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Under åren 2023-2025 leder jag projektet "Spel om pengar i arbetslivet", ett Afa-finansierat projekt som undersöker spel om pengar på arbetsplatsen. I mars 2023 disputerade jag med avhandlingen "A Workplace Prevention Program for Problem Gambling". Avhandlingen finns att läsa här.

I urval från Stockholms universitets publikationsdatabas

• A Workplace Prevention Program for Problem Gambling

  2023. Jonas Rafi.

  Avhandling (Dok)

  Gambling is an activity that may involve harm for the gambler and others close to the gambler. Since workplaces may be negatively affected by employees who gamble during work or are at-risk problem gamblers, this setting has been proposed as a suitable arena for prevention. However, the potential effects of such initiatives have not been evaluated. This thesis explored the effects of a workplace prevention program for problem gambling. The program comprised gambling policy development and skill development training for managers.

  Study I used pre-intervention measures to explore gambling characteristics of employees (n=3629) in ten organizations, including both private and public sector organizations, and blue- and white-collar workers. About one in 20 employees knew someone who gambled during work, and this proportion was similar for both managers and subordinates. Another finding was that 3.5% of respondents were categorized as at-risk problem gamblers, with a higher prevalence among subordinates (3.8%) than managers (1.3%). A third finding was that 11.4% of employees stated that the organization had a gambling policy, and that this did not differ between managers and subordinates. Gambling policy knowledge was considerably lower than alcohol policy knowledge, as an alcohol policy was believed to exist by 94.3% of managers and 63.3% of subordinates. Lastly, in regression analyses, the two outcomes “knowing about a colleague who gambles during work” and “at-risk/problem gambling” were associated with each other, male gender, and young age. Taken together, the findings offer evidence that gambling may be an important topic to target in workplace settings, although more research is needed to pinpoint specific workplace harms and whether certain gambling types are associated with more workplace harms than others.

  Study II used a cluster-randomized design to investigate the effects of a prevention program. Ten organizations were randomized to an intervention group or a waitlist group. Individuals who were employed on any of three measurement occasions were eligible to participate. A total of n=490 (response rate 73%) managers and n = 4146 (response rate 43.3%) subordinates participated in the study by providing informed consent and responding to the survey at least once. The prevention program included two main components: policy development and skill development training for managers. The main outcome was managers’ inclination to act when worried about an employee regarding gambling or other harmful use (e.g., alcohol), together with a range of secondary outcome measures. The results showed that managers who participated in the skill development training significantly increased their inclination to act compared to the waitlist group, but this finding was not generalized to the whole intervention group. Thus, including managers in the intervention group who did not participate in the skill development training when calculating intervention effects resulted in non-significant effects. The results of secondary outcome measures showed that there were significant intervention effects regarding managers’ knowledge of a gambling policy, their confidence in how to act when concerned about an employee’s possible problem gambling or other harmful use, and the proportion of managers who had acted to provide support. 

    Study III included semi-structured interviews with skill development participants (n=23) to inquire about their experiences of the prevention program. Interviews were transcribed and analyzed using qualitative content analysis, which yielded six distinct themes related to the participants, namely: 1) their expectations, 2) aspects of the skill development training they appreciated, 3) their experiences of PG, 4) their proposed areas of improvement, 5) whether they felt they had  received a good basis for PG and other harmful use, and 6) their thoughts about the so-called “difficult conversation”. Taken together, the findings provide ideas for improving gambling-specific interventions for the workplace and corroborate earlier research findings on workplace interventions in general.

  To conclude, the thesis shows that a workplace preventive intervention for gambling can have positive effects on managers’ intended and performed actions to help an employee who they suspect has a problem with gambling or other harmful use. However, further program improvements and in-depth studies are needed to draw conclusions on explanations, robustness, and mechanisms of change.

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• Gambling among employees in Swedish workplaces: A cross-sectional study

  2023. Jonas Rafi, Petra Lindfors, Per Carlbring. Environmental and Occupational Health Practice

  Artikel

  Objectives: Responsible workplaces strive to minimize the harmful effects of alcohol and drug abuse. However, gambling is still a neglected area in workplace research. This study describes workplace gambling and investigates variables associated with at-risk problem gambling and knowing about colleagues who gambles during work, using cross-sectional data from a large cluster-randomized controlled trial on gambling prevention in the workplace (N=3629).

  Methods: Measures included prevalence of workplace gambling policies, at-risk and problem gambling, and knowledge about colleagues who gamble during work.

