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How the causes, consequences and solutions for problem gambling are reported in Australian newspapers: a qualitative content analysis

How the causes, consequences and solutions for problem gambling are reported in Australian... P roblem gambling, defined as “difficulties in limiting money and/or time spent on gambling that leads to adverse consequences for the gambler, others, or for the community”, 1 is recognised as a significant public health issue. 2,3 In Australia, official statistics estimate that between 80,000 and 160,000 Australians experience problem gambling each year, 3 although these figures under‐estimate the true extent and impact of gambling harm both for individuals and communities. 4 Gambling harm includes a range of negative social outcomes (such as criminality, 5 housing instability, 6 relationship problems, 7 financial difficulties such as indebtedness, 8 and domestic violence 9 ) as well as health problems (including significant co‐morbidities with substance use disorder, depression and anxiety disorders 10,11 ). While researchers recognise that the causes of gambling harm are complex, and involve a range of social, psychological and biological factors, 12–14 most gambling research focuses on individual risk factors, rather than the broader range of environmental (including industry) factors that may increase vulnerability to risky patterns of gambling. 2 For example, while there have been calls to develop a more comprehensive public health framework to tackle harmful gambling, incorporating specific factors (the gambling environment, gambling exposure, gambling types and gambling resources) and general factors (cultural, social, psychological and biological), 15 there is still very limited research into how ‘Big Gambling’ targets, engages, and appeals to different population subgroups, and how they seek to influence public policy debates. 4,16 Many different types of gambling products are available in Australia, but electronic gaming machines (EGMs) – more commonly known as pokies or slots – account for more than half all gambling expenditure 3 and have been most strongly associated with problem gambling. 17,18 In 2010, there were about 198,300 EGMs in Australia, in 3,363 hotels, 2,320 clubs and 13 casinos. 3 There had been few attempts to implement comprehensive EGM reform in Australia until 2010, when a hung parliament after the Australian Federal Election left key independent Members of Parliament (MPs) holding the balance of power in the Australian House of Representatives. One of these MPs, Andrew Wilkie (from the Tasmanian seat of Dennison), was strongly in favour of introducing harm minimisation measures for EGMs, and made the introduction of mandatory pre‐commitment on all EGMs (where individuals must commit to a monetary limit before starting to play and are locked out of all machines for a 24‐hour period once that limit is reached) a condition of his support for the formation of a Labor government. This initiated several Federal parliamentary inquiries into harm minimisation measures associated with various gambling products. 19–22 It also stimulated major national debate on gambling reform (commonly known as the Wilkie Reforms). Much of the debate played out through the national media and included intensive (and ultimately successful) gambling industry lobbying against the reforms. Media analyses are important in identifying the ways in which public debates about an issue are framed and can provide important insights into how public health may be better placed to influence and advance policy arguments about key public health issues. 23 Media analysis has been used in research into other public health issues, including tobacco, 24 alcohol, 25–27 obesity, 28,29 crime 30 and health generally, 31,32 to explain how public health issues are framed and presented to the public, as well as the key ‘actors’ and sources that are used to influence both dominant discourses and counterframes about an issue. Despite the emergence of gambling as a key public health issue, there have been relatively few examinations of how the news media report issues and present debates relating to gambling either in Australia or internationally. 33–35 ‘Issue framing’ has been shown to influence public opinion, public health policies and legislation. 36 Guided by the approach used by Menashe and Seigal, who identified how tobacco had been framed in The New York Times and The Washington Post to provide “important clues as to why public health efforts to overcome the tobacco industry's influence on public policy and on tobacco use have not been entirely successful”, 24(p307) this paper uses a combination of qualitative and quantitative techniques to examine how the causes, consequences and solutions for problem gambling were framed in Australian media reporting. Methods Data collection Using the Factiva database, we searched the eight highest circulation newspapers in Australia: 37 The Age and The Herald Sun (Victoria), The Sydney Morning Herald and The Daily Telegraph (New South Wales), The West Australian (Western Australia), The Advertiser (South Australia), and The Courier‐Mail (Queensland), and The Australian (national). The sample included broadsheets ( The Age , and The Sydney Morning Herald published by Fairfax Media and The Australian published by News Limited) and tabloids ( The Herald Sun, The Advertiser, The Daily Telegraph and The Courier Mail published by News Limited and The West Australian published by West Australian Newspapers Ltd). Using the keywords: ‘gambling’, ‘gamble’, ‘betting’, ‘pokies’ and ‘poker machines’, we included news items, feature stories, editorials, opinion pieces and letters to the editor in the search (we were interested in capturing the breadth of public debate associated with gambling reform) published between 1 July 2011 and 30 June 2012. Each article was downloaded and read. Duplicate articles, including multiple editions of the same article, and those that did not relate to problem gambling were excluded from the dataset. Data analysis We chose a framing analysis to explore how different arguments about problem gambling and gambling reform clustered around different perspectives. 30,38,39 Entman 40 comments that the media frames an issue by selecting and emphasising a number of aspects, such as by defining problems, diagnosing causes, making moral judgments and suggesting remedies. These frames then encourage audiences to think, feel, and make decisions about an issue in a particular way. 41 A frame may include several arguments with a similar perspective and also symbols, metaphors and catch phrases 24 (e.g. the term ‘responsible gambling’, which may be used to place responsibility on individuals while excusing industry from responsibilities for harm). The content of each article (including the headline and byline) were imported into QSR NVIVO, which was used to manage the data during analysis. Articles were initially grouped by type of newspaper, and then by the main topic of the article. We drew upon the methods used in other media analyses, 29,32 which involved coding and then quantifying the key characteristics of the sample including: 1) the overall number of articles; 2) the newspaper the articles appeared in; 3) the main topic of the article; 4) the types of actors and sources quoted; and 5) the type of gambling discussed. Once these initial characteristics of each article were coded we conducted qualitative analysis to provide more detail about the discourses used within frames. 