Gambling and substance use: A cross-consumption analysis of tobacco smoking, alcohol drinking and gambling.

Background: Gambling has never been as popular and widely available as it is today. Despite the widespread normalization of gambling as just another form of leisure consumption, its potential interaction with substance use (e.g. smoking and drinking) is nowadays an issue of social concern. In fact, empirical research has found both substances to have strong interdependencies with gambling through multiple factors. Methods: Gambling is a two-step decision: potential gamblers first decide whether to participate, then their expenditure. Using data from the Spanish gambling prevalence survey, a double-hurdle model is proposed to estimate the effect of tobacco smoking and alcohol drinking on gambling participation and expenditure decisions utilizing binary consumption and frequency of consumption approaches. Results: In line with previous research, results showed that people who smoked tobacco and/or drank alcohol were more likely to gamble and to have a greater expenditure. Each additional level of frequency of consumption of both products was found to likely increase the prevalence of gambling. Conclusions: The frequency of consumption of tobacco and/or alcohol was positively associated with the likelihood of gambling and spending more on gambling products. Findings may assist gambling stakeholders to prevent potential gambling-related harm.