et al. 2016]. While there are many formsof gambling, some forms are identified as being more harmful thanothers [Browne et al., 2019; Rintoul and Thomas 2017]. Electronicgambling machines (EGMs, poker machines, pokies, or slots) are recognised as a form of gambling that is linked with considerable harm inmany countries [Productivity Commission, 2010; Ronzitti et al., 2016].EGMs have been referred to as the ‘crack cocaine of gambling’ or‘electronic morphine’ because of their complex and addictive designfeatures [Schüll 2012]. Some researchers argue that the structuralcharacteristics of EGMs may have an addictive or habitual effect on usersdue to the interplay of random outcomes and the rewards schedule of thegame, with users conditioned to associate sounds and images with rewards and success [Livingstone 2017; Yücel et al., 2018]. Some machines may play these sounds and display these images when a user isrewarded with less money than was originally bet [Dixon et al., 2010].Despite the above evidence, the structural characteristics of EGMs maybe unknown, unrecognised, or misinterpreted by individuals whogamble on these machines [Miller et al. 2018; Yücel et al., 2018]. Thismay be because the overall framing of EGMs is that they are a relativelynormalised leisure activity within community settings, and are safe andfun for those who are ‘responsible’ when engaging with them [Milleret al., 2016]. While many studies have examined how individuals* Corresponding author.E-mail addresses: simonemccarthy@deakin.edu.au (S. McCarthy), Samantha.Thomas@deakin.edu.au (S.L. Thomas), hannah.pitt@deakin.edu.au (H. Pitt), maria.bellringer@aut.ac.nz (M.E. Bellringer).Contents lists available at ScienceDirectSocial Science & Medicinejournal homepage: http://www.elsevier.com/locate/socscimedhttps://doi.org/10.1016/j.socscimed.2021.113674Received in revised form 16 December 2020; Accepted 30 December 2020Social Science & Medicine 272 (2021) 1136742functionally interact with EGMs [Newall 2019; Yücel et al., 2018], verylimited research has investigated how individuals conceptualise andinterpret the risks associated with EGMs.Older women are a population group that is vulnerable to the risksassociated with EGM gambling as compared to other age groups[Rockloff et al., 2020]. However, a range of factors may lead them toperceive that they are at a decreased risk of harm, or underestimate therisks posed by different gambling environments [Thomas et al., 2020].These factors include the positive perceptions about the social andfinancial benefits of gambling, which may also impact on how olderwomen conceptualise and experience gambling-related harm [Dowlingand Oldenhof 2017; Pattinson and Parke 2017; Thomas and Lewis2012]. For example, older women may perceive that they are at adecreased risk of gambling-related harm because they have a financialbuffer (through retirement savings, or no large financial commitmentssuch as home loans), which means that gambling is an affordable leisureactivity [McCarthy et al., 2018]. Thomas and Lewis [2012] found thatsome older women had lower perceptions of the harms associated withgambling because they perceived that there was a trade-off betweennon-gambling incentives offered by venues (for example, cheap meals)and the social benefits of venues (for example, social interaction andinclusion), and the money that they lost on EGMs. However, someresearch has identified that while older women are aware of the risksassociated with gambling, this does not necessarily influence theirbehaviour. For example, Pattinson and Parke [2017] identified thatolder women were motivated to attend gambling venues as theyperceived them as familiar and welcoming spaces which promoted social inclusion, despite recognising that the characteristics of gamblingvenues often enticed them to overspend on gambling.In understanding how older women may conceptualise and evaluatethe risks associated with gambling, it is important to understand existingtheories of risk perception. Situated rationality theories suggest that individual rationalities about risk are situation dependent and thereforeindividual risk behaviour is the outcome of socially situated risk perceptions [Rhodes 1997 p. 213]. Rhodes [1997] stated that risk is relativeand, in some contexts, perceived risks may not outweigh the perceivedbenefits of particular behaviours. Alternatively, social action theoriessuggest that risk behaviour is the product of social interactions [Poundand Campbell 2015; Rhodes 1997]. Risk is influenced by social dynamics, and perceptions are socially organised by social norms andcontexts, therefore moving away from individualised processes of decision making [Rhodes 1997 p. 216]. As such, how individuals makechoices based on how they perceive risks are socially calculated and maybe habituated as part of their everyday norms and routines [Rhodes1997]. This concept may be applied to risky gambling behaviour asgambling products and environments are embedded in everyday lives.This may mean that the risks of gambling are lost within the normalityand legality of the gambling environment, as well as the ‘cultures andspaces of convenience gambling’ [Egerer and Marionneau 2019 p. 126].Egerer and Marionneu [2019] suggest that there is an interaction between structural characteristics, the