42–45 Qualitative analysis involved open‐ended reading and re‐reading of the relevant sections of the articles (including the headlines and bylines) to identify key arguments, perspectives and themes. Data were initially coded by the lead author, with a random sample of 10% of all the articles coded by the co‐authors to ensure consistency and reliability of data interpretation. Where disagreements occurred, the article was re‐read and discussed until the coders reached consensus. Results General characteristics: key themes, actors, and sources. The general characteristics of the articles are presented in Table . A total of 339 articles was identified, the largest number in The Australian (n=96, 28%) and The Age (n=88, 26%), with the least in The West Australian (n=4, 1%), and The Daily Telegraph (n=2, 1%). Western Australia has no EGMs outside the Perth casino, which may explain the low level of coverage of gambling‐related issues in The West Australian . Sample characteristics. N % Newspaper Courier‐Mail Daily Telegraph Herald Sun Sydney Morning Herald The Advertiser The Age The West Australian The Australian Total 30 2 28 58 33 88 4 96 339 8.8% 0.6% 8.3% 17.1% 9.7% 26.0% 1.2% 28.3% 100% Section Main news Opinion or editorial Letters Sport Features Entertainment Finance or Business Other 195 27 51 13 35 1 12 5 57.5% 8.0% 15.0% 3.8% 10.3% 0.3% 3.5% 1.5% Product EGMs Sports or events betting Internet gambling Casino gambling Lotteries and scratchies Spread betting Racing No specific product Multiple products 272 17 15 5 2 1 1 24 2 80.2% 5.0% 4.4% 1.5% 0.6% 0.3% 0.3% 7.1% 0.6% Sources and actors General public (including gamblers) Medical or counselling professionals Problem gambler Academic or research findings Sporting body NGOs, campaigners and interest groups Government data, government report or statement from a government agency or official Industry Hotels Clubs Other industry Total Politician 7 11 23 30 41 49 81 7 71 40 105 196 2.1% 3.2% 6.8% 8.8% 12.1% 14.5% 23.9% 0.0% 2.1% 20.9% 11.8% 31.0% 57.8% Topics Proposed Commonwealth Government reforms (pre‐commitment) Gambling and sport Other gaming machine reforms Internet gambling Detailed discussion of problem gambling Community education or treatment programs Other topics 219 21 16 16 16 15 36 64.6% 6.2% 4.7% 4.7% 4.7% 4.4% 10.6% Gambling featured in a range of different articles, including: news articles (n=195, 58%); letters (n=51, 15%); feature articles (n=35, 10%); and opinion pieces and editorials (n=27, 8%). Most (315, 93%) discussed a specific type of gambling, including EGMs (n=273, 81%); sports‐based wagering (n=18, 5%); and internet gambling (n=18, 5%). About two‐thirds of articles focused on the Wilkie Reforms (n=219, 65%); followed by other policies or programs related to gambling including other EGM reforms, such as the removal of ATMs or the banning of headphones used with EGMs (n=16, 5%), and community education or treatment programs (n=15, 4%); internet‐based gambling (n=16, 5%); and gambling and sport (n=21, 6%), including the promotion of live odds by wagering companies during sporting events. The issue of live odds being promoted at sporting venues attracted significant political and media attention after the period studied. The largest group of ‘actors’ were state and federal politicians who featured in 196 articles (58%), followed by gambling industry representatives quoted in 105 articles (31%). Most of these (n=71, 21%) were representatives from Clubs Australia (the peak industry body for clubs with EGMs). Government agencies, including information contained in government reports, were cited in 81 articles (24%), with representatives from non‐governmental organisation (including activists, “anti‐gambling” campaigners and interest groups) quoted in 49 articles(15%). The least common actors were academics, or academic research findings, quoted in 30 articles (9%); problem or ex‐problem gamblers (n=23, 7%); and medical and counselling professionals (n=11, 3%). We identified a number of dominant and common frames of problem gambling in the newspaper reports. Within these frames there were different slants in the ways precise details were presented. Only a few articles were unusual in their presentation of stories and were not able to be analysed using our frames, although some articles used multiple frames. Framing the causes of problem gambling One in five articles discussed the causes of problem gambling (n=64, 20%). Most of these framed the causal factors associated with problem gambling to the promotion of products by the gambling industry (n=56, 17%), although a small number attributed it to individual factors (n=14, 4%). Frame One: The need for comprehensive reform – a problem industry with problem products The first frame associated with causal factors related directly to the factors associated with the gambling industry and its products. Articles from this frame were more often published by Fairfax Media papers ( The Age and The Sydney Morning Herald ) and less often in The Australian , and were mostly in the news section of a paper. These included the marketing or promotion of gambling products (n=19, 6%); product accessibility (n=10, 3%); and product design (n=28, 8%). For example, articles reporting the marketing strategies of the wagering industry to promote sports‐wagering products described this marketing as “grooming children to be problem gamblers”, 46 or increasing the risk of “recovering gambling addicts… returning to betting when odds were promoted at sporting venues and during broadcasts”. 47 Concerns about the gambling industry's role in causing problem gambling led to descriptions of the business model of the EGM industry as relying on “the exploitation of gambling addicts”, 48 with problem gamblers described by reform advocates, including politicians, as “vulnerable” to the tactics of the gambling industry. About one‐third of articles linked problem gambling to the design characteristics of EGMs (n=28, 8%). Most of these arguments were provided by politicians and by ‘anti‐gambling’ advocates and campaigners. Moral language was often used by these actors; for example, arguing that the machines and the design of machines were ‘dangerous’ or ‘evil’. Other articles featured commentary about the role of industry in causing problem gambling. Again, most actors were politicians; for example, Senator Nick Xenophon was quoted as stating that the gambling industry wanted to “put all the blame on the gambler and not take any responsibility for its dangerous product”. 49 Commentaries on the design of EGMs were often the only time the voices of problem gamblers were represented. Problem gamblers described the impact of the machines’ characteristics on development of their problems with gambling, with one problem gambler stating that “the bells, whistles and tunes, and icons of wealth and riches” 50 had a powerful influence on the development of his addiction. Another described her “physical response” to a particular type of gaming machine, with a dolphin theme. Finally, accessibility of products and incentive schemes used by the gambling industry were reported as leading to problem gambling, with gambling available “on every corner”, and the gambling industry encouraging problematic patterns of gambling, by offering “hotel upgrades, poker machine credits and exclusive events” 51 or “free bets to lure back gamblers”. 52 Frame Two: Personal responsibility – problem individuals with problem behaviours A much smaller number of articles (n=14, 4%) framed problem gambling as an issue of individual responsibility. These articles were also mostly in The Age and The Sydney Morning Herald , as well as in The Courier Mail . Most of these articles were news articles, with some opinion pieces and letters. Individualised factors associated with problem gambling included individuals gambling to ‘escape’ other problematic aspects of their lives, ‘genetic’ factors or traumatic life events. For example, one feature story in The Courier‐Mail focused on a problem gambler who could: ….trace the beginning of her destructive habit back to club visits with her parents and later with her pilot husband Jason… it was trauma after the birth of Chloe, who was diagnosed with cerebral palsy, that caused her to seek escape [at EGM venues]. 53 This story highlights an individual who previously interacted ‘responsibly’ with EGMs, triggered into problematic patterns of gambling by a negative life event. A lack of understanding about gambling and odds was raised as a cause of problem gambling in commentary from industry representatives. Letters to newspapers illustrated their writers’ view that individuals were personally responsible for their choices, with one letter writing that it was “…no‐one's fault except their own that they gamble.” 54 Framing the consequences of problem gambling The consequences of problem gambling were discussed in about one‐third of all articles (n=103, 30%). More than half these articles focused on social consequences (n=66, 20%), with others examining the individual financial (n=54, 16%) and health (n=24, 7%) consequences of gambling. There were two key frames in articles examining the consequences of problem gambling. Frame One: Individual consequences associated with lack of control The dominant frame in most articles described the consequences for individuals who were unable to control their gambling, and were influenced by actors from the gambling industry and the Federal Opposition (Liberal National Party) who emphasised that only a small number of gamblers experienced gambling problems. For example, a Federal Opposition policy document referred to “the small number of people for whom gambling can have tragic personal and financial consequences”. 