The Hidden Addiction: Problem Gambling in Asian American

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After reading Micheal Liao's essay on Asian Americans & Problem Gambling. Write an persuasive essay that argues:

That the role of culture, predisposition, life experience, and target marketing are factors that adequately explain the high rates of prevalence of problem gambling among Asian Americans.

Requirement: There are total 6 paragraphs- one introduction paragraph, four body paragraphs that culture, predisposition, life experience, and target marketing each factor has one paragraph. and last one is conclusion paragraph.

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ASIAN AMERICANS & PROBLEM GAMBLING By Michael S. Liao, NICOS Chinese Health Coalition INTRODUCTION Asian Americans are a diverse group. The U.S. Census defines an Asian person as having origins in countries of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. 1 According to the Asian Pacific Islander Health Forum, Asian and Pacific Islanders originate from over 50 countries and speak over 100 difference languages and major dialects. 2 It is difficult to pin-point a universal Asian American “culture” amidst a kaleidoscope of diverse experiences and cultures. However, despite the wealth of diversity, Asian Americans do share some commonalities – such as traditional values of collectivism and the importance of the extended familial networks. More recently, there has also been increased awareness of something that many members of the Asian American community share – a love for gambling. This article aims to explore the phenomenon of gambling in the Asian American community. Specifically, the article will examine the role of culture, predisposition, life experience, and target marketing in gambling behaviors among Asian Americans, and will propose some recommendations to service providers for prevention and intervention. ASIAN AMERICANS & GAMBLING Types of Gambling It was been noted that types of gambling preferred varies among ethnic groups. Even among various Asian American sub-groups, there may be differences in game preference. For example, several studies have noted that casinos games such as black jack, roulette, baccarat, and Pai Gow poker are favored by some Asian ethnic groups including Vietnamese, Chinese, and Koreans.3, 4 Some theorize that this preference for casino games may be related to the long historical practice of using cards and dice for wagers. In today’s society, the significant Asian presence in the glitzy world of poker tournaments, where many of the top players are of Asian descent, is fairly well-known.5 Other games favored by Asians include machine games such as slot machines and video lottery terminals. For example, one study in Australia found machine gambling to be popular among Koreans6, whereas other studies in the U.S. have found machine gambling to be popular also among Chinese7, Vietnamese, Cambodian, and Laotian populations.8 Other forms of gambling favored by various Asian groups include the lottery and sports betting.9 Besides commercial gaming, many Asian groups also engage in more “traditional” forms of wagering, especially during holidays and celebrations. Frequency of Gambling Do Asians gamble more than other groups? This idea has certainly been presented by many – and supported anecdotally by almost all who have ever been inside a card club or casino. In California, even the Attorney General’s report “Gambling in the Golden State” acknowledged that Asian Americans are “highly represented among recreational gamblers”,10 citing an article written by Casino City Times which estimated that up to 50% of the clientele at a popular tribal casino near Riverside and San Diego, CA, are Asian Americans.11 Similarly, an investigative report in the Silicon Valley Metro newspaper, variously reported that Asians make up between 50 – 80% of the clientele at the two local card clubs.12 Not surprisingly, much of this anecdotal information on gambling participation by Asians has been mirrored by empirical research. For example, in a study of gambling and problem gambling in Queensland, Australia, the results showed that gambling is a highly common social activity among Chinese and Vietnamese.13 In a study conducted in Connecticut with 96 Southeast Asian participants (herein referred to as the Connecticut study), it was found that nearly half of all participants had gambled within the past 2 weeks, and 42% had bet more than $500 in the previous two months.14 Finally, in survey study conducted by graduate students from the University of California, Berkeley (herein referred to as the UC Berkeley study) found that almost a third of the Chinese Americans surveyed in San Francisco’s Chinatown reported gambling once a week or more.15 Problem & Pathological Gambling While frequent gambling may certainly signal potential problems, to be certain whether gambling pathology disproportionately impacts the Asian American community, one must examine prevalence rates. In a study conducted in 1991 by Henry Lesieur, et al., examining gambling pathology among university students across five states, it was found that Asian American university students had the highest rates of pathological gambling (12.5%) compared to the overall study sample (4-8%).16 In a study conducted in 2001 by the Research Institute on Addictions with a nationally-representative sample, it was found that Asian Americans were more than 3 times likelier than Caucasians to be classified as problem gamblers.17 Interestingly, when the results of a California state prevalence study was released in 2006, it showed Asian Americans to have lower rates of pathological gambling as compared to the general population.18 Many in the Asian American community found issues with the findings, particularly the study’s method of telephone survey employed, and the lack of Asian-language interviewers to be problematic in capturing a representative Asian American sample. Groups such as the Asian Pacific Islander Task Force on Problem Gambling have since released public statements to highlight their concerns over the study’s findings. 