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Brittany.email@example.com Responsible Gambling Background: Few empirical studies have specifically evaluated the causal connection Research Group, Faculty between problem gambling and domestic or family violence within East and South- of Science, School East Asian populations. Evidence from qualitative and quantitative studies suggests of Psychology, Sydney University, 110 Darlington Rd, that at the very least, an association exists. Lifetime prevalence of intimate partner Darlington 2008, Australia violence has been drawn from various Asian communities, and ranges from 15.4 to 61.1%, which is generally higher than in western countries such as US, UK and Aus- tralia (17–26%). Problem gambling rates are similarly higher in certain Asian countries (3.8–6%), when compared to the international average (2.3%). The aim of this review was to evaluate the available literature on problem gambling and family violence in East and South-East Asian populations, and to highlight any consistencies between the two phenomena. The authors conducted an online literature search using the terms: “Asia”, “gambling”, “domestic violence”, “family violence”, and “abuse”; and accessed physi- cal libraries for literature not available online. Discussion: As evidenced by qualitative and quantitative studies, it is reasonable to suggest that a link does indeed exist between family violence and problem gambling in certain Asian communities. The authors argue that there may be specific cultural factors that underpin the acceptance, maintenance, and under reporting of both prob- lem gambling and family violence in some Asian communities. Such cultural factors include: patriarchal family systems, low help seeking and under reporting, the impact of collectivist culture on gambling normalisation, and immigration and acculturation stresses. Summary: This paper concludes East and South-East Asian communities display high rates of problem gambling and family violence. At the very least, there is some evidence to suggest a relationship between these two issues; however, immigration stresses and cultural beliefs may mediate this effect amongst migrant samples. The current state of research in this area is incomplete and requires rigorous methodologi- cal inquiry. Given strong preliminary evidence of a problem gambling-family violence link, it is recommended that future research endeavours focus on accurately assessing a causal relationship between problem gambling and family violence. Further research should be longitudinal, carried out in Asian countries, and use local resident popula- tions to consider whether or not underlying cultural traditions and beliefs engender or contribute to problem gambling and family violence. These findings have implications for the field of problem gambling and family violence by informing prevention and treatment strategies and services within the public health and welfare sectors. Keywords: Problem gambling, Gambling, Domestic violence, Family violence, Asia, Cultural © 2015 Keen et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 2 of 16 Background The scope of this review High rates of problem gambling and family violence exist in many Asian communities (Agbayani-Siewert and Flanagan 2000; Alegría et al. 2009; Bennett et al. 2011; Blaszc- zynski et al. 1998; Chan 2005; Lee 2007; Liao 2008; Nguyen and Yoshioka 2006; Thomas and Yamine 2000; Williams et al. 2012; Xu et al. 2005; Yick 2000; Yoshihama 1999). Inter- national empirical and qualitative research has suggested that a link may exist between the two behaviours (Afifi et al. 2010; Bellringer et al. 2008; Bland et al. 1993; Breen et al. 2013; Fehringer and Hindin 2014; Liao 2008; Lorenz and Shuttlesworth 1983). There are very few studies that specifically evaluate the association between problem gambling and domestic violence within Asian populations. Of those that do, there lacks robust quantitative data to infer that a causal relationship exists. However, evidence from quali- tative studies suggests that this may indeed be the case, and that at the very least, further research is warranted in the area. The following scoping review provides an overview of the prevalence of problem gambling and domestic violence in Asian communities. It critically analyses the current literature and examines evidence that may support a link between the two issues. Culturally-specific norms and belief systems are examined as means for the propagation of domestic violence and problem gambling, paying particu- lar attention to gender roles, ideals of masculinity, and settlement issues in migrants. The review highlights the importance of immigration and acculturation stresses on the development and maintenance of problem gambling, relationship breakdown among gamblers, the under reporting of violence, and low help seeking among problem gam- blers. The problematic issue of causality within the current literature is clearly indicated. In completing this review we acknowledge, (1) the extensive cultural diversity of the Asian continent, (2) that as a whole, Asian communities do not tolerate domestic vio- lence, and (3) the limitations associated with a review conducted by Western, English- speaking authors. Search method The following review is intended to provide a scope of the available literature regard - ing domestic violence and problem gambling in Asian communities, and is not intended to be a systematic review