55 These articles were in both Fairfax Media ( The Age, The Herald Sun ) and News Limited ( The Australian, The Herald Sun and The Courier Mail ) publications, and were mostly placed in the news section, although there were proportionately more opinion pieces. Fifty‐four (16%) of the articles focused on the negative financial consequences of problem gambling. While official data from the Australian Productivity Commission were quoted to show that the average amount of money spent by a problem gambler in a year was about $21,000 – noted in one article as “a third of the average household's annual income” 56 – tabloid papers often reported stories about individuals who had lost large amounts of money in a short period with quotes about how gamblers had “lost control” over their gambling. These articles often highlighted how problem gamblers had stolen from or exploited employers, family members or friends. For example, one article described how a problem gambler had taken money from “the family mortgage” and had also gambled money that her “father gave her to invest for his retirement.” 53 Only 28 articles (8%) discussed the broader health consequences associated with problem gambling, although again most of these were linked to individual behaviours and outcomes. For example, 15 articles (4%) mentioned the broad mental health consequences of problem gambling, including depression and anxiety, and provided expert opinion and statistics from leading peak bodies such as the Australian Medical Association or research commissioned by mental health charity beyondblue . Twenty articles (6%) reported suicide or attempted suicide, with several articles linking suicide to financial debt. For example, an article in The Age described how an international student who had come to Australia to study “eventually broke down under a mountain of debts and was taking antidepressants before he was placed under suicide watch.” 57 Frame Two: The social consequences associated with individual behaviours This frame, and associated articles, focused on the broader social consequences of problem gambling (n=66, 20%). These articles were in most publications, but were more likely to be in The Age and The Sydney Morning Herald , and were mostly placed in the news section, although there were proportionately more letters. A range of actors were involved in discussing the consequences of problem gambling, with politicians, particularly Xenophon, Wilkie and then Australian Prime Minister Julia Gillard, most commonly quoted. These articles discussed the ‘ripple effect’ of problem gambling, whereby problem gambling not only had an impact on the individuals, but also on family members and society. Crime was discussed in 19 articles, with several articles stating that criminality, and fraud in particular, was a direct consequence of problem gambling. For example, one article stated that an individual with a gambling addiction of “majestic proportions’’ 58 stole more than $3 million to cover debts at Melbourne's Crown Casino. Sixty articles (18%) discussed the negative social impact on family wellbeing. Sometimes family members and, in particular, children were described as the ‘real victims’ of problem gambling. Articles highlighted families devastated following a family member developing a gambling problem, when money allocated for necessities, such as food, shelter or clothing for children was spent on EGMs. In this context, many articles used family examples to argue for the effective reform of EGMs. Some articles argued that comprehensive harm minimisation measures on EGMs would help to protect families and children from the impact of addiction to EGMs. One article reporting the suicide of a Melbourne casino worker after losing $4,000 in 29 minutes on a “pokies binge”, quoted her mother stating that “imposing controls on pokies …. might have saved her life…”. 59 A few articles suggested that the consequences associated with problem gambling were caused by the gambling industry who were dependent on “the rent checks and food money of gambling addicts”. 60 However, some articles still linked the social consequences of problem gambling back to individual behaviour, stating that children were missing out on “meals on the table” and “school excursions”, and were often “neglected” because of their parents’ “addiction” to EGMs. The framing of solutions for problem gambling Solutions for problem gambling were discussed in most articles (n=299, 88%). The most discussed solution was the implementation of the Wilkie Reforms (n=250, 74%). Other solutions involving government regulation included: the implementation of a $1 maximum bet per spin on EGMs, mentioned in 84 articles (25%), either as part of the broader national gambling reform program, or as an alternative to the introduction of mandatory pre‐commitment; voluntary pre‐commitment (n=56, 17%); restrictions on or a ban of ATMs in gaming venues (n=19, 6%); and a ban on advertising live odds during sports telecasts (n=16, 5%). Other solutions less frequently discussed included greater investment in counselling and other treatments (n=31, 9%) and education programs (n=9, 3%). These programs, alongside voluntary pre‐commitment, were promoted as alternatives to mandatory pre‐commitment by industry sources and the Federal Opposition. Three frames emerged: Frame One: An exploitative product that requires reform This frame focused on the need for comprehensive reform of problematic or exploitative gambling products that could cause harm. Articles using this frame positioned problem gambling as a result of a dangerous or exploitative product (usually gaming machines), but sometimes other gambling products (such as sports betting), therefore requiring reform. This frame was used in 81 articles (24%). While not explicitly positioning problem gambling as a public health issue, this frame emphasised the industry and social determinants of problem gambling. Articles from this frame were seen more often in newspapers from Victoria ( The Age and The Herald Sun ), or published by Fairfax Media papers ( The Age and The Sydney Morning Herald ) and were more likely to be in letters or opinion sections of the paper. Frame Two: Personal responsibility and the perils of the ‘nanny state’ This frame focused on the role of greater personal responsibility for the way in which individuals interacted with gambling products and the problems with increased government regulation of gambling products. Articles that used a personal responsibility frame, opposing gambling reform, were associated with arguments that pre‐commitment was an unnecessary imposition on personal freedom by the ‘nanny state’. Sometimes mandatory pre‐commitment was opposed by industry as representing a “cost to individual freedom” where “citizens are wrapped in cotton wool ‘for their own good’”, 61 or argued that pre‐commitment system would be ineffective. Although fewer articles framed problem gambling in this way (n= 19, 6%), this frame was supported by the gambling industry and sporting organisations, as well as the Liberal National Coalition. While these groups appeared to support some degree of reform of EGMs, responses were always framed around the need to protect individuals who were unable to take control or responsibility for their gambling, while protecting the rights of those who gambled responsibly. For example, in response to questions about EGM reform, the Australian Football League stated that it supported a “sensible and pragmatic approach to combating problem gambling…. (that) will have a positive impact on helping the small minority of pokies players who cannot control their play.” 62 Articles from this frame were seen most often in The Australian and The Courier‐Mail , and were more likely to be in letters or opinion sections, although there were many news articles. Frame Three: A political controversy This frame positioned problem gambling primarily as a political controversy rather than a health or social issue. This was the frame used in a majority of articles (n=184, 54%). The focus of articles using this frame was on the way that the pre‐commitment debate had destabilised federal politics, and on the role of different interest groups in the debate. These articles often referred to problem gambling in passing, without any in‐depth discussion. Use of this frame sometimes involved discussions of poll results and speculation about the impact of this debate on the precarious hung Parliament. It is important to note that this frame did not emphasise policy analysis, with the focus being largely on political issues. Articles in this frame sometimes indicated some level of support or opposition to pre‐commitment (for example, articles in The Age using this frame tended to be more supportive of pre‐commitment, while articles in The Australian were more likely to oppose it). This frame was prevalent in all publications and was mainly found in news articles. All of the coverage in The West Australian