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Intervention Summary

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Stacked Deck: A Program To Prevent Problem Gambling

Stacked Deck: A Program To Prevent Problem Gambling is a school-based prevention program that provides information about the myths and realities of gambling and guidance on making good choices, with the objective of modifying attitudes, beliefs, and ultimately gambling behavior. The intervention is provided to students in 9th through 12th grade as part of a regularly scheduled class such as health education or career management. Trained facilitators (teachers, prevention specialists, or health educators) use a facilitator's guide to administer five 50- to 90-minute interactive lessons over a period of 2 to 3 weeks.

Lessons cover the history and realities of gambling (e.g., the "house edge"), risk factors for and signs of problem gambling, fallacies about gambling, calculated risk and the assessment of situations involving risk, and barriers to good decisionmaking and problem solving. An optional booster session to consolidate previous learning can be administered 1 month after the completion of the fifth lesson. In one of the two studies reviewed for this summary, implementation of the intervention included the booster session.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: April 2011
1: Attitudes toward gambling
2: Problem gambling
3: Resistance to fallacies about gambling
4: Gambling frequency
Outcome Categories No outcome categories are applicable.
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Non-U.S. population
Settings School
Geographic Locations Urban
Rural and/or frontier
Tribal
Implementation History Stacked Deck was pilot tested from 2001 to 2002 in Alberta, Canada, high schools and was subsequently revised. The revised version was evaluated in Alberta from 2003 to 2005 with more than 1,200 high school students. Outside of Canada, the program has been implemented in the United States (in approximately 30 States), Australia, and New Zealand.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: Yes
Adaptations The intervention has been adapted for use in a high school for Aboriginal students in Canada.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: April 2011

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Williams, R. J., Wood, R. T., & Currie, S. R. (2010). Stacked Deck: An effective, school-based program for the prevention of problem gambling. Journal of Primary Prevention, 31(3), 109-125.  Pub Med icon

Study 2

Williams, R. (2002). Final report. Prevention of problem gambling: A school-based intervention. Unpublished manuscript, School of Health Sciences, University of Lethbridge, Alberta, Canada.

Outcomes

Outcome 1: Attitudes toward gambling
Description of Measures Attitudes toward gambling were measured using two self-report scales created by the program developers. In one study, a 2-item scale was used. The first question asked the student about gambling's benefit versus harm to society, with response options ranging from "benefits far outweigh the harm" to "harm far outweighs the benefits." The second item asked the student to indicate whether gambling is morally wrong. Total scores ranged from -4 to +4, with lower scores reflecting more negative (or healthy) attitudes toward gambling. Another study used a 4-item scale with similar questions, as well as questions on how the student feels about legalized gambling and how the student would rank gambling as a leisure pastime. For this measure, total scores ranged from 4 to 18, with higher scores reflecting more negative (or healthy) attitudes toward gambling. Assessments were administered at baseline and 3-month follow-up.
Key Findings In one Canadian study, schools were assigned to one of three groups: a group receiving the standard Stacked Deck, a group receiving the standard Stacked Deck plus a booster session, and an assessment-only control group. At 3-month follow-up, attitudes toward gambling in the standard group were significantly more negative (i.e., healthier) than those in the control group (p < .001), and attitudes in the booster session group were significantly more negative than those in the standard group (p = .013).

A second Canadian study involved two schools in the Calgary high school system and two Aboriginal high schools in southern Alberta. Schools at each of the two sites were randomly assigned to the standard Stacked Deck group or an assessment-only control group. In the Aboriginal school selected for implementation, the program was adapted for the Blackfoot culture and delivered by a qualified teacher, who was a Blackfoot elder. From baseline to 3-month follow-up, the Stacked Deck group showed a greater increase in negative (i.e., healthier) attitudes toward gambling compared with the control group (p < .01).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)
Outcome 2: Problem gambling
Description of Measures Problem gambling was measured using a 2-part self-report item created by the program developers. The first part asked, "Has your gambling caused you or anyone else any problems in the past 12 months? By this we mean things such as stress or anxiety, arguments with friends or family, worries about money, health problems, legal problems, or problems at school or work." If the student answered affirmatively, a follow-up question asked the student to indicate the type of problems, their frequency, and their seriousness. Students were deemed problem gamblers if they reported "serious" or "very serious" problems of any frequency. Assessments were administered at baseline and 3-month follow-up.
Key Findings In a Canadian study, schools were assigned to one of three groups: a group receiving the standard Stacked Deck, a group receiving the standard Stacked Deck plus a booster session, and an assessment-only control group. At 3-month follow-up, the rate of problem gambling was significantly lower in the standard group (p = .032) and the booster session group (p = .013) than in the control group.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.7 (0.0-4.0 scale)
Outcome 3: Resistance to fallacies about gambling
Description of Measures Resistance to fallacies about gambling was assessed using two self-report measures created by the program developers that address common misperceptions about gambling (e.g., illusion of control, belief that one is luckier than other people). In one study, a 10-item scale was used. Scores ranged from 0 to 10, with higher scores reflecting greater resistance to gambling fallacies. Another study used a 9-item scale. Scores ranged from 0 to 19, with lower scores reflecting greater resistance to gambling fallacies. Assessments were administered at baseline and 3-month follow-up.
Key Findings In one Canadian study, schools were assigned to one of three groups: a group receiving the standard Stacked Deck, a group receiving the standard Stacked Deck plus a booster session, and an assessment-only control group. From baseline to 3-month follow-up, the standard group and booster session group showed a greater increase in resistance to gambling fallacies compared with the control group (p < .001).