of all published work on the issue. The authors conducted a web-based search of the literature using varying combinations of the keywords: “Asia”, “gambling”, “problem”, “domestic violence”, “family violence” and “abuse”. Keywords were searched through the Sydney University library web page, powered by Serial Solu- tions Summon . The University of Sydney’s Fisher Library was also accessed in order to obtain physical copies of articles and books not accessible online. Acknowledging the diversity of the Asian continent The Asian continent consists of 55 sovereign states and territories, each with their own unique set of cultural norms, traditions, and values. It is vital to stress that the authors’ intentions were not to generalise the findings of this review to all Asian countries, prov - inces, and cultural groups. Rather, the intention was to investigate and highlight the trends (if any) that appear within the literature with regards to problem gambling and family violence in Asian communities. In doing so, the authors have narrowed the scope Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 3 of 16 of this review to focus primarily on East and South-East Asian communities, with some mention of Asian-Pacific countries close to Australia. Discussion A working definition of family and domestic violence Defining domestic violence (DV) is difficult. It is variably defined as violence between intimate couples only, described as interpersonal violence (IPV); (Lee 2007; Liao 2008; Raj and Silverman 2002) or abuse toward children or other family members (family violence) (Dowling et al. 2014; Raylu and Oei 2009; Suomi et al. 2013; Tse 2007). Fur- thermore, although most definitions of DV comprise non-physical acts of aggression (Muelleman et al. 2002; Suomi et al. 2013), there are many studies that operationalise it in purely physical terms (Afifi et al. 2010; Liao 2008). There are also conflicting views as to whether DV by nature is mono-directional (i.e., male > female or female > male) (Taft et al. 2001) or reciprocal (i.e., male >< female) (Suomi et al. 2013). The current review adopts the following Australian Bureau of Statistics (ABS) (2013) comprehensive definition of family and domestic violence that takes into account various expressions of violence. “Family and domestic violence covers a wide range of abusive behaviours commit- ted in the context of intimate relationships such as those involving family members, children, partners, ex-partners, or caregivers. It can include many types of behav- iour or threats, including: physical violence, sexual abuse, emotional abuse, verbal abuse and intimidation, economic and social deprivation, damage of personal prop- erty and abuse of power.” (ABS 2013) For the purpose of this review, the term ‘family violence’ (FV) will be used, as it more accurately represents disruption to the entire family unit. Although this definition is wide in scope, it is relevant to note that the majority of studies reviewed have adopted a more narrow focus by examining physical violence between intimate partners. Accord- ingly, the current review is primarily limited to research on intimate partner violence (IPV). Prevalence of family violence in various Asian communities The prevalence of family violence in various Asian communities varies significantly between different countries, regions, samples (i.e., Asian immigrants living in foreign countries vs. country of origin), and cultural sub-groupings. Lifetime prevalence of IPV for Asian sub-populations has been estimated for the following international and Asian jurisdictions. IPV rates in country of origin: China (15.7–43%) (Chan 2005; Xu et al. 2005), Indonesia (43%) (Bennett et al. 2011), Japan (15.4%) (World Health Organisation [WHO] 2005), Philippines (17.9%) (National Statistics Office 2008), Thailand (41.1– 47.4%) (WHO 2005), Vietnam (34.4%) (United Nations 2010); and IPV among Asian communities living abroad: Chinese (18–45.2%) (Liao 2008; Yick 2000), Filipino (31.4%) (Agbayani-Siewert and Flanagan 2000), Japanese (61.1%) (Yoshihama 1999), Korean (29.4%) (Lee 2007), and Vietnamese (31%) (Nguyen and Yoshioka 2006) immigrants liv- ing in the US. Generally speaking, these rates are higher than comparative national rates observed in western countries such as Australia (17%), US (25%) and UK (26%) (ABS Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 4 of 16 2012; Mirrlees-Black 1999; Tjaden and Thoennes 2000). It is relevant to note that the reported estimate figures pertaining to Asian immigrants tend to be slightly higher than those living in their country of origin; consequently, it is possible that the elevated rates of violence in “Asian communities” abroad may be at least partly attributable to trans- migrational stresses. Nevertheless, it seems plausible that cultural differences may also play a role, given the similarly high rates of violence in local Asian jurisdictions (Bennett et al. 2011; Chan 2005; Xu et al. 2005). Notably, the aforementioned prevalence statistics pertain to IPV perpetrated against women, given their significantly higher rates of vic - timisation compared to males. The exception is studies by Liao (2008) and Yick (2000), whose data reflect total IPV victimisation across genders, and Nguyen and Yoshioka (2006) who measured male-perpetrated IPV. Of concern, it is possible that reported violence rates are much lower than in reality, due to high levels of under reporting by victims, which