used this frame. Discussion and implications for public health Research into how the media contributes to framing public discourses about harmful gambling in Australia, and in other countries, can play a key role in supporting media advocacy by researchers and other experts, 23,24 and also in understanding the impact of reporting on how the public understand and interpret health issues. Such analyses can inform public health advocacy initiatives by elucidating the relationships between politicians, industry and lobby groups. The findings from our study raise a number of points for discussion about how problem gambling is reported in Australia. While the solutions for problem gambling were frequently discussed and debated there was much less emphasis on the causes and consequences of problem gambling. As in research on the media reporting of other public health issues, 23,30 the framing of the causes, consequences and solutions to problem gambling showed a tension between frames that focused on the responsibility of individual problem gamblers compared with framing that focuses on broader social, ecological, and industry determinants of this important public health issue. This picture is complicated by the nature of government interventions proposed for problem gambling, such as mandatory pre‐commitment, which may implicitly assume individual responsibility for gambling behaviour, rather than solutions that aim to more comprehensively regulate industry. The framing of problem gambling varied between different publications. Although all papers represented a diversity of views, The Australian was more likely to focus on an individualised framing of the solutions to problem gambling, and was less likely to report on the causes or consequences of problem gambling. On the other hand, Fairfax Media papers ( The Age and The Sydney Morning Herald ) were more likely to frame problem gambling as a product requiring reform, and more likely to report on the causes and consequences of problem gambling. There was also variation in the section of the paper that covered each frame. While, overall, most articles were in the news section, some frames had proportionately more letters or opinion pieces. Most media reporting was influenced by the political debate surrounding one particular type of gambling product – EGMs. The stimulus for much of the media coverage came from actions proposed by politicians, and the dominant framing of solutions to problem gambling was political. This differs from the normal course of media coverage around public health issues, where health agencies and academics first present and promote the evidence, then call for action, following which politicians respond and make decisions as to the action they may (or may not) feel is appropriate to take. While there had been some coverage of gambling issues over time, we believe that the opportunistic calls for action by Wilkie and Xenophon, taking advantage of an unusual political circumstance, meant that health and social agencies had not prepared the way through reports, briefings and planned media strategies of the kind that have accompanied calls for action on issues such as tobacco, alcohol and junk food. As a consequence, we would argue that it is less likely that media outlets and politicians would have been informed by a range of independent information and evidence about the role the gambling industry may play in the development of gambling harm. Research shows that this type of information has been crucial in helping public health advocates change public perceptions so that some health risk behaviours are seen as being to a significant extent the consequences of activities by “unhealthy commodity industries” rather than of individuals. 63 Nevertheless, even well‐organised coalitions may find it difficult to gain media coverage for public health issues. 64 We believe that independent gambling coalitions should draw upon the lessons learned from action on tobacco and alcohol in recent decades, whereby coalitions of independent public health academics and health and social organisations have worked closely together to publicise the major areas of concern and identify evidence‐based recommendations. These recommendations have been used to press for action, with a focus on proactive work with the media that, in turn, leads to the media calling on them for reactive comment when new evidence appears, specific events related to these problems arise, governments and politicians discuss options for action or the relevant companies respond. Finally, it is notable that the voices of problem gamblers were rarely included in newspaper articles. When their voices or examples of their stories were included, these were mostly framed around personal (ir)responsibility discourses. This may be for a number of reasons. Problem gambling is characterised by intense stigma, 65 with few national or international initiatives aimed at comprehensively tackling this stigma. It is unsurprising that individuals who have experienced a problem with gambling are reluctant to tell their stories and contribute to the public debate on gambling reform. Our study did not identify any independent peak bodies as providing a strong, consumer‐driven, or public health advocacy voice in debate over gambling reform (as is provided effectively in other countries by organisations such as the Problem Gambling Foundation of New Zealand). These peak bodies provide a continuing means of ensuring public awareness of these problems, including the ways in which individuals and their families and social circles are affected. They also promote the need for action – while also promoting the case for preventive action and support, and ensure that sympathetic health organisations with a broader range of concerns (such as the Australian Medical Association or Public Health Association of Australia) have access to expert support and speedy information when needed. One example of such a coalition is the National Alliance for Action on Alcohol (NAAA), which has substantially increased the focus on alcohol issues at the national level, as have similar coalitions on alcohol in some states and territories. Further research is needed to guide strategies to develop approaches that are independent from government or industry interests and are able to influence the development of gambling policy. There are several limitations of this study that need to be considered in interpreting our results. First, by using the Factiva database to access our sample, we were unable to view accompanying pictures or graphics, or view the size of headlines or positioning of stories in newspapers. As we only included the top eight highest circulation newspapers we did not include media coverage from newspapers in Tasmania or the Northern Territory. These two limitations mean that we may have missed key information that may have featured in these sources. In addition, an analysis of other types of media coverage (such as television, radio or online news coverage) could have provided a broader perspective on problem gambling in the media, as could an analysis of industry advertising campaigns, which were prominent during this debate. Future research could examine these areas. While the deletion of duplicate articles may underplay the likely impact on the number of readers of an article, the aim of this study was to analyse presentation by media – not the effects of exposure on population. Our study can provide information only about the way the media frames problem gambling, but cannot provide information about the myriad ways the readers of newspapers may re‐interpret or resist interpretations provided by the media. Overall, this analysis has shown that while gambling issues occasionally attract public and political attention, there is a much broader role for individuals and organisations in public health to play in the national debate about the causes, consequences and solutions for harmful gambling in Australia. It is important that the recent public debates around EGMs and – more recently – live odds promotions are not perceived as having generated any significant reforms. Those concerned with harmful gambling prevention and gambling reform in Australia can learn from the issues identified through this media review and the experience of other public health campaigns, to ensure that there is a more coordinated and proactive approach to the media by both researchers and health groups. Public health academics and practitioners should consider establishing a gambling‐specific coalition to work with health and social groups in pressing for evidence‐based action. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

How the causes, consequences and solutions for problem gambling are reported in Australian newspapers: a qualitative content analysis

