cents is approximately 6.1 percent and for pathological and problem gamblers combined, about 20 percent. Taken at face value, these figures indicate considerably higher levels of pathological and problem gambling among adolescents than adults. And although the evidence consistently shows higher rates among adolescents, it is difficult to determine how much higher those rates are. Differences between survey instruments, in criteria for classification as a pathological or problem gambler, and in the significance of certain symptoms (e.g., incurring debt) complicate any attempt to directly compare adolescent and adult prevalence rates.

Nonetheless, the best available evidence indicates that pathological and problem gambling among adolescents is a significant problem. The proportions of adolescents classified as pathological and problem gamblers in recent studies examining this issue are roughly comparable to the proportions who use alcohol once a month or more or who use illicit drugs.

Although we have characterized the findings of the research currently available, it is important to emphasize how inadequate that research base is for drawing confident conclusions about the prevalence of pathological and problem gambling in the U.S. population or in important subpopulations. Only three national prevalence surveys have been conducted since 1977, and each estimated in a way quite different from ways used to operationalize and measure the prevalence of pathological (and problem) gambling in the past 10 years. All consideration of more recent periods must therefore rely on a modest number of state-level surveys. Moreover, the states covered in those surveys do not constitute a representative sample of U.S. states or even a reasonable purposive sample. Further limitations apply to the assessment of trends in pathological and problem gambling during the recent decades of great expansion in the availability of legal gambling opportunities. Prevalence surveys have been conducted at more than one time in only a handful of states, and in some of those cases the same instrument and sampling procedures were not used on both occasions.

Further complications are associated with the relatively unstandardized constructs, operational definitions, screening instruments, and criteria that have been used in research on patho-



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