is also evidenced in Asian com- munities (Aujla 2013; Ross 2014; Shankar et al. 2013). For example, survey data from the Project AWARE Study conducted in Washington DC (McDonnell and Abdulla 2001) revealed that 44.8% of female respondents living in the US from various Asian back- grounds did “nothing” to protect themselves, and 32.1% “kept quiet” about the abuse that they, or women they knew, experienced. The same study also found that only 15.7% of victims or their friends reported calling the police, while 9% sought help from an agency. These figures highlight the presence of potential cultural barriers to reporting and help seeking in migrant Asian communities. The potential role of cultural values and traditions in propagating domestic violence is explored in more detail later in this review. Gambling and problem gambling in Asia Gambling is a popular and acceptable social activity among many Asian communities around the world (Hobson 1995). Indeed, ‘social gambling’ is an integral part of the entertainment that occurs during many Asian countries’ festive periods (e.g., Chinese New Year) and special events such as birthdays and weddings (Oei and Raylu 2010). Interestingly, overall rates of gambling participation in Asian communities appear to be somewhat lower than those among Western cultures (40–65% vs. 60–78%, respectively) (Blaszczynski et al. 1998; Fong Ka-Chio and Ozorio 2003; Home Affairs Bureau [HAB] 2012; Hing et al. 2014; Kessler et al. 2008; National Council on Problem Gambling [NCPG] 2012; Productivity Commission 2010). Though, such findings may be attributa - ble to Asian respondents not regarding certain activities as gambling if played for enter- tainment/festive reasons (e.g., mah-jong, lotteries) (Blaszczynski et al. 1998). Similar to other cultures, the majority of Asian gamblers are able to gamble responsibly, in such a way that does not cause them or others harm; however, a certain number gamble beyond their affordable limits. In a recent meta-review, Williams et al. (2012) reported that the highest rates of prob- lem gambling in the world were found in Asian countries, with the exception of South Korea. Standardised averages across a decade (1991–2011) show a problem gambling prevalence of 5.6% in Hong Kong, 6% in Macau, and 3.8% in Singapore; compared to the international average of 2.3% (Williams et al. 2012). Furthermore, Asian groups living in Western countries have demonstrated relatively higher rates of problem gambling than Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 5 of 16 the host society. Studies with mostly Chinese-speaking, Asian immigrant samples, have reported problem gambling rates 1.5–5 times higher than those of the local population (Alegría et al. 2009; Blaszczynski et al. 1998; Thomas and Yamine 2000). Additionally, it has been shown that Asian people are often reluctant to report gambling problems, for fear of losing respect from their family, friends, and community members (Loo et al. 2008). Gambling forms Among the most common forms of gambling in East and South-East Asian provinces are Mark Six lottery (Hong Kong), “flower cards” (Korea), social forms of gambling such as playing mah-jong (Eastern and South Eastern Asia) or poker with friends or relatives, followed by horse racing and casino games (Home Affairs Bureau [HAB] 2012; Park et al. 2010). Evidently, games of some skill appear to be more popular among Asian gamblers than are games purely based on chance (e.g. electronic gaming machines and lottery) (Home Affairs Bureau [HAB] 2012; Park et al. 2010). Preferences for the mode of gambling among Asian groups may also be influenced by cultural beliefs and values that are maintained through inter-generational effects. Dice and card games, for instance, have been a part of oriental culture for centuries; thus potentially explaining the attraction held by Asian gamblers toward casino tables (Raylu and Oei 2004). Accordingly, one study conducted in Sydney, Australia, found that casino gambling is most popular among Chinese, Vietnamese, and Korean participants com- pared to other ethnic groups (GAMECS project 1999). Another revealed that more than 50% of gambling expenditure in the Sydney Chinese community was spent at casinos (McMillen et al. 2004). Exploring the link between family violence and problem gambling Numerous empirical studies have demonstrated correlational links between FV and problem gambling (Afifi et al. 2010; Bland et al. 1993; Liao 2008; Lorenz and Shut - tlesworth 1983). Furthermore, multiple lines of evidence suggest that this relationship holds in several non-western cultural groups, including Indigenous Australians (Breen et al. 2013), Phillipinos (Fehringer and Hindin 2014), Pacific Islanders (Bellringer et al. 2008), and Chinese–Americans (Liao 2008). Generally speaking, the reported rates of FV perpetration among problem gamblers range from 16% (Afifi et al. 2010) to 56% (Korman et al. 2008), whereas estimates of FV victimisation among problem gamblers fall between 22% (Afifi et al. 2010) and 68.6% (Echeburua et al. 2011). The same studies found that pathological gamblers were 6–28 times more likely to commit acts of FV than non-gamblers (Afifi et al. 2010; Liao 2008). Unfortunately, very few of these studies distinguish between FV of varying natures or severity. The exceptions being Afifi et al. (2010) who differentiate minor assaults (e.g., push, grab, etc.) from major ones (choked, punched, etc.); and Bellringer et