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Publisher
Wiley
Copyright
© 2014 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/1753-6405.12251
pmid
25169775
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Abstract

P roblem gambling, defined as “difficulties in limiting money and/or time spent on gambling that leads to adverse consequences for the gambler, others, or for the community”, 1 is recognised as a significant public health issue. 2,3 In Australia, official statistics estimate that between 80,000 and 160,000 Australians experience problem gambling each year, 3 although these figures under‐estimate the true extent and impact of gambling harm both for individuals and communities. 4 Gambling harm includes a range of negative social outcomes (such as criminality, 5 housing instability, 6 relationship problems, 7 financial difficulties such as indebtedness, 8 and domestic violence 9 ) as well as health problems (including significant co‐morbidities with substance use disorder, depression and anxiety disorders 10,11 ). While researchers recognise that the causes of gambling harm are complex, and involve a range of social, psychological and biological factors, 12–14 most gambling research focuses on individual risk factors, rather than the broader range of environmental (including industry) factors that may increase vulnerability to risky patterns of gambling. 2 For example, while there have been calls to develop a more comprehensive public health framework to tackle harmful gambling, incorporating specific factors (the gambling environment, gambling exposure, gambling types and gambling resources) and general factors (cultural, social, psychological and biological), 15 there is still very limited research into how ‘Big Gambling’ targets, engages, and appeals to different population subgroups, and how they seek to influence public policy debates. 4,16 Many different types of gambling products are available in Australia, but electronic gaming machines (EGMs) – more commonly known as pokies or slots – account for more than half all gambling expenditure 3 and have been most strongly associated with problem gambling. 17,18 In 2010, there were about 198,300 EGMs in Australia, in 3,363 hotels, 2,320 clubs and 13 casinos. 3 There had been few attempts to implement comprehensive EGM reform in Australia until 2010, when a hung parliament after the Australian Federal Election left key independent Members of Parliament (MPs) holding the balance of power in the Australian House of Representatives. One of these MPs, Andrew Wilkie (from the Tasmanian seat of Dennison), was strongly in favour of introducing harm minimisation measures for EGMs, and made the introduction of mandatory pre‐commitment on all EGMs (where individuals must commit to a monetary limit before starting to play and are locked out of all machines for a 24‐hour period once that limit is reached) a condition of his support for the formation of a Labor government. This initiated several Federal parliamentary inquiries into harm minimisation measures associated with various gambling products. 19–22 It also stimulated major national debate on gambling reform (commonly known as the Wilkie Reforms). Much of the debate played out through the national media and included intensive (and ultimately successful) gambling industry lobbying against the reforms. Media analyses are important in identifying the ways in which public debates about an issue are framed and can provide important insights into how public health may be better placed to influence and advance policy arguments about key public health issues. 23 Media analysis has been used in research into other public health issues, including tobacco, 24 alcohol, 25–27 obesity, 28,29 crime 30 and health generally, 31,32 to explain how public health issues are framed and presented to the public, as well as the key ‘actors’ and sources that are used to influence both dominant discourses and counterframes about an issue. Despite the emergence of gambling as a key public health issue, there have been relatively few examinations of how the news media report issues and present debates relating to gambling either in Australia or internationally. 33–35 ‘Issue framing’ has been shown to influence public opinion, public health policies and legislation. 36 Guided by the approach used by Menashe and Seigal, who identified how tobacco had been framed in The New York Times and The Washington Post to provide “important clues as to why public health efforts to overcome the tobacco industry's influence on public policy and on tobacco use have not been entirely successful”, 24(p307) this paper uses a combination of qualitative and quantitative techniques to examine how the causes, consequences and solutions for problem gambling were framed in Australian media reporting. Methods Data collection Using the Factiva database, we searched the eight highest circulation newspapers in Australia: 37 The Age and The Herald Sun (Victoria), The Sydney Morning Herald and The Daily Telegraph (New South Wales), The West Australian (Western Australia), The Advertiser (South Australia), and The Courier‐Mail (Queensland), and The Australian (national). The sample included broadsheets ( The Age , and The Sydney Morning Herald published by Fairfax Media and The Australian published by News Limited) and tabloids ( The Herald Sun, The Advertiser, The Daily Telegraph and The Courier Mail published by News Limited and The West Australian published by West Australian Newspapers Ltd). Using the keywords: ‘gambling’, ‘gamble’, ‘betting’, ‘pokies’ and ‘poker machines’, we included news items, feature stories, editorials, opinion pieces and letters to the editor in the search (we were interested in capturing the breadth of public debate associated with gambling reform) published between 1 July 2011 and 30 June 2012. Each article was downloaded and read. Duplicate articles, including multiple editions of the same article, and those that did not relate to problem gambling were excluded from the dataset. Data analysis We chose a framing analysis to explore how different arguments about problem gambling and gambling reform clustered around different perspectives. 30,38,39 Entman 40 comments that the media frames an issue by selecting and emphasising a number of aspects, such as by defining problems, diagnosing causes, making moral judgments and suggesting remedies. These frames then encourage audiences to think, feel, and make decisions about an issue in a particular way. 41 A frame may include several arguments with a similar perspective and also symbols, metaphors and catch phrases 24 (e.g. the term ‘responsible gambling’, which may be used to place responsibility on individuals while excusing industry from responsibilities for harm). The content of each article (including the headline and byline) were imported into QSR NVIVO, which was used to manage the data during analysis. Articles were initially grouped by type of newspaper, and then by the main topic of the article. We drew upon the methods used in other media analyses, 29,32 which involved coding and then quantifying the key characteristics of the sample including: 1) the overall number of articles; 2) the newspaper the articles appeared in; 3) the main topic of the article; 4) the types of actors and sources quoted; and 5) the type of gambling discussed. Once these initial characteristics of each article were coded we conducted qualitative analysis to provide more detail about the discourses used within frames. 