individual gambler, the gamblingsetting, and the cultural contexts in which gambling occurs. Gamblingpractices may be both acceptable and normal while simultaneouslypositioning the risks of gambling as the responsibility of the individual.This may help to partially explain why individuals who may be aware ofcertain risks may still engage in risk behaviours if they are inextricablybound by everyday normal life patterns and norms [Rhodes 1997].Zinn [2019] states that understanding risk-taking behaviours alsoinvolves understanding the practices and dynamics of risk-taking ineveryday life, including how risks are embedded in larger social dynamics. While individuals are knowledgeable actors who make sense oftheir environment and take risks as part of managing everyday challenges, the meanings and practices of risk in the social realm are complex, volatile and diverse [Zinn 2019]. Zinn [2019] p. 8] suggests thatattempts to change risk-taking behaviour are unlikely to succeed if thesocial conditions that drive these behaviours are not addressed. Theseinclude individuals’ motivations to take risks, which may be done for arange of complex reasons, including material gain, developing a valuedidentity, or vulnerability [Zinn 2019 p. 4]. As such, risk-taking may playdifferent roles in people’s lives depending on the degree of control theyperceive they have, and as they seek to balance the gains and risks ofparticular behaviours [Zinn 2019 p. 5]. For some individuals, risk-takingmay be a response to having no or little control in life and thereforetaking risks may provide the perception of control or pleasure and thrillin an otherwise stressful or mundane life [Zinn 2019]. For individuals inthis position, resources are limited and risk-taking may be consideredappropriate to deal with lack of control. The important aspect of this inrelation to older women and gambling is that when resources are limitedand only high risk-taking is considered an appropriate response, peoplemay disregard information about the potential negative outcomes of thebehaviour. In many cases when people’s practices deviate from expertadvice, risk-takers are aware that they are taking risks and weigh up thepros and cons of their behaviour. This is because the way individualsreflexively engage with the world is socially shaped [Zinn 2019 p. 7]. Assuch, risk-taking behaviours which are embedded in social activitiesmay be considered desirable, acceptable or normal, or sometimes be theonly choice. Reflexivity in a gambling environment may reflect theoryfrom Baudrillard [1994] who suggests that individuals are positioned inan environment where they are led to think they have more control thanthey do, and where reflexivity is concentrated. In this perspective, thereis a strong emphasis not on the agency of individuals but on the socialcontext and the role of social norms in influencing how individualscalculate the risks associated with gambling, as well as acknowledgingthe social conditions and power structures that influence behaviours.Finally, Zinn [2019] p. 9] argues that identity is central to risk-taking –whereby risks are taken to protect an identity or lifestyle. Risk-taking inthese cases is not based on a lack of knowledge, but on the different waysin which people make sense of their lives.If the above holds true, then strategies which aim to reduce olderwomen’s risky engagement with EGMs will involve understanding thefactors that may influence how they perceive the risks associated withEGM gambling (including their knowledge and understanding of thestructural characteristics of machines), and how these factors mayinteract with a larger range of complex social factors in their everydaylives to influence their risk behaviours. Using an in-depth qualitativeapproach with women who had self-identified as having negative experiences with EGMs, the analysis presented in this paper was guided byfour research questions:1) How do older women perceive the risks associated with EGMs andthe environments in which they are situated?2) Which social dynamics may influence risk behaviours in relation toEGM gambling?3) How do older women respond to information that is provided aboutthe risks associated with EGMs? How do they apply this informationto their own lives?4) How do older women who have experienced gambling-related harmreflect on their risk perceptions and behaviours?2. Methods2.1. ApproachThis study used Charmaz’ [2006] social constructionist approach.Social constructionism is a Grounded Theory approach that aims toconstruct theory from the emerging themes in the data. This approachviews theoretical understandings as abstract. The method recognises theactive role of the researcher in constructing theoretical categories andshaping the research results and acknowledges that the researchers’ ownexperiences and biases may influence the conclusions drawn from thedata [Charmaz 2006]. The social constructionist approach emphasisesthat individuals see and construct the world differently and assumes thatS. McCarthy et al.Social Science & Medicine 272 (2021) 1136743multiple realities exist [Charmaz 2006]. Individual perspectives andexperiences are grounded in the social and cultural context that shapeand sustain the social practices of individuals. As such, analysis involvesinterpreting