al. (2008) who distinguished between verbal and physical acts of violence. Typically, there appears to be a paucity of research identifying the prevalence of FV that is at a level of severity sufficient to warrant external intervention. Such cases represent a quantifiable cost to society and therefore are of particular interest to policy makers. Further, the findings that problem gambling is associated with both perpetration and victimization in IPV, Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 6 of 16 suggests a complex causal relationship. Theoretically, two logical paths of causality may be identified. Firstly, due to large losses suffered, problem gamblers may be the perpetra - tor or victim of FV, in that they may perpetrate aggressive acts in order to vent frustra- tion and stresses associated with gambling losses, or that they are violently targeted by family members disgruntled by their gambling behaviour. Secondly, in the reverse direc- tion, gambling may function as a refuge or distraction for problem gamblers from an existing turbulent family environment (Afifi et al. 2010; Echeburua et al. 2011; Fehringer and Hindin 2014). Longitudinal studies may elucidate the circumstances under which problem gambling is likely to lead to family violence, and conversely, the mechanisms by which exposure to family violence increases the risk for problem gambling. Family violence and problem gambling in the Asian context Few empirical studies have directly examined the link between family violence and prob- lem gambling in Asian communities. However, given the relatively high levels of both family violence and problem gambling found in Asian populations independently, there is good reason to believe that a robust relationship exists between the two, similar to the one evidenced among various other cultural groupings (Bellringer et al. 2008; Breen et al. 2013; Fehringer and Hindin 2014; Liao 2008). Furthermore, it could reasonably be argued that specific cultural norms such as rigid, hierarchical family structures found in many Asian cultures may also make the family violence-problem gambling link more pronounced. To date, a dearth of empirical studies have explored such a link, though a number of studies highlight the link between problem gambling and relationship break- down in the Asian context. Country of origin Two studies from Korea have found higher rates of relationship breakdowns, separation and divorce among populations of problem and pathological gamblers. For instance, Park et al. (2010) reported on a sample of 5,333 South Korean residents, 43 of who were pathological gamblers. The authors found that pathological gamblers were around three times more likely to be separated/divorced or widowed, and were 2.8 times more likely to suffer from a psychiatric disorder. Similarly, Chun et al. (2011) reported that among a sample of 12 South Korean problem gamblers, all had experienced disrupted relation- ships with family and friends, and 75% had experienced divorces or separations. Con- sistent with this finding, a small qualitative analysis from Macau involving four problem gamblers reported relationship problems and breakdowns as one of the adverse affects associated with gambling (Fong Ka-Chio and Ozorio 2003). At least one study from Hong Kong highlights the probable bi-directional nature of the link between family tur- moil and gambling, with Home Affairs Bureau (HAB) (2012) reporting family arguments as a commonly cited trigger for gambling, among a sample of 10 problem and patho- logical gamblers. While it is unclear whether the high rates of relationship breakdown among gamblers is due to FV, this data suggests that gambling can detrimentally affect one’s interpersonal relationships, and increase turbulence within intimate relationships. For some, violence may indeed be both a reaction to and part of gambling-related rela- tionship problems, albeit an extreme one. A number of studies provide convergent evi- dence in support of the gambling-family violence link in the Asian context. For instance, Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 7 of 16 Xu et al. (2005) found that among a sample of 600 Chinese women attending a gynae- cological clinic in Fuzhou, China, frequent quarrelling was the strongest predictor of IPV in the last 12 months, and critically, that women were at a greater risk of IPV if they refused or were refused money by their partner. This strongly suggested that finan - cial arguments were a significant contributing factor to those IPV cases. These findings align with those of Gallin (1997) who found that local Taiwanese women reported being beaten for refusing to hand over money for the purposes of gambling and alcohol. The abuse was often seen as a justified means of preserving hierarchical family structures. These studies suggest that financial arguments attributable to gambling may precipitate family violence in at least a proportion of cases, and furthermore, highlight the roles that patriarchal family structures may play in the gambling-violence link. Migrant communities Three studies have specifically examined the relationship between gambling and family violence among Asian communities living in western countries. Petry et al. (2003) col- lected data from 96 South-East Asian refugees living in the US and found that 59% of the sample met criteria for problem gambling, and that 39% of those were divorced or sepa- rated, compared to only 11% of the non-problem