42–45 Qualitative analysis involved open‐ended reading and re‐reading of the relevant sections of the articles (including the headlines and bylines) to identify key arguments, perspectives and themes. Data were initially coded by the lead author, with a random sample of 10% of all the articles coded by the co‐authors to ensure consistency and reliability of data interpretation. Where disagreements occurred, the article was re‐read and discussed until the coders reached consensus. Results General characteristics: key themes, actors, and sources. The general characteristics of the articles are presented in Table . A total of 339 articles was identified, the largest number in The Australian (n=96, 28%) and The Age (n=88, 26%), with the least in The West Australian (n=4, 1%), and The Daily Telegraph (n=2, 1%). Western Australia has no EGMs outside the Perth casino, which may explain the low level of coverage of gambling‐related issues in The West Australian . Sample characteristics. N % Newspaper Courier‐Mail Daily Telegraph Herald Sun Sydney Morning Herald The Advertiser The Age The West Australian The Australian Total 30 2 28 58 33 88 4 96 339 8.8% 0.6% 8.3% 17.1% 9.7% 26.0% 1.2% 28.3% 100% Section Main news Opinion or editorial Letters Sport Features Entertainment Finance or Business Other 195 27 51 13 35 1 12 5 57.5% 8.0% 15.0% 3.8% 10.3% 0.3% 3.5% 1.5% Product EGMs Sports or events betting Internet gambling Casino gambling Lotteries and scratchies Spread betting Racing No specific product Multiple products 272 17 15 5 2 1 1 24 2 80.2% 5.0% 4.4% 1.5% 0.6% 0.3% 0.3% 7.1% 0.6% Sources and actors General public (including gamblers) Medical or counselling professionals Problem gambler Academic or research findings Sporting body NGOs, campaigners and interest groups Government data, government report or statement from a government agency or official Industry Hotels Clubs Other industry Total Politician 7 11 23 30 41 49 81 7 71 40 105 196 2.1% 3.2% 6.8% 8.8% 12.1% 14.5% 23.9% 0.0% 2.1% 20.9% 11.8% 31.0% 57.8% Topics Proposed Commonwealth Government reforms (pre‐commitment) Gambling and sport Other gaming machine reforms Internet gambling Detailed discussion of problem gambling Community education or treatment programs Other topics 219 21 16 16 16 15 36 64.6% 6.2% 4.7% 4.7% 4.7% 4.4% 10.6% Gambling featured in a range of different articles, including: news articles (n=195, 58%); letters (n=51, 15%); feature articles (n=35, 10%); and opinion pieces and editorials (n=27, 8%). Most (315, 93%) discussed a specific type of gambling, including EGMs (n=273, 81%); sports‐based wagering (n=18, 5%); and internet gambling (n=18, 5%). About two‐thirds of articles focused on the Wilkie Reforms (n=219, 65%); followed by other policies or programs related to gambling including other EGM reforms, such as the removal of ATMs or the banning of headphones used with EGMs (n=16, 5%), and community education or treatment programs (n=15, 4%); internet‐based gambling (n=16, 5%); and gambling and sport (n=21, 6%), including the promotion of live odds by wagering companies during sporting events. The issue of live odds being promoted at sporting venues attracted significant political and media attention after the period studied. The largest group of ‘actors’ were state and federal politicians who featured in 196 articles (58%), followed by gambling industry representatives quoted in 105 articles (31%). Most of these (n=71, 21%) were representatives from Clubs Australia (the peak industry body for clubs with EGMs). Government agencies, including information contained in government reports, were cited in 81 articles (24%), with representatives from non‐governmental organisation (including activists, “anti‐gambling” campaigners and interest groups) quoted in 49 articles(15%). The least common actors were academics, or academic research findings, quoted in 30 articles (9%); problem or ex‐problem gamblers (n=23, 7%); and medical and counselling professionals (n=11, 3%). We identified a number of dominant and common frames of problem gambling in the newspaper reports. Within these frames there were different slants in the ways precise details were presented. Only a few articles were unusual in their presentation of stories and were not able to be analysed using our frames, although some articles used multiple frames. Framing the causes of problem gambling One in five articles discussed the causes of problem gambling (n=64, 20%). Most of these framed the causal factors associated with problem gambling to the promotion of products by the gambling industry (n=56, 17%), although a small number attributed it to individual factors (n=14, 4%). Frame One: The need for comprehensive reform – a problem industry with problem products The first frame associated with causal factors related directly to the factors associated with the gambling industry and its products. Articles from this frame were more often published by Fairfax Media papers ( The Age and The Sydney Morning Herald ) and less often in The Australian , and were mostly in the news section of a paper. These included the marketing or promotion of gambling products (n=19, 6%); product accessibility (n=10, 3%); and product design (n=28, 8%). For example, articles reporting the marketing strategies of the wagering industry to promote sports‐wagering products described this marketing as “grooming children to be problem gamblers”, 46 or increasing the risk of “recovering gambling addicts… returning to betting when odds were promoted at sporting venues and during broadcasts”. 47 Concerns about the gambling industry's role in causing problem gambling led to descriptions of the business model of the EGM industry as relying on “the exploitation of gambling addicts”, 48 with problem gamblers described by reform advocates, including politicians, as “vulnerable” to the tactics of the gambling industry. About one‐third of articles linked problem gambling to the design characteristics of EGMs (n=28, 8%). Most of these arguments were provided by politicians and by ‘anti‐gambling’ advocates and campaigners. Moral language was often used by these actors; for example, arguing that the machines and the design of machines were ‘dangerous’ or ‘evil’. Other articles featured commentary about the role of industry in causing problem gambling. Again, most actors were politicians; for example, Senator Nick Xenophon was quoted as stating that the gambling industry wanted to “put all the blame on the gambler and not take any responsibility for its dangerous product”. 49 Commentaries on the design of EGMs were often the only time the voices of problem gamblers were represented. Problem gamblers described the impact of the machines’ characteristics on development of their problems with gambling, with one problem gambler stating that “the bells, whistles and tunes, and icons of wealth and riches” 50 had a powerful influence on the development of his addiction. Another described her “physical response” to a particular type of gaming machine, with a dolphin theme. Finally, accessibility of products and incentive schemes used by the gambling industry were reported as leading to problem gambling, with gambling available “on every corner”, and the gambling industry encouraging problematic patterns of gambling, by offering “hotel upgrades, poker machine credits and exclusive events” 51 or “free bets to lure back gamblers”. 52 Frame Two: Personal responsibility – problem individuals with problem behaviours A much smaller number of articles (n=14, 4%) framed problem gambling as an issue of individual responsibility. These articles were also mostly in The Age and The Sydney Morning Herald , as well as in The Courier Mail . Most of these articles were news articles, with some opinion pieces and letters. Individualised factors associated with problem gambling included individuals gambling to ‘escape’ other problematic aspects of their lives, ‘genetic’ factors or traumatic life events. For example, one feature story in The Courier‐Mail focused on a problem gambler who could: ….trace the beginning of her destructive habit back to club visits with her parents and later with her pilot husband Jason… it was trauma after the birth of Chloe, who was diagnosed with cerebral palsy, that caused her to seek escape [at EGM venues]. 53 This story highlights an individual who previously interacted ‘responsibly’ with EGMs, triggered into problematic patterns of gambling by a negative life event. A lack of understanding about gambling and odds was raised as a cause of problem gambling in commentary from industry representatives. Letters to newspapers illustrated their writers’ view that individuals were personally responsible for their choices, with one letter writing that it was “…no‐one's fault except their own that they gamble.” 54 Framing the consequences of problem gambling The consequences of problem gambling were discussed in about one‐third of all articles (n=103, 30%). More than half these articles focused on social consequences (n=66, 20%), with others examining the individual financial (n=54, 16%) and health (n=24, 7%) consequences of gambling. There were two key frames in articles examining the consequences of problem gambling. Frame One: Individual consequences associated with lack of control The dominant frame in most articles described the consequences for individuals who were unable to control their gambling, and were influenced by actors from the gambling industry and the Federal Opposition (Liberal National Party) who emphasised that only a small number of gamblers experienced gambling problems. For example, a Federal Opposition policy document referred to “the small number of people for whom gambling can have tragic personal and financial consequences”. 