A second Canadian study involved two schools in the Calgary high school system and two Aboriginal high schools in southern Alberta. Schools at each of the two sites were randomly assigned to the standard Stacked Deck group or an assessment-only control group. In the Aboriginal school selected for implementation, the program was adapted for the Blackfoot culture and delivered by a qualified teacher, who was a Blackfoot elder. From baseline to 3-month follow-up, the Stacked Deck group showed a greater increase in resistance to gambling fallacies compared with the control group (p < .001).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)
Outcome 4: Gambling frequency
Description of Measures Gambling frequency was assessed using a self-report questionnaire created by the program developers. Using a 6-point scale ranging from "did not play" to "daily," participants indicated for each of 10 types of gambling activities the number of days on which they bet or personally spent money in the past 3 months. Assessments were administered at baseline and 3-month follow-up.
Key Findings In a Canadian study, schools were assigned to one of three groups: a group receiving the standard Stacked Deck, a group receiving the standard Stacked Deck plus a booster session, and an assessment-only control group. From baseline to 3-month follow-up, the standard group and booster session group showed a greater decrease in gambling frequency compared with the control group (p = .017).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 53% Male
47% Female
100% Non-U.S. population
Study 2 13-17 (Adolescent) 51.5% Male
48.5% Female
100% Non-U.S. population

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Attitudes toward gambling 1.3 2.0 1.6 2.6 3.4 3.5 2.4
2: Problem gambling 1.8 3.3 1.6 2.7 3.4 3.7 2.7
3: Resistance to fallacies about gambling 1.3 2.0 1.6 2.6 3.4 3.5 2.4
4: Gambling frequency 0.8 2.3 1.6 2.7 3.4 3.8 2.4

Study Strengths

Reliability tests were performed for some outcome measures, and for those, the test-retest reliability was found to be good. Some of the measures showed good concurrent and predictive validity. Implementation fidelity was supported through trainings and periodic observations of the trainings by the program developers. Follow-up rates 3 months after the intervention were acceptable. Imputation was used to address missing data for variables missing less than 5% of values. The numerous between-group differences identified at baseline were addressed statistically.

Study Weaknesses

For many outcomes, little information was provided about the reliability and validity of the measurement instruments. Teacher trainings were observed, but curriculum delivery was not observed and no intervention checklists were completed by the facilitator or students. Data were examined for missing values and accuracy, but it is not specified whether rates of missing data were equal between groups. While imputation was used to address missing data for variables missing less than 5% of values, it is unclear how researchers handled variables with a greater proportion of missing values. Many statistical tests were performed, and no multiple testing correction was used, thereby increasing the potential for outcomes due to chance to be found significant.

Readiness for Dissemination
Review Date: April 2011

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Williams, R., & Wood, R. (2010). Stacked Deck: A Program To Prevent Problem Gambling, grades 9-12. Facilitator's guide [with CD-ROM]. Center City, MN: Hazelden.

Williams, R., & Wood, R. (n.d.). Stacked Deck: A Program To Prevent Problem Gambling. Curriculum implementation training. Center City, MN: Hazelden.

Williams, R., & Wood, R. (n.d.). Stacked Deck training PowerPoint slides, Lessons 1-6.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5 2.5 2.4 2.8

Dissemination Strengths

The facilitator's guide provides detailed and well-structured content for each program session. Each session includes a review of the information presented in preceding sessions, increasing students' exposure to key content. The materials provide guidance on addressing issues and problems that might occur with students. A detailed matrix describing the content, methods, and supplies associated with each training session accompanies the curriculum implementation training guide. A pre- and posttest questionnaire that is well aligned with the structure of the program is available to support outcome monitoring.

Dissemination Weaknesses

Little guidance is provided on how to integrate the program with existing school curricula. The training includes limited instruction beyond requirements of session delivery, omitting important information for enhancing the delivery skills of the facilitators. Little attention is given to an overall quality assurance process, with no guidance provided for monitoring and maintaining fidelity to the model.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Facilitator's guide (includes CD-ROM with six sets of PowerPoint slides and reproducible materials) $59.99 Yes
1.5-day, on-site training of trainers $5,000 (for up to 25 participants), plus travel expenses Yes, if planning to conduct facilitator training

Additional Information

Discounts are available for bulk orders.

Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Kaylene McElfresh
(651) 213-4324
kmcelfresh@hazelden.org

Robert Williams, Ph.D., R.Psych.
(403) 382-7128
robert.williams@uleth.ca

To learn more about research, contact:
Robert Williams, Ph.D., R.Psych.
(403) 382-7128
robert.williams@uleth.ca

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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