processes, actions, assumptions, and consequences, ratherthan topics, to ground the categories in the data [Charmaz 2006]. Theaim of utilising this methodological approach was to understand howolder women constructed and interpreted their world, and how theirunique social contexts and dynamics influenced their EGM risk perceptions and behaviours.Ethical approval was received from the Deakin University HumanResearch Ethics Committee [2018-289].2.2. Sampling and recruitment strategiesConsistent with other studies relating to older adults and gambling[Tse et al., 2012], women aged 55 and over who gambled on EGMs andwho self-identified as being negatively impacted by gambling wererecruited for the study. Participants were eligible to participate in thestudy if they were Australian residents, spoke English at a level thatallowed them to confidently participate in an interview, and gave verbalconsent to participate before the interview.Participants were recruited via a range of community and treatmentsettings. These included via gambling advocacy and support groups,older adult and women’s groups, Gamblers Help counsellors, localcouncil newsletters, and public noticeboards. Snowball sampling techniques were also used, with participants referring women from theirsocial networks to the study. This was an important mechanism forrecruitment, given the theoretical focus of the study on understandinghow social norms and dynamics may influence EGM risk perceptions andbehaviours. The study aimed to recruit women with varying levels ofgambling-related harm and therefore targeted recruitment notices usingbroad, destigmatising language to engage not only those with high-risklevels of gambling but moderate and low-risk gamblers who mayconceptualise their experiences of harm differently. The study aimed tocollect detailed narratives from twenty women. This sample size wasdeemed appropriate for this study as it sought to explore a relativelyhomogenous population of older women [Charmaz 2006; Creswell andPoth 2016; Green and Thorogood 2018], and was consistent with thesample sizes of other studies that focus on women’s experiences of EGMgambling [Holdsworth et al. 2012; Holdsworth et al. 2013].2.3. Data collectionData was collected via one on one semi-structured interviews bytelephone (with interviews lasting an average of 66 min). Interviewscollected general socio-demographic information such as age, income,and employment status, as well as postcode data which was used toidentify Socio-Economic Indexes For Areas score (SEIFA) for relativeadvantage and disadvantage. Taking into account relative advantageand disadvantage, a decile of 1 shows the area is of low socio-economicadvantage and high disadvantage and a decile of 10 shows the area is ofhigh socio-economic advantage and low disadvantage [Australian Bureau of Statistics 2013]. Information was also collected about currentand past gambling behaviours, and risk of gambling harm using the5-item Brief Problem Gambling Screen (BPGS) [Volberg and Williams2011]. The positive endorsement of one or more items on this screenclassified an individual as ‘at risk’ of gambling harm [Dowling et al.,2018; Volberg and Williams 2011]. The interview then explored participant’s experiences with gambling, with a particular focus on EGMs.Themes covered included early experiences with gambling, the rolegambling played in social practices, the perceived risks and benefits ofgambling and how this changed over time, and specific risk perceptionsrelated to EGM use. Participants were also asked questions relating tothe impact of their gambling on their lives and the lives of others, theirconceptualisation of gambling harm, and their recommendations forreducing gambling harm specifically relating to women. Eachparticipant received a $60 grocery voucher as a token of appreciation fortheir time.2.4. Data interpretationInterviews were transcribed and uploaded into NVivo 12 Plus toassist with the management of the data [QSR International Pty Ltd2018]. To ensure anonymity and confidentiality, transcripts werede-identified, and each participant was assigned a pseudonym. Quotesfrom participants are presented in the results with these pseudonyms. Inline with the social constructionist approach, data analysis involvedidentifying and interpreting key concepts and categories to form thebasic codes of the analysis [Charmaz 2006]. Regular data interpretationmeetings were used to deliberate ideas, interpret semantic and latentthemes, and develop theoretical constructs from the data relating to riskperceptions and behaviours. Themes were then reduced to conceptualcategories, which formed the larger theoretical framework presented inthis study. Existing theories of risk were used to interpret and constructtheory from the data, with researchers aiming to show the complexitiesof views and experiences of participants [Charmaz 2006]. This includedinterpreting participant experiences, such as the way they perceived andinterpreted situations, to build theory [Charmaz 2006].3. Results3.1. Participant characteristicsThe average age of participants was 66 (SD 5.7), most participantslived in the state of Victoria (n = 17, 85.0%), and lived in medium tohigh areas of socio-economic advantage (SEIFA score 4 or above, n = 18,90.0%). The majority of