55 These articles were in both Fairfax Media ( The Age, The Herald Sun ) and News Limited ( The Australian, The Herald Sun and The Courier Mail ) publications, and were mostly placed in the news section, although there were proportionately more opinion pieces. Fifty‐four (16%) of the articles focused on the negative financial consequences of problem gambling. While official data from the Australian Productivity Commission were quoted to show that the average amount of money spent by a problem gambler in a year was about $21,000 – noted in one article as “a third of the average household's annual income” 56 – tabloid papers often reported stories about individuals who had lost large amounts of money in a short period with quotes about how gamblers had “lost control” over their gambling. These articles often highlighted how problem gamblers had stolen from or exploited employers, family members or friends. For example, one article described how a problem gambler had taken money from “the family mortgage” and had also gambled money that her “father gave her to invest for his retirement.” 53 Only 28 articles (8%) discussed the broader health consequences associated with problem gambling, although again most of these were linked to individual behaviours and outcomes. For example, 15 articles (4%) mentioned the broad mental health consequences of problem gambling, including depression and anxiety, and provided expert opinion and statistics from leading peak bodies such as the Australian Medical Association or research commissioned by mental health charity beyondblue . Twenty articles (6%) reported suicide or attempted suicide, with several articles linking suicide to financial debt. For example, an article in The Age described how an international student who had come to Australia to study “eventually broke down under a mountain of debts and was taking antidepressants before he was placed under suicide watch.” 57 Frame Two: The social consequences associated with individual behaviours This frame, and associated articles, focused on the broader social consequences of problem gambling (n=66, 20%). These articles were in most publications, but were more likely to be in The Age and The Sydney Morning Herald , and were mostly placed in the news section, although there were proportionately more letters. A range of actors were involved in discussing the consequences of problem gambling, with politicians, particularly Xenophon, Wilkie and then Australian Prime Minister Julia Gillard, most commonly quoted. These articles discussed the ‘ripple effect’ of problem gambling, whereby problem gambling not only had an impact on the individuals, but also on family members and society. Crime was discussed in 19 articles, with several articles stating that criminality, and fraud in particular, was a direct consequence of problem gambling. For example, one article stated that an individual with a gambling addiction of “majestic proportions’’ 58 stole more than $3 million to cover debts at Melbourne's Crown Casino. Sixty articles (18%) discussed the negative social impact on family wellbeing. Sometimes family members and, in particular, children were described as the ‘real victims’ of problem gambling. Articles highlighted families devastated following a family member developing a gambling problem, when money allocated for necessities, such as food, shelter or clothing for children was spent on EGMs. In this context, many articles used family examples to argue for the effective reform of EGMs. Some articles argued that comprehensive harm minimisation measures on EGMs would help to protect families and children from the impact of addiction to EGMs. One article reporting the suicide of a Melbourne casino worker after losing $4,000 in 29 minutes on a “pokies binge”, quoted her mother stating that “imposing controls on pokies …. might have saved her life…”. 59 A few articles suggested that the consequences associated with problem gambling were caused by the gambling industry who were dependent on “the rent checks and food money of gambling addicts”. 60 However, some articles still linked the social consequences of problem gambling back to individual behaviour, stating that children were missing out on “meals on the table” and “school excursions”, and were often “neglected” because of their parents’ “addiction” to EGMs. The framing of solutions for problem gambling Solutions for problem gambling were discussed in most articles (n=299, 88%). The most discussed solution was the implementation of the Wilkie Reforms (n=250, 74%). Other solutions involving government regulation included: the implementation of a $1 maximum bet per spin on EGMs, mentioned in 84 articles (25%), either as part of the broader national gambling reform program, or as an alternative to the introduction of mandatory pre‐commitment; voluntary pre‐commitment (n=56, 17%); restrictions on or a ban of ATMs in gaming venues (n=19, 6%); and a ban on advertising live odds during sports telecasts (n=16, 5%). Other solutions less frequently discussed included greater investment in counselling and other treatments (n=31, 9%) and education programs (n=9, 3%). These programs, alongside voluntary pre‐commitment, were promoted as alternatives to mandatory pre‐commitment by industry sources and the Federal Opposition. Three frames emerged: Frame One: An exploitative product that requires reform This frame focused on the need for comprehensive reform of problematic or exploitative gambling products that could cause harm. Articles using this frame positioned problem gambling as a result of a dangerous or exploitative product (usually gaming machines), but sometimes other gambling products (such as sports betting), therefore requiring reform. This frame was used in 81 articles (24%). While not explicitly positioning problem gambling as a public health issue, this frame emphasised the industry and social determinants of problem gambling. Articles from this frame were seen more often in newspapers from Victoria ( The Age and The Herald Sun ), or published by Fairfax Media papers ( The Age and The Sydney Morning Herald ) and were more likely to be in letters or opinion sections of the paper. Frame Two: Personal responsibility and the perils of the ‘nanny state’ This frame focused on the role of greater personal responsibility for the way in which individuals interacted with gambling products and the problems with increased government regulation of gambling products. Articles that used a personal responsibility frame, opposing gambling reform, were associated with arguments that pre‐commitment was an unnecessary imposition on personal freedom by the ‘nanny state’. Sometimes mandatory pre‐commitment was opposed by industry as representing a “cost to individual freedom” where “citizens are wrapped in cotton wool ‘for their own good’”, 61 or argued that pre‐commitment system would be ineffective. Although fewer articles framed problem gambling in this way (n= 19, 6%), this frame was supported by the gambling industry and sporting organisations, as well as the Liberal National Coalition. While these groups appeared to support some degree of reform of EGMs, responses were always framed around the need to protect individuals who were unable to take control or responsibility for their gambling, while protecting the rights of those who gambled responsibly. For example, in response to questions about EGM reform, the Australian Football League stated that it supported a “sensible and pragmatic approach to combating problem gambling…. (that) will have a positive impact on helping the small minority of pokies players who cannot control their play.” 62 Articles from this frame were seen most often in The Australian and The Courier‐Mail , and were more likely to be in letters or opinion sections, although there were many news articles. Frame Three: A political controversy This frame positioned problem gambling primarily as a political controversy rather than a health or social issue. This was the frame used in a majority of articles (n=184, 54%). The focus of articles using this frame was on the way that the pre‐commitment debate had destabilised federal politics, and on the role of different interest groups in the debate. These articles often referred to problem gambling in passing, without any in‐depth discussion. Use of this frame sometimes involved discussions of poll results and speculation about the impact of this debate on the precarious hung Parliament. It is important to note that this frame did not emphasise policy analysis, with the focus being largely on political issues. Articles in this frame sometimes indicated some level of support or opposition to pre‐commitment (for example, articles in The Age using this frame tended to be more supportive of pre‐commitment, while articles in The Australian were more likely to oppose it). This frame was prevalent in all publications and was mainly found in news articles. All of the coverage in The