gamblers in the sample. Similarly, Liao (2008) reported on a sample of 31 Chinese community members in San Francisco, and found that partners of problem gamblers were 27.5 times more likely to experience any intimate partner violence than those whose partners were not problem gamblers. Tse (2007) conducted a qualitative analysis of family violence amongst 56 Chinese, South Asian and South-East Asian immigrants living in New Zealand, and found that gambling was amongst the reported catalysts for violence. Other stressors associated with migra- tion such as employment concerns and financial hardship were also reported. The heightened levels of family violence attributable to gambling, especially that reported by Liao (2008), suggests that the patriarchal family structures prevalent in cer- tain Asian cultures may indeed exacerbate the gambling-family violence link. Although, as was mentioned above, because the majority of the available data is subjective, and correlational, it should be noted that the strengthened association between gambling and family violence among these migrant communities might be attributable to other stressors associated with the migrant experience. Exploring cultural factors The above analysis strongly suggests the possibility that certain cultural values that are present to varying degrees in some East and South-East Asian cultures, may have a part to play in exacerbating the link between problem gambling and family violence. The fol - lowing section further explores: (1) the manifestation of patriarchal values and how they may relate to family violence, and (2) cultural factors which may confer increased risk of problem gambling. Patriarchal values and family violence in the Asian context It is argued by some authors that cultural factors play a major role in the acceptance, main- tenance, and underreporting of family violence in certain Asian communities that share particular cultural norms and/or beliefs (Bennett et al. 2011; Tse 2007; Xu et al. 2005; Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 8 of 16 Yoshihama 2000; Yoshioka and Dang 2000). For instance, pervasive patriarchal belief sys- tems that engender male dominance, authority, and economic control may promote sub- mission in women, and underlie the controlling nature of family violence (Dempsey and Day 2011; Hunnicutt 2009). The pervasiveness of such patriarchal belief systems may be indirectly evidenced by markedly skewed male/female gender ratios at birth in countries such as China (118/100; 2009), South Korea (106.7/100; 2010), and Vietnam (111.2/100; 2010) (Guilmoto 2012). These gender statistics at least in part, reflect practices of prenatal sex selection, abortion of female fetuses, and neglect and abandonment of female chil- dren (Hesketh and Xing 2006; Lee 2015; Niaz and Hassan 2006). Family violence and patriarchal values in Asian migrant communities For Asian migrants, settlement issues including financial strain caused by unemploy - ment, isolation, and lack of acculturation may play a role in the development of both FV and PG (Lee 2007; Tran 1999; Tse 2007). Though, the available research suggests that at the very least, cultural factors appear to also play a role in the problem gambling-family violence link. A number of qualitative studies have evidenced the enduring influence of patriarchal values in Asian migrants’ experience of family violence. For instance, Yoshi- hama (2000) found that 71% of Japanese women living in an abusive relationship in Los Angeles believed that the experience of their partners’ violence was influenced by their Japanese culture. A number of culturally specific beliefs associated with the under-reporting of family violence, were identified in qualitative studies evaluating attitudes of family violence vic - tims in various Asian communities. (a) Conflict avoidance facilitated by the suppression of emotion and self-blame. “… I wouldn’t confront the situation. I would try to solve the problem in my head. I basically thought the problem was me…” (3rd generation Japanese in US; Yoshihama 2000, p. 215) (b) Endurance to tolerate abuse in a marriage, uncomplaining and with grace. “Your body belongs to him until he dies… he can do anything he wants to do— there is no concept of marital rape.” (Asian woman in New Zealand; Tse 2007, p. 176) (c) Acceptance of male domination women should be submissive, subservient, and sub- ordinate. “The husband is like God” … “a man should always control his wife… he should never accept different opinions from his wife”… “Women are brought up to service men, to be obedient, to be submissive.” (Asian immigrant women in New Zea- land; Tse 2007, p. 177) (d) Collective family welfare the family unit should remain intact regardless of circum- stance. “…When you get married, you don’t leave. You don’t divorce, you don’t do any- thing. You just put up with it… ” (3rd generation Japanese in US; Yoshihama 2000, p. 217) Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 9 of 16 (e) Aversion to help seeking problems are kept internal so to avoid shame. “Family violence is a private matter… Women can’t make complaints against their husband… We need to hide things, thinking what will happen if anybody knows.” (Asian immigrant women in New Zealand; Tse 2007, p. 183) There is evidence that greater exposure to local norms and relatedly, acculturation, may allow female Asian migrants to re-evaluate their culture-specific roles and behav - iours imposed