The WAGER Vol. 5(11) – An 11-Year Follow-Up Study


Previous WAGERs have extolled the virtues of follow-up and longitudinal studies [e.g., WAGER 5(2)]. Studies that collect data at multiple points in time have several advantages over studies that collect data only once. One of the best-known follow-up studies ever conducted is the Epidemiologic Catchment Area (ECA) Study, a national study of psychiatric disorders funded by the National Institute of Mental Health (NIMH). The ECA used a complex sampling strategy to collect data from five sites across the United States. Linda Cottler and Renee Cunningham-Williams, two of the investigators from the St. Louis site, used the framework of the ECA to examine gambling behavior across an 11-year period.1

Eleven years after the commencement of the ECA, the authors re-interviewed a sample of 162 drug users from whom gambling-related data had been collected at baseline.2 The animation below demonstrates changes in prevalence over the 11-year period.

A clear pattern appears: Over the 11 years, the prevalence of abstinence decreased while the prevalence of problem and pathological gambling increased. It should be noted that casino riverboats were introduced into the St. Louis area during the time frame covered by the study. However, it is wrong to conclude that the introduction of riverboat gambling caused the increase in problem and pathological gambling behavior. The present study does not provide the data that would be necessary to evaluate a possible causal relationship.

It is important to remember that the sample used for the present analysis is not representative of the general population. Rather, subjects were drug users from the St. Louis area. Using a general population sample may have resulted in very different findings.

Finally, it should be noted that a subject who had never gambled at the time of the first data collection can only increase his or her level of gambling behavior at the time of the second collection.


1Cunningham-Williams, R.M., Cottler, L.B., Comptom III, W.M., & Spitznagel, E.L. (1998, June). Taking chances: Problem gamblers and mental health disorders- Results from the St. Louis Epidemiologic Catchment Area Study. American Journal of Public Health, 88, 1093-1096.

2Cottler, L.B. & Cunningham-Williams, R. (1998, June). The 11 year incidence of gambling problems among drug users recruited from the St. Louis ECA Study. Presented to the National Academy of Sciences Workshop on the Social and Economic Impact of Gamling. Washington, DC.

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