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be necessary for at least one of these criteria to be met. However, satisfying one or more of the criteria would not be sufficient to positively determine if there is a causal relationship between an exposure and pathological or problem gambling. In many gambling studies, the first criterion (that a risk factor necessarily precedes the outcome of pathological or problem gambling) is unknown. Without this principal evidence, an exposure, a situation, or an event is not proven to be causal.
Furthermore, many studies reviewed by the committee collected data without exploring when and to what extent subjects were exposed to potential risk factors, or the age of onset of their pathological or problem gambling. Again from an etiological standpoint, these methodological limitations make it impossible to determine whether suspected risk factors might ''cause" pathological or problem gambling, or whether they are only correlated or associated with these behaviors. Thus, much of the evidence presented or implied in the literature as causal to pathological and problem gambling is, by commonly accepted etiological standards, better defined merely as evidence for an association. Still, despite the generally deficient state of etiological research on pathological and problem gambling, there does exist some tangible evidence to suggest certain risk factors and associations.1
Psychosocial and Environmental Risk Factors
Determining psychosocial and environmental risk factors for pathological and problem gambling is guided by the following question: Is the risk for pathological or problem gambling associated with sociodemographic factors, such as age, gender, ethnicity, and family effects, or is it associated with the availability of gambling to the gambler? In this section, we pay special attention to studies having sufficient sample sizes to generalize findings to larger groups within the population and studies that examine: (1) sociodemographic, family, and peer influences that
Some demographic risk factors pertaining to pathological and problem gamblers in vulnerable populations were previously discussed in Chapter 3.