West Australian used this frame. Discussion and implications for public health Research into how the media contributes to framing public discourses about harmful gambling in Australia, and in other countries, can play a key role in supporting media advocacy by researchers and other experts, 23,24 and also in understanding the impact of reporting on how the public understand and interpret health issues. Such analyses can inform public health advocacy initiatives by elucidating the relationships between politicians, industry and lobby groups. The findings from our study raise a number of points for discussion about how problem gambling is reported in Australia. While the solutions for problem gambling were frequently discussed and debated there was much less emphasis on the causes and consequences of problem gambling. As in research on the media reporting of other public health issues, 23,30 the framing of the causes, consequences and solutions to problem gambling showed a tension between frames that focused on the responsibility of individual problem gamblers compared with framing that focuses on broader social, ecological, and industry determinants of this important public health issue. This picture is complicated by the nature of government interventions proposed for problem gambling, such as mandatory pre‐commitment, which may implicitly assume individual responsibility for gambling behaviour, rather than solutions that aim to more comprehensively regulate industry. The framing of problem gambling varied between different publications. Although all papers represented a diversity of views, The Australian was more likely to focus on an individualised framing of the solutions to problem gambling, and was less likely to report on the causes or consequences of problem gambling. On the other hand, Fairfax Media papers ( The Age and The Sydney Morning Herald ) were more likely to frame problem gambling as a product requiring reform, and more likely to report on the causes and consequences of problem gambling. There was also variation in the section of the paper that covered each frame. While, overall, most articles were in the news section, some frames had proportionately more letters or opinion pieces. Most media reporting was influenced by the political debate surrounding one particular type of gambling product – EGMs. The stimulus for much of the media coverage came from actions proposed by politicians, and the dominant framing of solutions to problem gambling was political. This differs from the normal course of media coverage around public health issues, where health agencies and academics first present and promote the evidence, then call for action, following which politicians respond and make decisions as to the action they may (or may not) feel is appropriate to take. While there had been some coverage of gambling issues over time, we believe that the opportunistic calls for action by Wilkie and Xenophon, taking advantage of an unusual political circumstance, meant that health and social agencies had not prepared the way through reports, briefings and planned media strategies of the kind that have accompanied calls for action on issues such as tobacco, alcohol and junk food. As a consequence, we would argue that it is less likely that media outlets and politicians would have been informed by a range of independent information and evidence about the role the gambling industry may play in the development of gambling harm. Research shows that this type of information has been crucial in helping public health advocates change public perceptions so that some health risk behaviours are seen as being to a significant extent the consequences of activities by “unhealthy commodity industries” rather than of individuals. 63 Nevertheless, even well‐organised coalitions may find it difficult to gain media coverage for public health issues. 64 We believe that independent gambling coalitions should draw upon the lessons learned from action on tobacco and alcohol in recent decades, whereby coalitions of independent public health academics and health and social organisations have worked closely together to publicise the major areas of concern and identify evidence‐based recommendations. These recommendations have been used to press for action, with a focus on proactive work with the media that, in turn, leads to the media calling on them for reactive comment when new evidence appears, specific events related to these problems arise, governments and politicians discuss options for action or the relevant companies respond. Finally, it is notable that the voices of problem gamblers were rarely included in newspaper articles. When their voices or examples of their stories were included, these were mostly framed around personal (ir)responsibility discourses. This may be for a number of reasons. Problem gambling is characterised by intense stigma, 65 with few national or international initiatives aimed at comprehensively tackling this stigma. It is unsurprising that individuals who have experienced a problem with gambling are reluctant to tell their stories and contribute to the public debate on gambling reform. Our study did not identify any independent peak bodies as providing a strong, consumer‐driven, or public health advocacy voice in debate over gambling reform (as is provided effectively in other countries by organisations such as the Problem Gambling Foundation of New Zealand). These peak bodies provide a continuing means of ensuring public awareness of these problems, including the ways in which individuals and their families and social circles are affected. They also promote the need for action – while also promoting the case for preventive action and support, and ensure that sympathetic health organisations with a broader range of concerns (such as the Australian Medical Association or Public Health Association of Australia) have access to expert support and speedy information when needed. One example of such a coalition is the National Alliance for Action on Alcohol (NAAA), which has substantially increased the focus on alcohol issues at the national level, as have similar coalitions on alcohol in some states and territories. Further research is needed to guide strategies to develop approaches that are independent from government or industry interests and are able to influence the development of gambling policy. There are several limitations of this study that need to be considered in interpreting our results. First, by using the Factiva database to access our sample, we were unable to view accompanying pictures or graphics, or view the size of headlines or positioning of stories in newspapers. As we only included the top eight highest circulation newspapers we did not include media coverage from newspapers in Tasmania or the Northern Territory. These two limitations mean that we may have missed key information that may have featured in these sources. In addition, an analysis of other types of media coverage (such as television, radio or online news coverage) could have provided a broader perspective on problem gambling in the media, as could an analysis of industry advertising campaigns, which were prominent during this debate. Future research could examine these areas. While the deletion of duplicate articles may underplay the likely impact on the number of readers of an article, the aim of this study was to analyse presentation by media – not the effects of exposure on population. Our study can provide information only about the way the media frames problem gambling, but cannot provide information about the myriad ways the readers of newspapers may re‐interpret or resist interpretations provided by the media. Overall, this analysis has shown that while gambling issues occasionally attract public and political attention, there is a much broader role for individuals and organisations in public health to play in the national debate about the causes, consequences and solutions for harmful gambling in Australia. It is important that the recent public debates around EGMs and – more recently – live odds promotions are not perceived as having generated any significant reforms. Those concerned with harmful gambling prevention and gambling reform in Australia can learn from the issues identified through this media review and the experience of other public health campaigns, to ensure that there is a more coordinated and proactive approach to the media by both researchers and health groups. Public health academics and practitioners should consider establishing a gambling‐specific coalition to work with health and social groups in pressing for evidence‐based action.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 2014

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