participants did not have an education beyondhigh school (n = 13, 65.0%), and were currently working in either unpaid work or were retired (n = 12, 60.0%). Nearly two-thirds of participants had been divorced or separated (n = 12, 60.0%), with anadditional fifth of participants widowed (n = 4, 20%). All participantsendorsed at least two out of five items on the Brief Problem GamblingScale.3.2. Social practices and dynamics: early experiences to regular gamblingThe first stage of analysis sought to understand women’s socialpractices relating to EGMs, and how these practices may have changedover time. For several women in this study, their earliest memory ofEGM gambling was on holidays with family and friends interstate toNew South Wales before Victoria had legalised EGM gambling. Thefeminisation of EGMs occurred relatively quickly, with this form ofgambling viewed as a more socially acceptable form of gambling thanthe male-dominated track-based horse race gambling. Some womencommented that EGM gambling was viewed as being relatively easy andrisk free simple to use, required no skill, and were embedded in socialpractices such as socialising with friends:“I think it was just like a bit of a social thing, people went to have a fewdrinks and gamble on the pokies, just a bit of harmless fun to start with.” –Mary: 55 years oldA few women in the study were introduced to EGM gambling by amale partner and perceived this type of gambling as a shared activity.Some described that they gambled on EGMs only because their partnerwanted to, while other women initially associated EGM gambling with asocial outing:“It started off socially where somebody I was going out with introducedme to poker machines, and I actually had never had anything to do withthem. It started off that way socially with him.” – Elizabeth: 65 years oldFor other women, and particularly those who described that they feltS. McCarthy et al.Social Science & Medicine 272 (2021) 1136744very socially isolated, lonely or alone, EGM venues were a place wherethey sought social connection with others. One of the factors thatattracted them to venues was that they were a socially acceptable spacefor women to be by themselves. Several commented on the lack of socialspaces in the community where women could feel safe, and where theycould be alone without feeling stigmatised. These women perceived thatEGM venues were one of the few entertainment spaces for older, singlewomen. They could attend these venues at any time of the day, andcould meet people:“[EGM venues were] somewhere you could go, you could sort of meetpeople and talk to people and hear their different stories” – Julia: 59years oldFinally, EGM venues were a place of escape for some women, wherethey could be on their own and away from the problems of theireveryday lives. Some of these women described a range of stressful ortraumatic life experiences, with EGM venues described as somewhere to“get away from everything”. Karen described how effective she perceivedEGM gambling was to relieve the stress of her daily life:“My job was really stressful, I ran an office…. and I just did everything.So it was a way of, I suppose, getting rid of all that tension. It does, itworks….. it works too good.” – Karen: 67 years old3.3. The embedding of EGM use in individual and social identitiesThe next stage of analysis explored the way in which EGM gamblingbecome an integral part of women’s identities. Identities were formedand then maintained through the established social practices associatedwith gambling. Using EGMs enabled some participants to maintain theirvalued identities as socially connected, socially active women. This wasdescribed as essential for a couple of women who had retired but whoperceived themselves as outgoing, social, and needing to live a busy, andfulfilled life. For a few women from isolated or regional communities,EGM venues were the only entertainment space where they felt theycould go to socialise. For example, Julia stated that going to EGM venuesfor a night out was integral to her identity:“I’ve never been one to want to stay home of a Friday night. I’ve alwayswanted on Friday night to go and do something. You’re home all week ifyou don’t work. I’d notice on a Friday night that I would go [to thevenue]. And that happened to be a pension night for me. But where elsecould I go? Especially when I lived in [a regional suburb]. There’snothing there. So where else do you go to but a club? That’s pretty muchall there is to do.” – Julia: 59 years oldHowever, while some sought social connection, a few women soughtanonymity. For example, Margaret described how she enjoyed attendingEGM venues as they enabled her to remain “faceless” and be aroundpeople who didn’t know who she was in order to relax. She indicatedhow critical EGMs were for her at a difficult stage of her life to have anoutlet and to be able to switch off:“I just found it was a good way of escaping from the world. I could sit inthere and listen to the ‘music machine’. Socialise with the people I wasn’tsocialising with. Have a drink and switch off…. More about being aroundother people than actually wanting to talk to people and be involved inwith people…When I think back now, I think it just played an importantpart in my life. Because I needed that outlet. Because I was