Pursuing a passion to improve public health
Are picture or text warnings on cigarette packages more likely to influence people’s thinking, and choices, about their smoking? The answer to this question can influence government policy and, ultimately, people’s health across large populations.
As an undergraduate, Dr. Tara Elton-Marshall, Scientist in CAMH’s Institute for Mental Health Policy Research (IMHPR), had the unique opportunity to study this intersection of public health research and policy at an international level, as part of the first global study on tobacco control policies. Led by Dr. Geoffrey Fong at the University of Waterloo, the International Tobacco Control Policy Evaluation Project continues to be a world-leading survey.
“As part of this project, I learned first-hand how to conduct policy evaluation work, and how to translate that research to have real-world impact,” she says.
Dr. Tara Elton-Marshall
This pivotal early experience has shaped Dr. Elton-Marshall’s career, and led to her current research that is informing discussion on public policy in places as diverse as California and China, as well as in Canada. Today, her overarching goal is to reduce addiction and substance use problems more broadly, through research that provides the evidence base to improve both policies and programs.
She did, in fact, lead a study comparing different types of health warnings on cigarette packs in Malaysia and China. Picture warnings instituted in Malaysia led to significant changes in smokers’ awareness and attitudes, while the effect of text warnings in China was much weaker. The findings were published in 2015 in BMJ’s journal Tobacco Control.
Online gambling and youth
A current focus for Dr. Elton-Marshall is new forms of online gambling, which range from the official Ontario Lottery and Gaming (OLG) gambling site to unregulated gambling websites.
Her 2016 study on youth gambling was cited by US Senator Dianne Feinstein in a letter to representatives in the California State legislature, in an appeal to stop a bill to introduce online poker in California. This study showed that nearly 10 per cent of teens, a figure much higher than expected, reported that they had gambled online in the past three months. The survey included more than 10,000 students aged 13 to 19 in three Canadian provinces.
The emerging online gambling market remains a relatively unexplored area.
“The gambling market has shifted, and we don’t know what impact this has on the population,” she says, particularly following the legalization of online gambling in Ontario, which took place after Dr. Elton-Marshall’s youth gambling study. The province’s PlayOLG website, which is strictly regulated to ensure participants are 18 years or older, launched in January 2015.
To understand this changing environment, Dr. Elton-Marshall and Dr. Scott Leatherdale of the University of Waterloo are completing the first study to evaluate the long-term effects of the legalization of online gambling. The study is supported by the Gambling Research Exchange Ontario (formerly the Ontario Problem Gambling Research Centre).
With funding from Ontario’s Ministry of Health and Long-Term Care, she is also leading a project with CAMH’s Dr. Nigel Turner, Scientist with IMHPR, to inform future prevention strategies related to online gambling, including strategies targeting youth.
“We know that young people are still engaging in online gambling,” says Dr. Elton-Marshall, who is also investigating how adolescents are gambling online, and identifying problematic types of online gambling. The results will better inform the provincial school curriculum and teaching materials on gambling.
“There needs to be a more vigilant look at how online gambling is having an impact on young people,” says Dr. Elton-Marshall. “The better we understand how youth are engaging in online gambling, and how it is affecting them, the better we can create teaching materials to provide an evidence-informed prevention strategy,” she says.
At a broader level, Dr. Elton-Marshall hopes to see a change in how gambling addiction is viewed. For one, “people involved in gambling are typically also involved in other substance use,” she says, explaining that it’s important to consider the multiple forms of addiction that people might be experiencing, instead of perceiving gambling and substance use as separate issues.
As well, traditionally, gambling has not been seen as a public health issue in the same way as illicit drugs or alcohol. “These perceptions can have impacts on those affected, as well as the policies and treatments that are put in place,” says Dr. Elton-Marshall. “What is not recognized are the devastating impacts that problem gambling can have on individuals and their families. It’s time that these issues are viewed as public health issues.”