19 More recently however, a secondary analysis on the California prevalence study data was conducted which revealed some new information on problem/pathological gambling rates for Asian Americans. Lui and Chung 20 found that while the overall rates of problem/pathological gambling were lower for the Asian American sample as a whole, those Asian Americans whose primary language was not English were 2.8 times more likely to be a problem/pathological gambler as compared to the general population in California. Lui and Chung’s findings underscore the importance of recognizing the diversity within the Asian American community, and highlight a short-coming of population studies that aggregate the Asian American sample, which makes it impossible to make comparisons between different Asian ethnic groups. Studies that have focused on specific Asian ethnic groups have in fact found some to be much more vulnerable to developing gambling problems. For example, in the afore-mentioned UC Berkeley study, it was found that among the Chinese surveyed, 21% met the criteria for pathological gambling.21 Also, in the afore-mentioned Connecticut study, it was found that among the sample of Vietnamese, Cambodian, and Laotian participants, nearly 60% met the criteria for pathological gambling.22 To put these findings into perspective, the national prevalence rate for pathological gambling (meeting criteria for the pathological gambling diagnosis in the Diagnostic and Statistical Manual for Mental Disorders, 4th Edition) in the U.S. is roughly 1%.23 In general, more research is needed, but it would appear that Asian Americans may have heightened risks for problem and pathological gambling, and in particular, several Asian sub-groups may have particularly high rates of gambling pathology. FACTORS FACED BY ASIAN AMERICANS Culture of Acceptance, Availability, and Access Asian Americans arguably exist within two main cultures that widely accept and even encourage gambling. Many Asian Americans grew up with traditional notions that gambling is an acceptable social activity. As previously mentioned, many Asian sub-groups routinely engage in various forms of gambling during special cultural celebrations and holidays. For various Asian sub-groups, gambling may have played a role in the cultural/social fabric for centuries. In an oped published in The Electronic Journal of Gambling Issues, the authors noted that the first examples of gambling in Chinese societies were recorded around 700 BC. 24 One Chinese proverb demonstrates the culture’s acceptance of gambling, at the same time signaling a warning to those who overindulge: “A little gambling is soothing and relaxing; heavy gambling could affect your mental health”. Despite the ancient adage promoting moderation in gambling, we are now witnessing a boom in countries like Hong Kong for state-operated lotteries and resort-style casinos. Asian immigrants, upon arriving in the U.S., also find a culture which promotes government-run and government-sanctioned gaming, where gambling opportunities are plentifully available. Given the factors of historical tolerance, social acceptance, and availability, it is not entirely surprising to find so many Asian Americans drawn to the local gambling facilities. Predisposition The apparent popularity of gambling with many Asian Americans have prompted some within the community to speculate whether this is “in our blood” – alluding to some inheritable predisposition. If one were to assume that there is a genetic explanation for why Asians may be more likely to develop problems as a result of gambling, one would also expect to find higher overall rates of disordered gambling in Asian countries. When national prevalence rates were examined in countries such as Taiwan25, Hong Kong26, and Korea27, it was found that the rates of problem and pathological gambling were consistent from those found in European and New World countries (Taiwan – 5%, Hong Kong – 1.5%, and Korea – 1%). In contrast, rates of disordered gambling among Asian immigrants in western countries often yield much higher rates of gambling pathology compare to the general population. For example, research in Montreal, Canada28 have shown problem gambling rates for Chinese to be about 5% and an additional pathological gambling rate of 2%, while research in Calgary, Canada29 have found a problem gambling rate of 8%, and research in Sydney, Australia30 have shown a pathological gambling rate of about 8%. The finding that immigrants have higher rates of problem gambling would seem to suggest that the process of immigration may play a key role in the development of gambling pathology. Two main theories have been proposed to explain the correlation between immigration and problem gambling. The first theory posits that immigrants and refugees may have personality traits that make them greater risk takers. Immigration for most involves taking some risks – some have even braved dangers and other challenges in order to emigrate. Therefore it is argued that these individuals, who took a gamble to leave their country in search of a new home, may have a propensity to take risks. In deed, personality traits such as sensation seeking31, risk-taking32, and impulsivity33 have been found to be linked to pathological gambling. While personality traits may certainly play a role in rates of problem gambling, to date there is no conclusive data to show that Asian immigrants as a whole exhibit personality traits that are correlated to problem gambling. Life Experience The second theory to explain problem gambling among Asian immigrants posits that the experience of immigration – including any experience of trauma and subsequent stresses of adaptation contribute to greater likelihood of problem gambling. Trauma has been linked to the development of problem and pathological gambling.34 It is not surprising therefore, to find that pathological gambling has been found to be more prevalent among those who have experienced childhood sexual and physical abuse 35 , among war veterans 36 and refugees 37 . In the aforementioned Connecticut study, it was found that nearly 60% of the Vietnamese, Cambodian, and Laotian refugees and asylum-seekers met criteria for pathological gambling.38 One reason for such high rates of pathological gambling in the Connecticut study can be attributed to the participants’ potential experience of trauma. In addition to blatant forms of trauma as a result of escaping genocides, war, and torture, there are also more subtle acculturative stresses that can impact behavioral health. In a qualitative case study of four Chinese –Canadian immigrants, immigration and acculturation stresses were cited as key factors in problematic gambling behaviors.39 The case studies also highlighted the impact of loss and isolation as a result of immigration. Loss of social and supportive networks such as extended families and tight-knit communities can create a sense of isolation. This is often where local gambling establishments step in to fill the void. In addition, immigrants also typically work very hard in order to care for their loved ones and send money back home, and gambling is often viewed as a source of stress-relief. Gambling may also help immigrants fulfill a sense of status. Many Asian immigrants report that success in gambling can bring about recognition, in addition to being a quick way to make money. Further, studies have often pointed to decisionmaking opportunities as motivation for gambling – particularly among marginalized populations who feel a lack of control in their daily lives.40 Life stressors such as adjustment problems, preexisting trauma, can therefore predispose immigrant populations to be more likely to gamble excessively. Gaming Industry’s Target Marketing Last but not least of the factors to consider when addressing the issue of gambling in the Asian American community is the gaming industry’s methods of outreach and marketing. What are some of the ways that the gaming industry caters to Asians specifically? Gambling establishments frequently shuttle potential patrons from communities with large Asian populations (Chinatowns, Koreatowns, etc.) to their facilities. 41 Further, gambling establishments frequently hire bilingual staff in order to increase comfort and ease for their Asian patrons.42 For many Asian immigrants who reside in communities that lack linguistically and culturally-specific entertainment and media outlets, the local card club or casino may serve as the de facto community center and gathering ground. Attractions at these gaming venues may include Asian food and entertainment.43 For the latter, it is not uncommon to see gambling venues feature top-name performers from various parts of Asia. The Silicon Valley Metro article revealed that many Vietnamese are drawn to a local card club in part for the free accompanying shows – such as Vietnamese bands and DJ’s that would otherwise cost $10 to $20 to see elsewhere.44 Many gambling establishments also boast tables or even entire sections devoted to Asian-style games. For example, a tribal casino in Northern California has an ‘Asian Gaming Lounge’ featuring table games such as Pai Gow poker. Some casinos have also gone as far to cater to their Asian clientele as to redesign their facilities to meet certain needs – such as the case of a $1.6 billion luxury resort casino in Australia, where Feng Shui consultants were brought in to design the tower and internal layouts.45 Casinos and other gambling establishments further develop name-recognition in Asian communities by having a presence in major ethnic events such as Lunar New Year celebrations and other cultural festivals. 