***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract From an eligible population of 9,943 casino employees , 6,067 volunteered to participate in this study . Of this sample , 1,176 provided data at 3 observation points approximately 12 months apart . Using the  South Oaks Gambling Screen  ( SOGS ; H. R. Lesieur & S. B. Blume , 1987 ) and the CAGE ( J. A. Ewing , 1984 ) question naire , the authors prospect ively examined the prevalence and patterns of alcohol and gambling problems among those employees . Among the casino employees with gambling and drinking problems , a segment displayed the capacity to diminish those problems even when the difficulties had reached disordered levels . The authors also examined the comorbidity of gambling and drinking as well as the relationships among changes in SOGS scores and CAGE scores and changes in demographic and biological variables . The women were more likely to decrease their problem-drinking scores , but not their gambling scores , when compared with the men . In addition , 2 key variables ( i.e. , disabling depression and dissatisfaction with one 's personal life ) emerged as predictors of transitions to healthier levels of disordered gambling . The authors cautiously suggest , in light of the results taken together , that more fluctuation is associated with gambling and drinking problems than previously thought and that the conventional wisdom about disordered gambling as “ always progressive ” needs reconsideration Youth gambling was investigated in a prospect i ve sample of 532 Minnesota adolescents and young adults . Of particular interest was the possible impact among the study sample of a recent state lottery and of reaching the legal age for gambling on changes in the rate and type of gambling . Overall rates of gambling involvement and pathological gambling did not change across the 1.5 year interval . However , a preference for certain types of gambling activities ( e.g. ,  lottery , casino machines )  significantly increased , whereas more informal and unregulated games ( e.g. , betting on games of personal skill ) significantly decreased . Also , access to gambling activities by underage youths was high , suggesting the need for tighter controls of legalized games and greater awareness of this problem by the gaming industry and public health officials A r and om telephone survey was conducted with a representative sample of 2,274 U.S. residents aged 14–21 . The prevalence of problem gambling , as measured by the SOGS-RA , was 2.1 % . Sixty-eight percent ( 68 % ) of the respondents had gambled in the past year , and 11 % had gambled more often than twice per week . Males had much higher gambling involvement than females , and gambling involvement increased among older respondents . Blacks were less likely than average to have gambled in the past year , but if they gambled , they were more likely to do so frequently . Low SES respondents were less likely to have gambled in the past year , but if they gambled , they were more likely to be problem gamblers . Life transitions that are associated with assuming adult roles ( employment , living independently of parents , non-student status ) are also associated with greater gambling involvement . The rates of problem and pathological gambling were lower than those in an adult survey conducted earlier , when measured with the same question naire UNLABELLED Previous survey research with both clinical population s and r and om sample s of the general population has established that individuals may experience harmful impacts arising from both their gambling and their consumption of alcohol . Experimental study of the interaction of alcohol consumption on gambling is notable for its absence from the literature . AIM To experimentally study the interaction of alcohol consumption and gambling behaviour . DESIGN Participants were r and omly allocated into two groups -- placebo administered and alcohol administered , thus making an independent sample s experimental design . SETTING Laboratory . PARTICIPANTS Forty young , male , regular EGM players , who also regularly consumed alcohol . MEASUREMENTS The NEO Personality Inventory ; The Scale of Gambling Choices ( Revised ) ( SGC ) ; persistence at gambling while losing , as measured by the number of gambling trials played and amount wagered . FINDINGS Subjects either received a prior intake of three alcoholic drinks each containing approximately 10 g of pure alcohol ( beer or wine ) or an equal volume of an equivalent non-alcoholic beverage . The alcohol group persisted for twice as many gaming trials as the placebo group with significantly more players who had consumed alcohol losing all their original cash stake ( 50 % compared with 15 % of the placebo group ) . CONCLUSIONS The consumption of alcohol appeared to eliminate the strong associations found in placebo group between individual difference measures and persistence . The analogue game was accepted by participants as a