during their upbringing. For instance, Yoshihama (2002) conducted a study that compared Japanese–American women who were born in the US with those who were born in Japan and migrated to the US. The study found that there were sig - nificantly higher rates of help seeking (82.8 vs. 43.3%) and confrontation to abusive part - ners (86 vs. 68%) by those born in the US compared to those born in Japan (Yoshihama 2002). Such behaviours are indicative of active responses to family violence, which are inconsistent with conservative values promoting passivity. Consequently it appears that perhaps US born Japanese women were less constrained by the cultural expectations and traditions of their ethnic background than those born in Japan. Similarly, Lee (2007) col- lected survey data from 136 Korean women and conducted multiple regression analyses to find a positive association between low levels of acculturation among Korean–Ameri - cans, and male-perpetrated psychological assault. Further, Korean immigrant women who were part of more traditional families, experienced a higher level of violence when compared to those in less traditional families (Lee 2007). Also, Yick and Agbayani-Siew- iert (1997) found that the longer Chinese residents lived in the USA, the more likely they were to disagree that violence was justified when a spouse does not obey his/her partner. However, this study employed a small telephone survey of only 31 respondents, consequently the reliability of their conclusions is questionable. Additionally, it should be noted that although acculturation significantly predicted physical violence in Yick’s (2000) study, it was not significantly associated with physical violence or injury in Lee’s (2007) study. This indicates that perhaps violence results as a consequence of stressors of the acculturation and migration process, rather than from low levels of acculturation itself. As suggested above, difficulty adjusting to new gender roles may help to explain some of the violence experienced by Asian immigrants living in Western countries. Tran (1999) interviewed Vietnamese service workers and detailed circumstances in which Vietnamese men living in Australia are faced with feelings of disempowerment follow- ing migration. Upon migration to Australia, Vietnamese women often welcome newly acquired freedom and equal rights to men. However, some husbands find this demoral - ising or threatening, interpreting it to ultimately lead to their obsolescence in the fam- ily. This phenomenon has been termed the ‘backlash’ hypothesis, where the fall from authority to equality can be seen as a loss of control, and therefore, the pursuit to regain control can result in family violence (Tran 1999; Whaley 2001; Yllo 1983). Tse (2007) depicts a similar narrative, using qualitative data from 56 Asian women who migrated to New Zealand. Focus groups revealed that immigrant wives aspired to adopt the host country’s culture and attain paid work. However, husbands perceived this as a loss of control over their wives, and in many cases husbands became “more Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 10 of 16 oppressive” (pg. 178) than they were in their home country. This was described as cling - ing to traditional values, resulting from feelings of uncertainty in a new environment. Consequently, husbands used violence as a means to reinforce social customs and prac- tices when they felt they were losing control over their wives. Moreover, husbands were frequently reported to have threatened to send their wives back to their home country if they did not comply with their demands (Tse 2007). Such intimidation represents a unique threat to immigrants experiencing family violence. It should also be noted that accepted definitions of IPV among Asian communities appear to depend greatly on contextual factors. For example, in some Asian communi- ties, declarations of rape are seen to be less legitimate or sometimes even illegitimate if they occur within the bounds of a marriage or intimate relationship (Tse 2007; National Asian Women’s Health Organization 2002 as cited in Yoshihama and Dabby 2009). Sim- ilarly, around one-third of the 507 Asian–American participants surveyed agreed that husband-perpetrated violence was justified if a wife was unfaithful (36.2%), or nagged her husband too much (30.8%) (Yoshioka et al. 2001). Furthermore, while most of the 440 Vietnamese–American phone survey respondents in Bui’s (2006) study believed IPV to be a problem in the Vietnamese community, only two in five considered it to be “seri - ous” or “very serious”. Interestingly, under half of the sample (46.8%) said they knew that perpetrators of FV could be prosecuted in a criminal court. Indicating a clear lack of knowledge and education in the area of family violence. In short, while it appears that persistent traditional values and customs play a role in the perceptions of violence in certain Asian migrant communities, it should be noted that rigorous, empirical research is still scarce in this area, with many of the studies reported relying on subjective accounts of a small number of violence victims or service workers. Notwithstanding, larger-scale quantitative telephone surveys appear to support claims made by smaller qualitative studies. Cultural factors and problem gambling in Asian communities The variance and rates of gambling and problem gambling among Asian populations, both local and migrant, owes considerable explanation