  Results: Of the respondents, 168 (4.7%) knew of someone who gambles at work, of whom 29 (17.3%) also worried about the harmful consequences of workplace gambling. Moreover, 395 (11.2%) believed that a gambling policy existed in their workplace. Knowing about a colleague who gambles during work was more common among employees who were men (OR = 2.98), aged 16–34 (OR = 1.97), knew about a gambling policy (OR = 1.57), and who themselves were classified as at-risk problem gamblers (OR = 2.95). Similarly, being classified as an at-risk problem gambler was significantly associated with being male (OR = 2.14), aged 16–34 (OR = 2.35) or 35–44 (OR=2.36), being a subordinate (OR = 2.53), and knowing about a colleague who gambles during work (OR=4).

  Conclusions: Gambling during work is a prevalent phenomenon. Organizations should consider implementing gambling policies that facilitate helping workers who are problem gamblers. To determine policy contents and measures to implement, the type of gambling and its effect on employees should be explored.

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• Effects of a workplace prevention program for problem gambling: A cluster-randomized controlled trial

  2022. Jonas Rafi (et al.). Journal of Gambling Issues 50, 73-97

  Artikel

  Background and Aims: This study evaluated whether a preventive intervention program for problem gambling would increase managers’ inclination to act when concerned about gambling in the workplace. Design: Cluster- randomized controlled trial. Ten workplaces were randomized to either intervention or control condition. Participants: At the 12-month endpoint, there were n = 136 managers and n = 1594 subordinates in the intervention group, and n = 137 managers and n = 1150 subordinates in the waitlist group. Intervention: The intervention consisted of (1) six hours of skill-development training for managers regarding gambling, problem gambling, gaming, and harmful use of psychoactive drugs, and (2) six to eight hours of assistance in developing or improving workplace gambling policy. Measurements: The primary outcome was the managers’ self-rated (on a 1 to 10 scale) inclination to act when concerned about an employee’s problem gambling 12 months after baseline. Findings: The between-group difference in the managers’ inclination for the full intervention group (M = 8) and the control group (M = 7.4) was not significant at the 12-month follow-up, but it was when only including managers who attended the skill- development training (M = 8.2), d = 0.31, p = .04. Conclusion: A workplace prevention program aimed to increase managers’ inclination to act when they are concerned regarding an employee’s gambling resulted in statistically significant changes for those who attended training, but not for the whole intervention group when non-attendees were included.

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• Dropouts’ usage of a responsible gambling tool and subsequent gambling patterns

  2020. David Forsström, Jonas Rafi, Per Carlbring. Cogent Psychology 7 (1)

  Artikel

  Responsible gambling measures are mainly implemented by the gambling industry to reduce excessive gambling and gambling-related harm. These measures include responsible gambling tools that target online gamblers, typically through behavior tracking, feedback, and, in some cases, advice on how to reduce gambling. Playscan is a responsible gambling tool implemented at gambling sites in several countries with many users in Norway and Sweden. Previous studies have indicated that these tools have limited repeated use. Also, the tools have shown to have a low effect on decreasing gambling behavior. Our aim has been to investigate usage and effect of Playscan among Norwegian gamblers (N = 835) that began to use Playscan and then opted out. These gamblers had a high initial use, but extensive lack of repeated use of the functions included in the tool (secondary data was used). The majority of the gamblers used Playscan for a short period of time. The results indicate that the participants did not gamble less after using Playscan (gambling data analyzed using ANOVA). A hypothesis that can be suggested is that short-term use of Playscan do not decrease the level of gambling for this sample. Also, low-risk gamblers seems to have increased their gambling after using Playscan. The results implies that level of use and length of use needs to be taken into account when evaluating the effect of responsible gambling tools. The low level of use in this sample and in other studies implies that strategies to increase is needed.

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• Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment

  2019. Alexander Miloff (et al.). Behaviour Research and Therapy 118, 130-140

  Artikel

  This study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design. Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin. Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects. Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment. ClinicalTrials.gov (NCT02533310).

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• What Did You Do Yesterday? A Meta-Analysis of Sex Differences in Episodic Memory

  2019. Martin Asperholm (et al.). Psychological bulletin 145 (8)

  Artikel

  To remember what one did yesterday is an example of an everyday episodic memory task, in which a female advantage has sometimes been reported. Here, we quantify the impact of sex on episodic memory performance and investigate whether the magnitude of the sex difference is modified by study-, task-, and sample-specific moderators. Analyses were based on 617 studies conducted between 1973 and 2013 with 1,233,921 participants. A 5-level random-effects meta-analysis showed an overall female advantage in episodic memory (g = 0.19, 95% CI [0.17, 0.21]). The material to be remembered affected the magnitude of this advantage, with a female advantage for more verbal tasks, such as words, sentences, and prose (g = 0.28, 95% CI [0.25, 0.30]), nameable images (g = 0.16, 95% CI [0.11, 0.22]), and locations (g = 0.16, 95% CI [0.11, 0.21]). and a male advantage in more spatial tasks, such as abstract images (g = -0.20, 95% CI [-0.35, -0.05]) and routes (g = -0.24, 95% CI (-0.35, -0.12]). Furthermore, there was a female advantage for materials that cannot easily be placed along the verbal-spatial continuum, such as faces (g = 0.26, 95% CI [0.20, 0.33]), and odor, taste, and color (g = 0.37, 95% CI [0.18, 0.55]). These differences have remained stable since 1973. For verbal episodic memory tasks, differences were larger in Europe, North America, Oceania. and South America than in Asia, and smaller in childhood and old age than for other ages. Taken together. results suggest that men may use their spatial advantage in spatially demanding episodic memory tasks, whereas women do well in episodic memory tasks that are verbalizable and tasks that are neither verbal nor spatial, such as remembering faces and odors/tastes/colors.

