Export file:


  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text


  • Citation Only
  • Citation and Abstract

Occupational exposures and associated risk factors among U.S. casino workers: a narrative review

1 Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, KY, USA
2 College of Public Health, Department of Epidemiology, University of Kentucky, Lexington, KY, USA
3 School of Social Work, University of Maryland Baltimore, Baltimore, MD, USA
4 Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
5 Health Sciences and Human Services Library, University of Maryland Baltimore, Baltimore, MD, USA
6 Coppin State University, 2500 West North Avenue, Baltimore, MD, USA
7 Maryland Center of Excellence on Problem Gambling, University of Maryland Baltimore, Baltimore, MD, USA
8 Providence College, Providence, Rhode Island, USA

† These two authors contributed equally.

We conducted a narrative literature review of U.S. casino occupational health and safety research based on the following inclusion criteria: 1) focused on workers, 2) provided information pertaining to exposures present in the occupational environment (e.g., hazards, stressors, etc.), and 3) pertained to casino, gaming, or gambling workers. Following a multi-step process, a total of 11 articles were identified that related to the occupational health and safety of U.S. casino workers. These articles primarily focused on environmental tobacco smoke (ETS) exposures (n = 7 articles), with the remaining articles related to casino worker risk behaviors (i.e., problem gambling and drinking) (n = 2), and psychosocial stressors (n = 2). Our results demonstrate that the overwhelming consensus in the literature is that ETS leads to high respirable particulate matter (PM2.5), tobacco toxin levels and exposures among gaming employees. Our results also suggest that harassment, low autonomy at work, and unsafe work conditions may be of concern, especially for female workers. We identified major gaps in the casino worker occupational safety literature including a lack of studies that evaluated noise exposure, injury data, ergonomics, psychosocial hazards, or long term respiratory health outcomes related to ETS exposure. Future research regarding the occupational safety and health of U.S. casino workers should address these gaps in the literature.
  Article Metrics

Keywords casino workers; narrative review; occupational health

Citation: Jessica Miller Clouser, John C. Flunker, Jennifer E. Swanberg, Gail Betz, Surjeet Baidwan, J. Kathleen Tracy. Occupational exposures and associated risk factors among U.S. casino workers: a narrative review. AIMS Public Health , 2018, 5(4): 378-393. doi: 10.3934/publichealth.2018.4.378