so unhappy. Ineeded that outlet.” – Margaret: 63 years oldWomen also described that their EGM gambling was a hiddenidentity, which was able to be incorporated into their life while protecting their everyday identity. However, this also led to secretivegambling behaviour, with a couple of older women describing the liesthey told to ensure no one found out about their gambling. Margaretdescribed negotiating her gambling identity with other aspects of herlife:“I’d be up early at a venue at nine o’clock, full of excitement, tellingmyself I was only going to spend a few dollars. But it never worked outthat way. And I could spend either all day in the venue or a couple ofhours. It just depended on how much I won, how much I lost, how I felt onthe day, and what my work schedule was… People would never haveknown ever that I had a problem because I could hide it so well. I stillpresented myself well. Still went about my business. I still went out. I stilldid things. I had holidays. Nobody would have ever known.” – Margaret:63 years old3.4. Shaping perceptions of risk: The interplay between environments,products, and identitiesWomen’s perceptions about the safety of venues were reinforced byhaving women who “looked like me” in the venues, that venues hadsecurity guards, and were embedded within their local communities –often accessible by a short walk or drive from their home. Importantly,for some women, venues were open late at night, and perceived as safespaces:“I had a place to go at one o’clock in the morning… that was a safeplace.” – Claire: 72 years oldA few women described how the machines influenced their perceptions of risk and led them to conceptualise that EGM gambling was apositive activity that made them feel good about themselves. Forexample, Donna described how the adrenalin rush associated with themachine enabled her to ‘feel alive’:“I enjoyed the adrenalin rush. That was probably what I liked about them.They made me feel alive. So yeah I think it’s very dangerous because theyare extremely well designed to actually make you addicted very easily.” –Donna: 64 years oldOther factors that decreased perceptions of risk included early wins,the belief that some machines were luckier than others, or that machineswith high jackpots would eventually pay out. Karen described how thiscontributed to the perception that she would eventually win:“You watch all these machines and then you’d look at other people onthese other machines and they’d be winning on those. And you know whenyou jump on those you don’t win. So you don’t play that one. It’s all afallacy now. I think it’s the colours, the sounds, it all gets to you.” –Karen: 67 years oldSome women also perceived that they had a degree of control overthe machines. This included that they could influence a winningoutcome, for example through the timing of placing a bet, or the waythat they pressed the buttons on the machines.“People will go in and they’re playing very high bets. Obviously, there’s abigger chance of getting a bigger win. But there’s also a bigger chance oflosing the lot. And to be playing a machine at $5 a push is a lot of moneyto lose in in a short space of time. But people do it. And they don’t haveenough understanding of them. They don’t have the education.” – Lisa:60 years old3.5. The benefit of hindsight: justifying and reflecting on risk behavioursMany women in this study initially perceived EGM gambling asbeneficial to their lives, with financial losses outweighed by theperception that it met a social or emotional need in their lives. Forexample, Margaret, who felt isolated after moving to a new city with nosocial networks, and who described gambling on EGMs as a way to copewith loneliness, reflected on how she perceived that the benefits associated with EGM gambling outweighed the consequences of regularlyS. McCarthy et al.Social Science & Medicine 272 (2021) 1136745gambling on the machines.“I thought it was giving me all the social needs that I wanted. Beingaround people, being out, doing something on my own without having torun. It felt like my guilty pleasure. …..Like sitting in front of this innateobject and not having to think about anything think about what was goingon in my life.” – Margaret: 63 years oldSome women reflected that in hindsight they were so focused on thebenefits that the machines and the venue provided them, that they rarelythought about risks. It was only after entering recovery that they realisedthe risk and harm that they had experienced. Donna reflected that if shecould have predicted the future, she would never have placed herself inthat position:“Hindsight is excellent. I think a lot of people have the same experiencethough. You don’t really see the dangers of it at the time. Because most ofus wouldn’t even embark on it if you could see the future.” – Donna: 64years oldA few women recognised but tolerated the harms they were experiencing. For these women, EGMs were used as a coping mechanismwhere they felt they “had no choice” but to attend venues. This wasparticularly the case for one woman who had a violent home environment. Claire conceptualised the risks of staying at home with an abusivepartner as greatly outweighing the risks of losses on EGMs and associated harms. While she understood the risks associated with hergambling, she felt