Background/Objectives: Valid and reliable measurement of dental anxiety is of importance in both clinical and research settings. The aim of this study was to adapt and evaluate the Swedish child and adolescent version of the index of dental anxiety and fear (IDAF). Methods: A total of 142 dental patients aged 10–15 completed the four-components (IDAF-4C) and stimulus module (IDAF-S). Convergent validity was evaluated by correlating IDAF with CFSS-DS and a single item question on self-reported dental anxiety (SQDA). Reliability was investigated using Cronbach’s alpha, test–retest measurements (n = 16) and interviews. Results: IDAF-4C had a high correlation to CFSS-DS (r = 0.72). IDAF-4C convergent validity to SQDA (r = 0.76) was higher than the correlation between CFSS-DS and SQDA (r = 0.62). Convergent validity between IDAF-S and CFSS-DS was high (r = 0.83). Test–retest for IDAF-4C resulted in a moderate ICC of 0.72 (95% CI 0.37–0.89) and a correlation coefficient of 0.74. The difference in skipped items suggests that IDAF has higher usability than CFSS-DS. Conclusions: IDAF-4C provides a reliable estimate of dental anxiety, while IDAF-S provides clinical insights in individual aspects of dental anxiety similar to CFSS-DS. Further research includes evaluating the specific phobia module of IDAF and include more test–retest participants. The Swedish child and adolescent version of IDAF-4C and IDAF-S show good psychometric properties and usability and may be used as a dental anxiety measurement among children and adolescents.

Background: A significant number of individuals with depression in Hong Kong remain undiagnosed and untreated through traditional face-to-face psychotherapy. Internet-based cognitive behavioral therapy (iCBT) has emerged as a tool to improve access to mental health services. However, iCBT remains underdeveloped in Chinese communities, particularly in Hong Kong.

Objective: This study aims to (1) develop and evaluate the effectiveness of a culturally and linguistically appropriate guided iCBT program for Hong Kong Chinese with depressive symptoms, and (2) explore their treatment adherence.

Methods: An 11-week guided iCBT program, “Confront and Navigate Depression Online” (CANDO), consisting of 8 online modules, was developed and implemented for Hong Kong residents. The program was accessible via either an online platform (web-based iCBT) or a smartphone app (app-based iCBT). A 3-arm randomized controlled trial was conducted, with participants recruited through open recruitment and referrals from 2 local non-governmental organizations. A total of 402 eligible participants with mild to moderate depressive symptoms were randomly allocated into 3 groups: (1) web-based iCBT (n=139); (2) app-based iCBT (n=131); and (3) waitlist control (WLC) group (n=132), who transitioned to the web-based iCBT group after waiting for 11 weeks. Therapist support was provided by a clinical psychologist through 3 counseling sessions and weekly assignment feedback. The primary outcomes were the Beck Depression Inventory-II (BDI-II) and the 9-item Patient Health Questionnaire (PHQ-9), while the secondary outcome measures included the 12-item General Health Questionnaire (GHQ-12), the Chinese Automatic Thoughts Questionnaire (CATQ), and the Chinese Affect Scale (CAS). These scales were administered at preintervention, postintervention, and at 3-month and 6-month follow-up assessments. Data analysis was conducted using linear mixed effects modeling, adhering to the intent-to-treat principle.

Results: Participants in both the web- and app-based iCBT groups reported significant improvements compared with the WLC group on all primary (P<.001) and secondary measures (P<.001 and P=.009) at posttreatment. Large between-group effect sizes were observed in the reduction of depressive symptoms, with Cohen's d value of 1.07 (95% CI 0.81-1.34) for the web-based group and 1.15 (95% CI 0.88-1.43) for the app-based group on the BDI-II. Additionally, the web- and app-based groups showed effect sizes of 0.78 (95% CI 0.52-1.04) and 0.95 (95% CI 0.63-1.27) on PHQ-9, respectively. Medium to large effect sizes were observed for secondary outcomes at posttreatment. These positive effects were maintained at both the 3- and 6-month follow-ups, with medium to large within-group effect sizes. The adherence rate in the 2 iCBT groups was 154 out of 270 (57.0%) for completing all 8 online modules and 152 out of 270 (56.3%) for attending all 4 counseling sessions (including an intake interview). The recovery rate, as measured by the BDI-II at posttreatment, was 35 out of 90 (39%) for the web-based group and 36 out of 91 (40%) for the app-based group, compared with 3 out of 112 (3%) in the WLC group.

Conclusions: Culturally and linguistically adapted iCBT is an effective and feasible treatment for Hong Kong Chinese with mild to moderate depressive symptoms, demonstrating a satisfactory recovery rate and treatment adherence. ICBT offers an accessible and viable alternative to face-to-face interventions in Hong Kong. The Hong Kong government should allocate more resources and support the use of iCBT as a tool to treat people with depressive symptoms.

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.

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.

In this talk, I will discuss how we can improve workplace interventions aimed at preveting gambling harms, using the results of three new studies. 

Gambling and gambling problems differ in prevalence between occupational groups. In some organizations, almost 10% know someone who gambles during work. At the same time, some managers are unaware of their responsibilities or are not inclined to talk to employees who may have a problem with gambling or other harmful use. 

Using behavioral data, we have found evidence that managers who participate in a skill-development training performed more actions to help employees who they suspect have a problem with gambling or other harmful use. However, there were many challenges and lessons learned. These include how to measure gambling harms related to work, the effectiveness of specific components such as policies, disseminating knowledge through the organizations, and finding a balance between tailoring the intervention and maintaining intervention fidelity.

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.

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.

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).

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.

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.