to the influence of cultural fac - tors (Oei and Raylu 2007). Reviewing this topic, Raylu and Oei (2004) argue that culture provides the framework through which individuals attribute meaning to gambling and shape how risk is managed, such valuations being passed down historically from one generation to the next. Accordingly, the authors identified three core interrelated vari - ables that contribute significantly to the development and maintenance of problem gam - bling in both local and migrant Asian communities, including: 1. Cultural values and beliefs Perhaps the most observable way in which cultural beliefs and values manifest is within the family structure. Patriarchal family systems, such as those valued in most Asian cultures, are more likely to have a stronger modeling-impact of parental gam- bling. For example, children are more likely to gamble if the head of their family (the father) gambles, because their culture requires them to respect and obey him. Raylu and Oei (2004) also suggest that collectivist cultures may experience greater influ - ence on gambling behaviour among its members, and therefore, stronger impacts Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 11 of 16 of modeling behaviour. Consequently, compared to individualistic cultures such as in the West, members of collectivist Asian cultures may be more or less inclined to gamble (and gamble to excess) if members of their cultural group do. 2. Issues with acculturation/immigration Immigration stressors including difficulties with acculturation may play a mediat - ing role in the development of gambling problems. However, the precise mecha- nisms by which acculturation per se affects problem gambling are not entirely clear. Raylu and Oei (2004) describe two theories regarding this association. The first is that less acculturation leads to more stressors including psychological, financial, and unemployment problems, and that these stressors increase one’s risk of developing problem gambling (Raylu and Oei 2004; Tse 2007). For example, adapting to life in a new country carries an increased risk of experiencing unique hardships related to minority status and acculturation, specifically in familial (e.g., intergenerational dif - ferences), social (e.g., perceived discrimination), and economic (e.g., poor finances) domains (Berry 1997; Cervantes and Cordova 2011). Furthermore, the process of immigration is commonly associated with feelings of boredom, isolation, and loneli- ness that can lead to mental illness (Jamil et al. 2007; Roche and Kuperminc 2012; Trevorrow and Moore 1998). These constructs are also frequently reported as moti - vations for gambling among problem gamblers (Blaszczynski and Nower 2002; Halle- bone 1999), thus suggesting that immigrants may be at a higher risk of developing gambling problems. Conversely, successful acculturation to a host country that endorses gambling behaviour may act to normalize betting and therefore increase one’s risk of developing gambling problems (Raylu and Oei 2004). Data from the Victorian Casino and Gambling Authority (VCGA) (1999) appears to support the former hypothesis. In addition to feelings of loneliness and boredom, the effects of migration were cited as some of the most common reasons for gambling by Asian–Australian migrants (Victorian Casino and Gambling Authority [VCGA] 1999). However, acculturation may play a larger role in the maintenance and progres- sion of gambling problems by effecting help seeking behaviours (Atkinson and Gim 1989). Immigrants who are more acculturated to their host country are more likely to adopt the help seeking behaviours of that country (Tata and Leong 1994). Likewise, less acculturated immigrants who have come from a low help seeking background may be less inclined to seek help, even when help is available in the host country. Therefore, it is likely that less acculturated Asian people (from low-help seeking backgrounds) living in the West (higher help seeking behaviours) will be less inclined to pursue assistance when it is needed. 3. Attitudes toward seeking professional help Low help seeking is common among cultures such as the Chinese that prefer cop- ing strategies with high reliance on self-help measures, and family and community support (Cheung 1986; Luk and Bond 1992). Further, collectivist cultures such as those in Asia are more likely to hide gambling problems due to feelings of shame and stigma associated with problem gambling (Scull and Woolcock 2005). As such, gam- blers will often be concealed within the family, where the head of the family decides on alternative support and treatment (such as traditional healing and herbal med- icine) (Cheung 1993). It is likely that by not seeking help early, and attempting to Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 12 of 16 hide gambling problems, or self-manage, that problems may become more severe, increasing the likelihood of a later gambling disorder. Additionally, Asian commu- nities living in Queensland, Australia have reported a lack of culturally appropriate support services for problem gambling, further contributing to the lack of help seek- ing among this population (Scull and Woolcock 2005). Acknowledging diversity and limitations The Asian continent is vast, and is comprised of a great diversity of countries, peoples, and cultures. To encompass every country belonging to the Asian continent is beyond the scope of the this review and would deviate from its