powerless to overcome the situation that she foundherself in:“I just had no choice. I didn’t feel I had a choice. I saw the casino or pokievenue as a good place to be …. I couldn’t be at home, I couldn’t be. I meanit was so serious I had to put a lock on the bedroom door, so he couldn’tget in at times.” – Claire: 72 years old3.6. Recognising and deflecting risk informationWomen were aware of the ‘responsible gambling’ messages that weredisplayed in venues. However, some women suggested that these messages in venues and on television campaigns reinforced that EGMgambling was relatively harmless, and something that could be easilycontrolled. This further contributed to the stigma associated with theirgambling and made it more difficult to seek help. Patricia explained howindividualised messaging exacerbated the harm she experienced:“I came out hating myself. And thinking it was all my fault. If I had justbeen more responsible. Because the sign said it. ‘Responsible gambling; seta limit and stick to it’. I hated all those phrases. They made it worse. Theymade it my fault. They made it impossible for me to ask for help.” –Patricia: 70 years oldFinally, a few women stated that the nature of their addiction tomachines meant that they deflected or ignored risk information. Susandescribed how her addiction meant that no matter what risk informationwas provided, she found it difficult to seek help:“I didn’t even think about it. You’re lost in another world, are you goingto seek help? You just don’t. Because we’re all different so you knowpeople will seek help at different times, but you just keep thinking thatyou’ll be ok, but you’re not ok.” – Susan: 61 years old4. DiscussionThis exploratory study aimed to understand the factors that mayinfluence how older women perceive the risks associated with EGMgambling and how these factors may interact with other social factors intheir everyday lives. Fig. 1 illustrates the factors that may shape olderwomen’s risk perceptions, how they interpret risks and and the role ofrisk information and messaging.First, this study demonstrates how gambling becomes embedded inthe social practices and valued identities of older women. The findingsshow that early experiences with some forms of gambling may be drivenby a desire to be socially connected. This confirms previous literaturethat women are motivated to attend gambling venues for social reasonsand builds on the research that suggests gambling for social connectionmay lead to regular and harmful gambling practices [Berry et al. 2002;Holdsworth et al. 2012]. Previous research suggests that youngerwomen’s gambling practices are often influenced by that of friends, witha degree of socio-cultural acceptance associated with gambling for somegroups of women [McCarthy et al., 2018]. The current study suggeststhat some older women may have similar experiences when firstgambling. As they age and experience life changes, women maycontinue to seek out opportunities to socialise to maintain a valuedidentity. This supports Rhodes’ [1997] social action theory, whichproposes that risk-taking behaviours are socially calculated and influenced by social dynamics and situations. This may also explain whywomen who were aware of the risks, still engaged with EGMs. Theresearch also suggests that some older women may develop gamblingidentities that centre on the value of being social or socially connected.Tthe need for these socially connected identities may outweigh the risksFig. 1. A proposed model of the interplay between risk perceptions, interpretations and risk information in influencing gambling behaviour of older female gamblersin Australia.S. McCarthy et al.Social Science & Medicine 272 (2021) 1136746associated with the gambling products that they engage with. Thisfinding provides support for theories of risk which state that one reasonthat individuals may engage in risk-taking behaviour is to develop (orcontinue) an identity that is personally valued and meaningful [Zinn2019].Second, this study found that older women may connect EGMs withpositive associations which may influence their risk perceptions. Charmaz [1990] observed that symbolic interactionism relates to an individual’s actions following the interpretation of their environment. Thecurrent study shows that this (mis)interpretation of risk may be based onthe interaction between the framing of venues as fun, safe spaces, andthe social needs of women. This demonstrates the range of determinantsother than individual responsibility that may influence older women’sgambling practices and affect their perceptions of risk and control. It isimportant to note that symbolic interactionism also assumes that individuals have the power to create change, despite the structural andcultural factors that influence their behaviour [Reynolds and Herman1994]. This suggests that interventions that focus on the risk information of the product may be effective in changing older women’sgambling practices and risk perceptions and may disrupt reduced interpretations of risk. Researchers have argued the importance of identifying, describing and disrupting the influence of the commercial sectorand holding commercial actors to account [de Lacy-Vawdon and Livingstone 2020; Maani et al., 2020]. Acknowledging the commercial influences on