valid form of gambling . The result showed that relatively small quantities of alcohol have a significant effect on the psychological processes that underpin self-control over gambling . This finding challenges the conceptual research paradigm of study ing co-morbidity or dual-addicted clinical population s as the most appropriate method of underst and ing how two addictive behaviours interact Using data from the large , 30-year prospect i ve Dunedin cohort study , we examined whether preexisting individual differences in childhood temperament predicted  adulthood disordered gambling  ( a diagnosis covering the full continuum of gambling-related problems ) . A 90-min observational assessment at age 3 was used to categorize children into five temperament groups , including one primarily characterized by behavioral and emotional undercontrol . The children with undercontrolled temperament at 3 years of age were more than twice as likely to evidence disordered gambling at ages 21 and 32 than were children who were well-adjusted at age 3 . These associations could not be explained by differences in childhood IQ or family socioeconomic status . Cleanly demonstrating the temporal relation between behavioral undercontrol and adult disordered gambling is an important step toward building more developmentally sensitive theories of disordered gambling and may put research ers in a better position to begin considering potential routes to disordered-gambling prevention through enhancing self-control and emotional regulation PURPOSE Communities That Care ( CTC ) is a prevention system design ed to reduce levels of adolescent delinquency and substance use through the selection and use of effective preventive interventions tailored to a community 's specific profile of risk and protection . This article describes early findings from the first group-r and omized trial of CTC . METHODS A panel of 4407 fifth- grade students was surveyed annually through seventh grade . Analyses were conducted to assess the effects of CTC on reducing levels of targeted risk factors and reducing initiation of delinquent behavior and substance use in seventh grade , 1.67 years after implementing preventive interventions selected through the CTC process . RESULTS Mean levels of targeted risks for students in seventh grade were significantly lower in CTC communities compared with controls . Significantly fewer students in CTC communities than in control communities initiated delinquent behavior between grade s 5 and 7 . No significant intervention effect on substance use initiation by spring of seventh grade was observed . CONCLUSIONS CTC 's theory of change hypothesizes that it takes from 2 to 5 years to observe community-level effects on risk factors and 5 or more years to observe effects on adolescent delinquency or substance use . The early findings indicating hypothesized effects of CTC on targeted risk factors and initiation of delinquent behavior are promising AIMS Problem gambling can create major financial , emotional and sometimes criminal problems for an individual . This study prospect ively investigated the association between impulsive behavior at age 7 and the development of life-time problem gambling by adulthood . We also examined the specificity of any observed association between impulsive behaviors and problem gambling by conducting parallel analyses examining the link between respondents ' shy/depressed behavior in childhood and later problem gambling . DESIGN , SETTING AND PARTICIPANTS Cohort study of 958 offspring of mothers enrolled in the Collaborative Perinatal Project who participated in an adult follow-up study at a mean age of 39.2 years . MEASUREMENTS Multivariable logistic regression models were fitted to determine associations between psychologist-rated impulsive and shy/depressed behaviors at age 7 and life-time self-reported gambling  as measured by the South Oaks Gambling Screen administered during the adult follow-up study . FINDINGS Children who exhibited impulsive behaviors at age 7 , compared to their non-impulsive counterparts , were 3.09 ( 95 % confidence interval : 1.40 - 6.82 ) times as likely to report problem gambling years later . In contrast , we did not find a significant association between childhood shy/depressed behavior and problem gambling by adulthood in adjusted analyses . CONCLUSIONS Impulsive behaviors at age 7 are a specific and significant risk factor for later problem gambling AIMS This study investigated whether impulsivity measured in 12 - 14-year-olds could predict problem gambling in late adolescence , above and beyond other personality factors such as aggressiveness and anxiety . DESIGN A prospect ive-longitudinal design was used , thus overcoming limitations of past studies which used concurrent or retrospective design s. PARTICIPANTS AND MEASUREMENTS The sample included 154 boys living in economically deprived neighborhoods .  