46 All the marketing and catered services boil down to patronage and profits. However, the question becomes: Is there a line that should be drawn between the promotions of goods and services in a free enterprise and the potential exploitation of vulnerable populations? Also, if the gaming industry profits from marketing to a segment of the population, should it have equal responsibility to give back in ways to mitigate the adverse impacts of its products? SUGGESTIONS FOR PREVENTION & INTERVENTION In the next section, the article will share information and lessons learned from the Chinese Community Problem Gambling Project (CCPGP) in San Francisco. The project, a pioneering effort between NICOS Chinese Health Coalition, Richmond Area Multi-Services and Donaldina Cameron House, was created to meet the unmet needs of Chinese problem gamblers in San Francisco and the greater bay area. The project grew out of a local task force on Asian problem gambling which was formed in 1998. In the subsequent years of addressing problem gambling among the Chinese and the broader Asian American community, the CCPGP today is recognized as a leader in providing culturally relevant problem gambling services. Its unique and comprehensive approach covers the wide spectrum from prevention to clinical intervention to systems advocacy. Each of those components will be addressed in the following section. Early Intervention It has been documented that children growing up in households where one or more parents gambled excessively are more likely to become a problem gambler. 47,48 Since gambling is prevalent among many Asian cultures, early intervention may be particularly important. There is evidence that even among youth, Asians might be at a greater risk of developing gambling problems. In a survey study conducted with 246 Asian students from three major high schools in San Francisco (hereto referred to as the SF Asian Youth Gambling Study), the prevalence rate for pathological gambling was found to be 10.9%.49 This is much higher than the 2-5% national prevalence rates found among this age group. 50 The SF Asian Youth Gambling Study also uncovered that most teens reported learning gambling from friends, relatives or fathers, in that order.51 This particular finding tells us that effective early intervention strategies must address the culture of acceptance, in order to reshape social norms and learned behaviors. Similar to other studies, the SF Asian Youth Gambling Study also found that teens who started gambling at a younger age are more likely to be problem gamblers.52 This finding points to the importance of well-timed interventions. Research has shown that problem gamblers often start gambling before the age of 10.53 Effective early intervention programs should consider the impact of early onset of gambling when designing outreach efforts. Family & Community Support As previously mentioned, many Asian gamblers often report immigration stresses and difficulties with adjusting into American society as reasons for gambling. Strengthening family and community can be a powerful tool to help Asian gamblers. Service providers working with Asian gamblers often have to act as a liaison, linking gamblers to other services such as ESL classes, job training, public benefits assistance, and financial counseling. Such resources are essential for helping to stabilize the gambler’s present situation and to help strengthen the support network in the client’s recovery. While the social service providers is not expected to play the role of immigration lawyer or financial adviser, those working closely with Asian gamblers should still gain familiarity with important issues such as immigration policies, bankruptcy law, public benefit eligibility, etc. Service providers working in areas that do not have an obvious Asian community may need to network and outreach to local ethnic faith-based organizations, community centers, and cultural institutions. As many problem gamblers report isolation and lack of recreational outlets to be reasons for gambling, linkages to alternative social outlets would be beneficial. For many Asian gamblers, family is a big motivating factor to stop or cut-back on gambling. The CCPGP, for example, found that of the callers to the Chinese language gambling helpline, the second most commonly reported reason for their call is impacts to the family, second only to financial troubles.54 The importance of family in the Asian community means that family can either be a resource or a roadblock to recovery. For service providers working with Asian gamblers, getting the family involved in the treatment/helping process may be crucial. Family members may need to be referred for services as well related to mental health, domestic violence, and also financial planning. The CCPGP runs support groups for family members of problem gamblers to educate them about issues such as codependency and unhealthy ways of helping. Asian families and communities are collectivist by nature, and it is often difficult for Asian families to be told that they should not bail the gamblers out. In many Asian traditions, it is natural for family and community members to help one another – by lending money for debt relief, vouching for a loan, etc. However, in situations related to problem gambling, Asian families may have to get assistance in setting firm boundaries, avoiding codependency, and encouraging gamblers to take responsibility. Mental Health Support Research shows that Asian Americans may be more reluctant to seek help from outsiders, particularly when it comes to issues such as mental health.55 As a result, in many instances when Asian gamblers and their loved ones contact the CCPGP, they are already in a very desperate situation. The prolonged wait to seek help makes matters more difficult to handle, and the treatment more complicated. Programs set up to meet the needs of Asian problem gamblers and their loved ones must overcome the stigma of seeking help. Help can be tailored and reframed to be more culturally acceptable. St. Mary’s Center in San Francisco, a former partner in the CCPGP, for example, framed services in the context of a teahouse.56 Clients are invited over to “chat over tea” rather than for “counseling”. While downplaying the mental health aspect