public health and their contribution to health inequalitiesrecognises the role the private sector plays in shaping the broaderenvironment, individual behaviours and population health outcomes.Third, older women may justify the risks or tolerate the harms theyexperience when they perceive that there are benefits that outweighthese harms. This was particularly evident among women who werevulnerable with limited resources to mitigate harms. For these women,gambling was a way to cope with other problems in their lives. Risktaking behaviour was an appropriate response to their life situation.Zinn [2019] explains that risk-taking plays different roles in people’slives depending on the degree of control they perceive they have, and asthey evaluate the risks and benefits of their behaviours. Women in thisstudy were able to reflect upon their gambling experiences suggestingthat for much of the time, the benefits were important to them in thecontext of their lives. This involved reflecting on stressful and traumaticlife experiences where EGM gambling was considered an effectiveescape mechanism to cope with stressors and EGM venues wereconsidered a safe space. With limited control over other aspects of theirlife, individuals in similar situations may overestimate the control theyhave over the outcomes of EGMs and interpret information in a way thatis consistent with their motivations to win money or recover losses[Livingstone 2017]. However, at some point, many women in this studycould no longer accept the harm they were experiencing. Gamblingbecame the worst problem they experienced and significant damage andharm had occurred, which eventually led to help-seeking. This providesa rationale not only for stronger risk messages about the structuralcharacteristics of machines but also the need for stronger policies. Policyaction that regulates the availability of EGMs in community settings andthe amount of money that can be lost within a certain time may help toprevent gambling harm among older women (and other at risk groups)and would complement the provision of independent evidence-basedrisk information that is unlikely to be effective on its ownFinally, this research determined that current harm minimisationmessaging strategies may be ineffective in reducing risk. This may notonly be the case just for older women, but for all individuals who gambleregularly on EGMs and who subsequently are more likely to experienceharm. Women in this study suggested that responsible gambling messages further stigmatised help-seeking. This is consistent with previouscriticisms that responsible gambling approaches to harm minimisationoverwhelmingly focus on the individual rather than the broader determinants of gambling harm [Miller and Thomas 2017; Reith 2007;Young et al. 2011]. Further, the current study demonstrates that olderwomen may deflect risk information, particularly when they are at theheight of their gambling addiction. This supports commentary relatingto the flaws in ‘responsible gambling’ models [Hancock and Smith 2017]and again reinforces the need for a strong public health response whichaddresses all of the determinants of gambling harm [Livingstone andRintoul 2020].4.1. LimitationsDue to the small sample of women in this study, the research findingsare not generalisable to all women who have experienced harm fromEGM gambling. The study sample was primarily limited to women whospoke fluent English. Investigating the experiences of women fromculturally diverse and non-English speaking backgrounds will beimportant in understanding how a range of cultural practices and socialdynamics may influence risk perceptions.This study only recruitedwomen who self-identified as having negative experiences withgambling. Future research is needed to determine the factors that influence risk perceptions for women who may not believe that they havenegative experiences but may still be experiencing some form ofgambling-related harm.5. ConclusionThis research provides exploratory information about the factors thatmay influence the gambling risk perceptions of older women, and howthese perceptions and interpretations may influence gambling behaviour. This study found that risk perceptions may be shaped by earlyexperiences, and the interplay of safe environments, gambling products,and valued social identities. Older women may misinterpret or minimisethe risks of EGMs and may justify the risks and the harm they experiencewhen these are outweighed by the social and emotional benefits thataddress a range of complex social factors in their everyday lives. Thisstudy signals the importance of moving away from individualised publichealth messages towards messages that reflect a range of determinantsof harm.Author contributionsSM: PhD student researcher. Led the study design, data collection,data analysis, drafting of the paper, and critical revisions of the manuscript. ST, HP and M.E.B: Study investigator. Contributed to study designdata interpretation, manuscript drafting, and critical revision ofmanuscript.Funding declarationsThis research study was not funded. An internal university grantprovided the funds to pay for grocery vouchers for participants.ReferencesAustralian Bureau of Statistics, 2013. SEIFA Iin TableBuilder. 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