Impulsivity measures comprised  self-reports , teacher ratings and laboratory tasks , and were administered during early adolescence . Gambling behavior was assessed at age 17 using a self-report measure .  Early gambling behavior and socio-demographic information were also collected for control purpose s. FINDINGS Results revealed that a self-report measure of impulsiveness and a card-sorting task  significantly predicted problem gambling , even after controlling for socio-demographic variables , early gambling behavior and other personality variables such as aggressiveness and anxiety . Moreover , the predictive link held across all levels of aggressiveness and anxiety . Both impulsivity measures seemed to tap an inability to foresee negative consequences and an inability to stop responding despite unfavorable contingencies . CONCLUSION These findings suggest that disinhibited individuals with response modulation deficits are at risk for problem gambling , thus supporting the DSM-IV classification of pathological gambling as an impulse control deficit OBJECTIVE To test whether the Communities That Care ( CTC ) prevention system reduces  adolescent alcohol , tobacco , and other drug use and delinquent behavior communitywide . DESIGN The Community Youth Development Study is the first r and omized trial of CTC . SETTING In 2003 , 24 small towns in 7 states , matched within state , were r and omly assigned to control or CTC conditions . PARTICIPANTS A panel of 4407 fifth- grade students was surveyed annually through eighth grade . Intervention A coalition of community stakeholders received training and technical assistance to install the CTC prevention system . They used epidemiological data to identify elevated risk factors and depressed protective factors in the community , and chose and implemented tested programs to address their community 's specific profile from a menu of effective programs for families , schools , and youths aged 10 to 14 years . MAIN OUTCOME MEASURES Incidence and prevalence of alcohol , tobacco , and other drug use and delinquent behavior by spring of grade 8 . RESULTS The incidences of alcohol , cigarette and smokeless tobacco initiation , and delinquent behavior were significantly lower in CTC than in control communities for students in grade s 5 through 8 . In grade 8 , the prevalences of alcohol and smokeless tobacco use in the last 30 days , binge drinking in the last 2 weeks , and the number of different delinquent behaviors committed in the last year were significantly lower for students in CTC communities . CONCLUSION Using the CTC system to reduce health-risking behaviors in adolescents can significantly reduce these behaviors communitywide AIM Building on the recent emerging literature on the impulsivity trajectory-gambling association , this study investigated the association between developmental trajectories of teacher-rated impulsivity in early adolescence ( ages 11 - 15 years ) and subsequent gambling and gambling problems ( i.e. at-risk and problem gambling ) by age 19 . DESIGN Prospect i ve cohort design . SETTING Urban communities in Baltimore , Maryl and . PARTICIPANTS The sample consists of 310 predominately minority ( 87 % ) and low socio-economic status ( SES ) ( 70 % ) males followed from first grade to late adolescence . MEASUREMENTS  Impulsivity  was measured using teacher ratings of classroom behavior .  Self-reported gambling behavior was assessed using the  South Oaks Gambling Screen-Revised for Adolescents ( SOGS-RA ) . FINDINGS Results from a conventional growth model suggest that the intercept of the impulsivity development ( as measured by the repeated assessment s of impulsivity across the entire developmental period ) was associated significantly with gambling . Results from a general growth mixture model evidence d two distinct trajectories : a high impulsivity trajectory ( 41 % of the sample ) and a low impulsivity trajectory ( 59 % of the sample ) . Despite its non-significant association with any gambling , heterogeneity in impulsivity development was associated significantly with gambling problems . Specifically , being in the high impulsivity trajectory doubled the odds of meeting criteria for at-risk or problem gambling [ odds ratio ( OR ) = 2.09 , 95 % confidence interval ( CI ) : 1.02 , 4.27 ) ] and tripled the odds of meeting criteria for problem gambling ( OR = 2.84 , 95 % CI : 1.02 , 7.91 ) . CONCLUSIONS Development in impulsivity is associated strongly with problem/at-risk gambling in adolescence among urban male youth . Findings highlight the importance of distinguishing gambling problems from any gambling when evaluating programs aim ed at reducing youth gambling problems through reducing impulsivity This paper reports the results of a preliminary investigation into whether the drinking of alcohol contributes to  impaired control of gambling behaviour .  The sampling method consisted of a two-phase survey design 
    Output:
    
There is insufficient investigation of protective factors to adequately guide prevention initiatives .