  • 1. American Gaming Association, AGA, State of the States. The American Gaming Association Survey of the Casino Industry, 2016. Available from: https://www.americangaming.org/sites/default/files/2016%20State%20of%20the%20States_FINAL.pdf.
  • 2. Fong TW, Campos MD, Brecht ML, et al. (2011) Problem and pathological gambling in a sample of casino patrons. JGamb Stud 27: 35–47.
  • 3. Lesieur HR, Rosenthal RJ (1991) Pathological gambling: A review of the literature (prepared for the American Psychiatric Association Task Force on DSM-IV Committee on Disorders of Impulse Control Not Elsewhere Classified). J Gambling Stud 7: 5–39.    
  • 4. National Opinion Research Center, Gambling Impact and Behavior Study, Report to the National Gambling Impact Study Commission, 1999. Available from: www.norc.org/PDFs/publications/GIBSFinalReportApril1999.pdf.
  • 5. Muelleman RL, Denotter T, Wadman MC, et al. (2002) Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. J Emerg Med 23: 307–312.
  • 6. Lesieur H (1998) Costs and Treatment of Pathological Gambling. Ann Am Acad Poltical 556: 153–171.    
  • 7. Stitt G, Nichols M, Giacopassi D (2013) Does the Presence of Casinos Increase Crime? An Examination of Casino and Control Communities. Crime Delinquency 49: 253–284.
  • 8. Grinols EL, Mustard DB (2006) Casinos, crime, and community costs. Rev Econ Stat 88: 28–45.
  • 9. Hakim S, Friedman J (1985) Impact of Casino Gambling on Crime in Atlantic City & Its Region. Impact Of Casino Gambling On Crime In Atlantic City & Its Region.
  • 10. Keith M, Cann B, Brophy JT, et al. (2001) Identifying and prioritizing gaming workers' health and safety concerns using mapping for data collection. Am J Ind Med 39: 42–51.    
  • 11. Chan SH, Pilkington P, Wan YKP (2012) Policies on smoking in the casino workplace and their impact on smoking behavior among employees: Case study of casino workers in Macao. Int J Hosp Manage 31: 728–734.    
  • 12. Hu SX, Luk A, Leong CUC, et al. (2013) The correlations of work conditions with unhealthy lifestyles and occupational health problems of casino croupiers in Macau. J Gamb Stud 29: 255–268.    
  • 13. Tiyce M, Hing N, Cairncross G, et al. (2013) Employee stress and stressors in gambling and hospitality workplaces. J Hum Resour Hosp Tourism 12: 126–154.    
  • 14. Parke A, Griffiths M (2004) Aggressive behaviour in slot machine gamblers: A preliminary observational study. Psychol Rep 95: 109–114.
  • 15. Parke A, Griffiths M (2005) Aggressive behaviour in adult slot-machine gamblers: A qualitative observational study. J Community Appl Soc Psychol 2: 50–58.
  • 16. Lee TK, Labrie RA, Rhee HS, et al. (2008) A study of South Korean casino employees and gambling problems. J Occ Med 58: 191–197.    
  • 17. Guttentag D, Harrigan K, Smith S (2012) Gambling by Ontario casino employees: Gambling behaviors, problem gambling and impacts of the employment. Int Gamb Stud 12: 5–22.    
  • 18. Hing N, Gainsbury S (2011) Risky business: Gambling problems amongst gaming venue employees in Queensland, Australia. J Gamb Issues 25: 4–23.
  • 19. Jiang RT, Cheng KC, Acevedo-Bolton V, et al. (2011) Measurement of fine particles and smoking activity in a statewide survey of 36 California Indian casinos. J Exp Sci Environ Epi 21: 31–41.    
  • 20. Achutan C, West C, Mueller C, et al. (2011) Environmental tobacco smoke exposure among casino dealers. J Occ Environ Med 53: 346–351.    
  • 21. Trout D, Decker J, Mueller C, et al. (1998) Exposure of casino employees to environmental tobacco smoke. J Occ Environ Med 40: 270–276.    
  • 22. Repace JL (2009) Secondhand smoke in Pennsylvania casinos: A study of nonsmokers' exposure, dose, and risk. Am J Pub Health 99: 1478–1485.    
  • 23. Repace JL (2009) Erratum. 'Secondhand smoke in Pennsylvania casinos: A study of nonsmokers' exposure, dose, and risk'. Am J Pub Health 99: 1734.
  • 24. Repace JL, Jiang RT, Acevedo-Bolton V, et al. (2011). Fine particle air pollution and secondhand smoke exposures and risks inside 66 US casinos. Environ Res 111: 473–484.    
  • 25. Marin HA, Diaz-Toro EC (2011) Reduced exposure to secondhand smoke at casinos in Puerto Rico after the implementation of a workplace smoking ban in 2007: A pre-post design. P R Health Sci J 30: 182–187.
  • 26. Shaffer HJ, Vander BJ, Hall MN (1999) Gambling, drinking, smoking and other health risk activities among casino employees. Am J Ind Med 36: 365–378.    
  • 27. Shaffer HJ, Hall MN (2002) The natural history of gambling and drinking problems among casino employees. J Soc Psychol 142: 405–424.    
  • 28. Stedham Y, Mitchell MC (1998) Sexual harassment in casinos: Effects on employee attitudes and behaviors. J Gamb Stud 14: 381–400.    
  • 29. Jones JB, Chandler S (2001) Connecting Personal Biography and Social History: Women Casino Workers and the Global Economy. J Sociol Soc Welfare 28: Article 10.
  • 30. American NonSmokers' Rights Foundation (2017). Summary of 100% Smokefree State Laws and Population Protected by 100% Smokefree Laws. January 2, 2017. Available from: www.no-smoke.org/SummaryUSPopList.pdf.
  • 31. Boo SY, Okada SS (2015) Banning indoor smoking in the gaming industry. Int J Tourism Sci 4: 101–121.
  • 32. Barker J (2015) Smoking and slots-casinos' terraces ignite debate. The Baltimore Sun, July 8.
  • 33. Jones JB, Chandler S (2007) Surveillance and regulation: Control of women casino workers' bodies. Affilia 22: 150–162.
  • 34. Frey JH, Carns DE (1988) Job satisfaction of casino card dealers. Sociol Soc Res 72: 159–164.
  • 35. Byler CG (2013) Hispanic/Latino fatal occupational injury rates. Mon Lab Rev 136: 14–23.
  • 36. York NL, Lee K (2010) A baseline evaluation of casino air quality after enactment of Nevada's clean indoor air act. Pub Health Nurs 27: 158–163.    


This article has been cited by

  • 1. Shuqing Xu, Lei Wang, Boshen Wang, Haoran Guo, Lei Han, Surong Xu, Hong Chen, Baoli Zhu, Occupational safety and health in China: junior college students’ knowledge from a large cross-sectional survey in Jiangsu Province, Journal of Public Health Policy, 2020, 10.1057/s41271-020-00225-2
  • 2. Minxuan Lan, Lin Liu, John E. Eck, A spatial analytical approach to assess the impact of a casino on crime: An example of JACK Casino in downtown Cincinnati, Cities, 2020, 103003, 10.1016/j.cities.2020.103003

Reader Comments

your name: *   your email: *  

© 2018 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Copyright © AIMS Press All Rights Reserved