of services may increase ease of access, outreaching to the Asian community to emphasize the availability of professional help for problem gamblers is also needed. The CCPGP runs media campaigns composed of print, radio, and television spots.57 In the years of running the project, there has been clearly established correlation between advertisement of the helpline number and the volume of helpline calls.58 The educational campaign capitalizes on the importance of family by focusing more on gambling addiction’s impact on the family, rather than individual pathology. Of course, services provided by existing institutions trusted by the local Asian community can be helpful in gaining instant legitimacy and rapport with the constituents. For service providers who are not steeped in the local Asian community, partnering up with organizations that are key players in the community may be important. For clinicians working with Asian gamblers and loved ones, screening for co-occurring disorders that may impede the progress of recovery for problem gambling is very important. When working with Southeast Asian refugees for example, service providers should also screen for history of trauma, and assess for possible Post-Traumatic Stress Disorder (PTSD) or depressive symptoms. 59 Being aware of the sociopolitical experiences of one’s clients is important regardless of country of origin. In addition, given that the Asian American community is so diverse, service providers also should take care not to prescribe a monolithic culture or treatment approach to all Asian American clients. Advocacy In recent years there has been a movement toward examining problem gambling through the public health lens – where personal responsibility, government involvement, research, and industry participation all play a role in promoting responsible gambling. 60 Within this framework, service providers should take an active role in advocating for more personal responsibility – through educating clients about responsible gambling strategies. For Asian immigrants, it may also entail sharing about resources that they may not be familiar with such as self exclusion policies – whereby they can sign up with local gambling establishments to be restricted from the premises. Service providers working with Asian gamblers can also work in collaboration with the client to empower her/him to utilize resources such self-help manuals. The California Office of Problem Gambling has developed and translated a self-help booklet to help gamblers to, among other things, develop more self awareness of their own gambling behaviors, track spending, and self-strategize ways to limit gambling.61 The manual is currently available in five languages – English, Spanish, Chinese, Korean and Vietnamese. Service providers can also get involved in advocating for needed policies. The government plays an important role in protecting its constituents, and can be instrumental in ensuring that resources are available to mitigate the impacts of gambling. Some examples of advocacy on this level can include lobbying local, state and federal government for funding of ethnically-specific problem gambling resources. Currently, there are neither federal nor state dollars in California for problem gambling treatment.i Most insurance companies either will not reimburse for services or will impose severe restrictions when the primary diagnosis is pathological gambling.62 While some problem gamblers may be able to pay out of pocket to see one of the few private certified gambling counselors in the state, for gamblers who speak limited or no English, options may be few to none. To this day, there are only less than a handful of certified problem gambling counselors in California who speak an Asian language. Even Gamblers Anonymous – a voluntary, 12-step support group for gamblers, at the time of this article, only has four Asianlanguage meeting in the entire state of California, three of which were in Southern California.63 The CCPGP is one of the only programs set up primarily to meet the needs of Chinese problem gamblers. More services for Asian American gamblers and their families are direly needed. Along with need for services comes more need for research. While there are a few studies in existence that examines the phenomenon of gambling within the Asian American communities, there needs to be more. For example, data is currently lacking on various Asian sub-groups such as Japanese or Pacific Islanders. In addition, more research is needed on effective prevention and treatment strategies when working with various Asian groups. Thus far, most of the information on treatment for Asian gamblers has been anecdotal, from treatment groups around the world. More systematic and evidence-driven program evaluations are needed. The CCPGP has learned from experience that research finding is invariably tied to advocacy, as one must show empirical proof of a need, and a proven method of solving the problem in order to make the case for needed resources. The field of problem gambling prevention has been moving toward examining the gaming industry’s role in promoting responsibility gambling. There are several different ways for the gaming industry to partner with the local community to prevent problem gambling. One way is for local gaming establishments to contribute to prevention and treatment programs. Several jurisdictions in California currently have problem gambling intervention programs directly funded by local casinos (i.e. Placer County). Community task