Report 2021-102 Recommendation 10 Responses

Report 2021-102: Indian Gaming Special Distribution Fund: The State Could Better Manage Its Distribution Fund and Its Problem Gambling Programs (Release Date: August 2022)

Recommendation #10 To: Public Health, Department of

To ensure that it can better identify which populations need problem gambling prevention or treatment services and the factors that contribute to problem gambling, the Office of Problem Gambling should, as soon as possible, obtain data on the number of Californians who currently suffer or have recently suffered from problem gambling. The office should also update this information annually and use it to identify the locations and populations most in need of program service and to evaluate how well it is serving that population. Until it obtains this information, the office should take additional steps to determine whether it is providing services to a reasonable number of individuals by comparing its programs to those in other states.

1-Year Agency Response

-The Office analyzed pooled data from the 2018, 2020, and 2021 California Behavioral Risk Factor Surveillance Surveys. Of California (CA) adults who responded:

o 1% of the population surveyed reported a problem gambling (PG) behavior in the past year. Extrapolated to CA's adult population, about

304,650 people experienced at least one PG behavior during the past year.

o Of those who reported gambling in the past year, 4.8% reported symptoms of PG.

-The Office is participating in the California Health Interview Survey, providing a larger and more detailed reporting of PG by demographic group. Estimated availability is Spring 2025.

-The Office consulted with the National Association of Administrators of Disordered Gambling Services (NAADGS) to review the 2021 Survey of Publicly Funded PG Services in the U.S. data. CA ranked 2nd in the U.S. for public funds invested in PG services, but 27th in per capita invested in PG services.

-The Office examined the PG treatment rate per 100,000 adults and compared to the per-capita investment in other large states (population of 5 million or more).

-CA's treatment rate (2.85 per 100k adults; per capita investment in PG services $0.22) is comparable to large states with similar per capita investment rates (NY and NC). CA's investment in PG lags behind other large states with higher treatment rates (IL and OH).

-The Office aligns with the NAADGS research, finding the number of problem gamblers treated significantly correlated with total amount spent on PG services. See (Figure 45, pg. 71 of the survey report) of the 2021 Survey of Publicly Funded Problem Gambling Services in the United State.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

6-Month Agency Response

Activities remain on-track.

- OPG's request to participate in the California Health Interview Survey (CHIS), which will provide a more sufficient sample size to better understand prevalence of problem gambling behaviors in California, was approved.

- The comparison to other state treatment services programs will be complete by June 2023. Substance and Addiction Prevention Branch has identified one staff person to support this effort for the Office.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

While the Office has participated in the state's BRFSS survey in 2018, 2020, and 2021, the sample size of BRFSS may be inadequate to accurately estimate population levels of problem gambling behaviors. Therefore, the Office has taken the following additional actions:

- Analyzed existing BRFSS data sets over multiple years. Known as "pooling," this analytic technique would combine data over multiple years to generate a three- or five-year estimate. Pending the results of this analysis, pooled results may be available in Spring 2023.

- Initiated contact with the CHIS, which will provide a more sufficient sample size to better understand prevalence of problem gambling behaviors in California. The request to participate is under review; pending approval, the Office will participate in CHIS in the 2023-24 cycle and will seek out sustainable funding for ongoing annual cycles.

Future steps will involve working with national partners such as NAADGS to evaluate whether California's treatment program provides services to a reasonable number of individuals, by comparing to treatment services provided in other states. Program will prioritize this project as an interim step until population-level survey data are available.

To improve data collection, no later than June 30, 2023, the Office will:

- Conduct a comparison to other state treatment services programs.

- Provide preliminary population-level problem gambling estimates based on pooled BRFSS data over multiple years.

- Work toward a better understanding of population-level problem gambling data through participation in CHIS; note, these data will not be available until 2024/25.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2021-102

Agency responses received are posted verbatim.