purpose, therefore the focus has been narrowed to literature on East and South-East Asian communities, and Asian immigrants living abroad. Perhaps the most evident limitation of this review is the authors’ Western cultural backgrounds. Language barriers limited the authors from including articles published in languages other than English. This has likely resulted in a bias of studies conducted in or by western countries such as the US, Canada, the UK, Australia and New Zealand, and an overrepresentation of Asian migrant samples rather than Asian residents. Fur- thermore, because of a lack of exhaustive research in this niche area, few robust conclu- sions can be drawn, emphasising the need for further studies evaluating the problem gambling-family violence link in Asian populations. Finally, while this review explores the cultural underpinnings that may influence family violence, we emphasise that on the whole, Asian communities do not consider cultural traditions or expectations to be ade- quate justification for violence and agree that family violence is a problem that should be stopped (Bui 2006; Tse 2007; Yoshioka and Dang 2000). Recommendations for future research It would be helpful if future research endeavours utilised samples of Asian citizens living in Asian countries, rather than Asian migrant communities living abroad. This would provide a more localised and focused view of family violence and problem gambling in Asian countries. While comparative data from Asian migrant communities is a useful reference, the English-speaking literature is typically saturated with studies of this kind, emphasising a need for local research that can be used as a point of reference. More specifically, future research should focus on studies that directly evaluate the association between family violence and problem gambling in East and South-East Asia, employing methodologies that aim to answer four research questions: 1. Does problem gambling directly lead to family violence? 2. Does family violence exacerbate gambling to the point of a gambling disorder? 3. Are there common underlying cultural traditions and/or belief systems that under- pin both problem gambling and family violence and therefore serve as a facilitating third factor (i.e. patriarchal family systems/migration/acculturation)? 4. Are there differences between Asian countries/states/regions in terms of the nature of the problem gambling-family violence relationship and how it is manifested? If so, what are they? Keen et al. Asian J of Gambling Issues and Public Health (2015) 5:3 Page 13 of 16 Methodologies used to test these research questions should also aim to: 1. Collect longitudinal data—this will help to indicate the direction of correlation, i.e. does problem gambling lead to family violence or vice versa. 2. Collect qualitative data that pays particular attention to cultural belief systems around control, masculinity and violence. 3. Collect quantitative data that evaluates the extent to which one type of behaviour causes the other, or is caused by outside cultural factors. 4. Collect qualitative/quantitative data from different Asian areas and compare relevant outcomes between groups. Summary The literature provides a substantial amount of preliminary evidence to suggest that cultural norms and attitudes present in some Asian traditions play a strong role in the development and maintenance of gambling problems, particularly its role in avoid- ance of help seeking. Similarly, there is evidence that demonstrates traditional patriar- chal family systems contribute to the development and concealment of family violence in Asian families. While there is considerable data supporting a link between problem gambling and family violence in Asian communities, a large proportion of the data is subjective, qualitative, and based on very small sample sizes. This is not to say that a link does not exist, rather that sound research, specific to this topic, has not been carried out in order to accurately measure the association and thoroughly investigate its underly- ing causes. Preliminary evidence suggests that Asian immigrants living abroad should be considered ‘at-risk’ for both problem gambling and family violence perpetration and victimisation. Likewise, policy makers in Asian jurisdictions should focus on education and awareness campaigns in an effort to increase help seeking for gambling problems and family violence, as well as increasing treatment service availability for both issues. Abbreviations ABS: Australian Bureau of Statistics; DV: domestic violence; FV: family violence; GAMECS: gambling among members of ethnic communities in Sydney survey; HAB: Home Affairs Bureau; IPV: intimate partner violence; NCPG: National Council on Problem Gambling; PG: problem gambling; VCGA: Victorian Casino and Gambling Authority; WHO: World Health Organization. Authors’ contributions All authors (BK, DP, MW and AB) contributed substantially to (1) the literature review, including searching for, collat- ing and critically analysing research articles and (2) the drafting and revision of the manuscript. All authors read and approved the final manuscript. Acknowledgements This was an unfunded project, conducted independently by the authors. Compliance with ethical guidelines Competing interests The authors declare that they have no competing interests. Received: 29 April 2015 Accepted: 9 July 2015 Keen et al. 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