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• Experiences of responsible gambling tools among non-problem gamblers

  2019. Ekaterina Ivanova (et al.). Addictive Behaviors Reports 9

  Artikel

  Introduction: Responsible gambling (RG) tools, aiming at helping gamblers to avoid gambling-related harms, are common in online gambling platforms. Gambling industry, policy makers, and researchers have warned that RG tools can potentially disturb recreational gamblers, channeling them to less protective operators. No evidence exists to support these concerns, and they can hinder the development of effective RG tools. The current study aimed to investigate the recreational gamblers' experiences of RG tools.

  Methods: A total of 10,200 active customers of an online gambling service were invited to complete an online survey and rate their overall reactions, attitudes, disturbance and irritation towards RG tools, as well as their inclination to abandon a gambling service due to overexposure to RG tools. N = 1223 surveys were completed.

  Results: Non-problem gamblers had positive experiences of RG tools. Moderate-risk gamblers had more positive overall reaction and less irritation to previous experiences of RG tools compared to non-problem gamblers. Problem gamblers had least positive attitudes, most disturbance and most irritation towards RG pictures. Non-problem gamblers had lowest rates of having abandoned a service because of perceived overexposure to RG tools (5.2% compared to 25.9% of problem gamblers), with a significant between-group difference (OR [95%CI] = 7.17 [3.61–14.23], p < .001).

  Conclusions: Non-problem gamblers were not particularly disturbed by RG tools and were not at risk of abandoning online gambling services because of overexposure to RG tools. The study found no grounds for limiting the design and implementation of RG tools due to fears of disturbing recreational gamblers.

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• Participants' Experiences of a Workplace-Oriented Problem Gambling Prevention Program for Managers and HR Officers

  2019. Jonas Rafi (et al.). Frontiers in Psychology 10

  Artikel

  Workplace health promotion programs (WHPPs) refer to a set of health promotion and protection strategies implemented at a worksite and designed to meet the health and safety needs of employees. One important question for WHPPs is how middle management experience their participation in a WHPP. This study aims to explore this question further by applying a qualitative content analysis to interviews with thirteen managers and ten human resource officers participating in a WHPP focusing on problem gambling. The WHPP consisted of two components: policy implementation and skills-development training. The participants were interviewed about their experiences of these two components and the implementation process. The qualitative content analysis resulted in six themes: (1) Expectations of the skills-development training, (2) Experiences of and prior beliefs about problem gambling, (3) A good foundation, (4) The difficult conversation, (5) Appreciated aspects of the training sessions, and (6) Remaining obstacles. The results suggest that the presentation of cases, facts, and general knowledge was appreciated by most participants. However, participants also expressed that they would benefit from tailored interventions, more support in the policy implementation process, and following up on the results.

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• Effects of a workplace prevention programme for problem gambling

  2018. Per Carlbring, Jonas Rafi.

  Konferens

  Despite being considered a public health problem, no prevention programme for problem gambling in workplace settings has been scientifically evaluated. The aim of this study was to investigate the effects of a problem gambling (PG) prevention programme in a workplace setting. It was hypothesised that the workplace PG prevention programme will result in (1) managers reporting a higher inclination to engage in a conversation with an employee when suspicion or worry about PG arises, (2) an increase in the employees’ knowledge about where in the workplace one might get support regarding problem gambling, (3) an increased number of early interventions by the managers (eg, engage in a conversation) to help employees with PG or other types of harmful use, (4) managers and employees engaging in more sustainable gambling practices as measured by sum of Problem Gambling Severity Index (PGSI) scores, (5) fewer cases of PG among managers and employees as measured by PGSI categories and (6) managers reporting being more confident in handling gambling and PG in the workplace.Ten organisations, with a total of n=549 managers and n=8572 employees, were randomised to either receiving a prevention programme or to a waitlist control condition. Measurements was collected at the baseline and 3, 12 after intervention. At the time of the EASG-conference 12-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).

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Visa alla publikationer av Jonas Rafi vid Stockholms universitet