forces or coalitions formed to address gambling in the Asian community are encouraged to engage with local gaming establishments to have open dialogue about target marketing, community impacts, and impact mitigation. Service providers can best engage the gaming industry by recognizing that gambling itself is not inherently harmful, but rather, focus on how gambling can be marketed more safely for the minority of individuals who are vulnerable to gambling pathology. Strategies that gambling venues can utilize include the posting of multilingual signage with helpline information; offering multilingual materials with information on responsible gambling resources such as self-exclusion; training of multilingual employees to recognize and respond to problem gamblers; and balancing outreach efforts with responsible gambling information at shuttle bus stops and outreach events. i At the time of this article’s printing, California’s Office of Problem Gambling is in the process of making available for the first time in the state’s history, funding for problem gambling treatment services. CONCLUSION The Asian American community is composed of diverse peoples with very different experiences and cultural practices. However, there is some evidence that due to commonalities in cultural values, experiences of immigration and the target marketing by the gaming industry, Asian Americans are at a greater likelihood to participate in gambling activities. There is further evidence to show that Asian Americans may also be disproportionately impacted by problem gambling. While Asian Americans constitute one of the fastest growing minority groups in the United States, there is still a lack of data on issues such as American Americans’ health behaviors.64 More well-designed research is needed in order to quantify the impacts of problem gambling in the Asian American communities, a phenomenon that has been well-documented anecdotally by service providers and community leaders alike. The Asian American community may be at a disadvantage when it comes to problem gambling and the availability of mainstream resources, however, the Asian American community itself is also rich with resources that service providers can tap into in order to facilitate recovery. For example, family and community can be great resources in helping problem gamblers to stop or reduce harmful gambling behaviors. Strong networks of Asian service providers, faith and religious groups, and voluntary organizations exist in many communities throughout California. Such resources can make a great difference in the healing process. Finally, the issue of problem gambling is beginning to be recognized, and momentum is gaining. The Asian community along with social scientists and service providers must engage and dialogue with both governmental and gaming industry entities to arrive at solutions to problem gambling on multiple levels – including personal, industry, and in public policies. Only by working together can the goal of responsible gambling be effectively attained. 1 U.S. Bureau of the Census. (2000). We the People: Asians in the United States. Available: http://www.census.gov/prod/2004pubs/censr-17.pdf 2 National Asian Pacific Islander Health Forum website. Available: http://www.apiahf.org 3 GAMECS Project (1999). 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Adolescent gambling and problem gambling in Alberta. Edmonton, Alberta: Alberta Alcohol and Drug Abuse Commission. 54 NICOS Chinese Health Coalition. Final Year-End Helpline Data Report to Office of Problem Gambling, 06-07. NICOS Chinese Health Coalition: Author 55 AskCHIS. (2001). California Health Interview Survey. Available: http://www.chis.ucla.edu/ 56 Tran, R. (2008). Evaluation of the Chinese Community Problem Gambling Project (CCPGP). Unpublished Manuacript. NICOS Chinese Health Coalition, San Francisco. 57 Tran, R. (2008). Evaluation of the Chinese Community Problem Gambling Project (CCPGP). Unpublished Manuacript. NICOS Chinese Health Coalition, San Francisco. 58 NICOS Chinese Health Coalition. Final Year-End Helpline Data Report to Office of Problem Gambling, 06-07. NICOS Chinese Health Coalition: Author 59 Petry, N. M., Armentano, C., Kuoch, T., Norinth, T. & Smith, L. (2003). Gambling participation and problems among South East Asian refugees to the United States. 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Explanation & Answer

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Running head: GAMBLING

Gambling Problem in Asian American
Institution:
Date:

GAMBLING

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Gambling has become a problem among many individuals in the contemporary society.
Individuals are indulging in gambling in their daily lives to the extent of abandoning their daily
activities. Young people are the most affected lot when it comes to gambling. It has become a
global issue that needs to be addressed. This study, therefore, will explore the role of life
experience, target marketing, predisposition and culture as factors which lead to high rate of
gambling among the Asian Americans.
Culture
Asian Americans share many similarities despite their differences in culture. For
example, the importance of extended family network and the value of collectivism. Gambling
among the Asian Americans can be said to be prevalent due to their culture. The group of Asian
Americans exists within two main cultures. These cultures accept and incite gambling. As such,
ma...


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