A Critical Review of the Harm-Minimisation Tools Available for Electronic Gambling

Mapping Youth Awareness of Sports Betting Advertising During the 2022 FIFA World Cup

Young people are known to be highly engaged in sports betting and therefore may be particularly susceptible to the effects of gambling-related advertising. The purpose of the present study was to examine young people's recall of sports betting advertising during the 2022 FIFA World Cup. The sample consisted of 190 UK residents aged 18-24 who had watched at least one 2022 World Cup match. A cross-sectional survey was conducted to collect data on participants' recall of sports betting advertisements across several media types and for different bets and betting offers, as well as their problem gambling scores. The findings indicated that young people were able to recall a high amount of advertising for various types of bets (95.6%) and betting inducements (89.5%). A high proportion of young people recalled advertising for risky bet types and promotions, such as 64.2% for in-play betting and 68.1% for sign-up offers. Overall, higher-risk gamblers recalled encountering more advertising than lower-risk gamblers. Participants recalled encountering sports betting advertisements on social media the most (10-14 ads per week), then on internet banners and television (5-9 ads per week, respectively). Less than half (46.3%) of respondents were aware of advertising for responsible gambling tools. This study underscores the need for policy measures that limit young people's exposure to gambling advertising, particularly for products that may contribute to gambling-related harm, and that increase the promotion of responsible gambling tools.

Exploring the Impact of Safer Sports Betting Promotion on Social Media: An Experimental Study

The current study assessed the effectiveness of delivering safer gambling messaging to regular sport bettors on social media. It also assessed whether the content of the message impacted message effectiveness. A 3 × 2 mixed factorial design was employed, with 281 participants randomly assigned to follow one of three Twitter accounts. The accounts either sent out informational messages, self-appraisal messages or emotional self-efficacy messages. Participants reported betting behaviour from the two weeks prior to following the accounts, in addition to during the two-week intervention period, using information from their online gambling accounts. Participants reported readiness to change gambling behaviour pre and post the two-week intervention period. A significant main effect of intervention stage highlighted reductions in betting behaviour and increased readiness to change behaviour. However, there was no significant main effect of condition and no significant interaction between intervention stage and condition upon betting behaviour or readiness to change. The findings suggest receiving safer gambling messages on social media may lead to a reduction in betting behaviour. However, similar reductions in behaviour were observed in the experimental and control conditions. Further research is needed to clarify whether changes in behaviour observed in the current study would extend over a longer period of time.

What is known about population level programs designed to address gambling-related harm: rapid review of the evidence

BACKGROUND

Gambling and gambling-related harm attract significant researcher and policy attention. The liberalisation of gambling in most western countries is strongly associated with a marked rise in gambling activity and increases in gambling-related harm experienced at the population level. Programs to address gambling-related harm have traditionally focused on individuals who demonstrate problematic gambling behaviour, despite clear evidence of the effectiveness of a public health approach to high-risk activities like gambling. Little is known about the availability or efficacy of programs to address gambling-related harm at a population level.

METHODS

The Victorian Responsible Gambling Foundation commissioned a rapid evidence review of the available evidence on programs designed to reduce gambling-related harm at a population level. The review was conducted using a public health and harm reduction lens. MEDLINE, ProQuest Central and PsychInfo databases were searched systematically. Included studies were published in English between 2017 - 2023 from all countries with gambling policy contexts and public health systems comparable to Australia's; included primary data; and focused on primary and/or secondary prevention of gambling-related harm or problems.

RESULTS

One hundred and sixty-seven articles were eligible for inclusion. Themes identified in the literature included: risk and protective factors; primary prevention; secondary prevention; tertiary prevention; target population group; and public health approach. The evidence review revealed a gap in empirical evidence around effective interventions to reduce gambling-related harm at the population level, particularly from a public health perspective.

CONCLUSIONS

Addressing gambling-related harm requires a nuanced, multi-layered approach that acknowledges the complex social, environmental, and commercial nature of gambling and associated harms. Moreover, evidence demonstrates community programs to reduce gambling-related harm are more successful in reducing harm when based on sound theory of co-design and address the social aspects that contribute to harm.

The Differences of Gambling-Related Harms Among Low-Investment and Normal-Investment Pachinko/Pachislot Players in Japan: A Cross Sectional Study

Pachinko and pachislot are popular types of gambling activities in Japan. Prior studies in Japan have reported a concerning prevalence of problem gambling among adult players. While these studies have identified various gambling-related harms, Japanese research on harm-minimization strategies is scarce. Therefore, the present study aimed to compare differences of gambling-related harms among normal-, half-, and quarter-pachi players to the usefulness of low-investment pachinko and pachislot as a harm-reduction strategy. We considered gamblers who played games that cost the typical amount of money to be "normal-pachi players." Those who played low-investment games were categorized as "half-pachi players" and "quarter-pachi players," reflecting those who played games at half or one quarter the cost of a typical machine, respectively. To assess the harm-reduction effect, a one-way ANCOVA was conducted to compare the impact of the groups (normal-pachi players [n = 101], half-pachi players [n = 104], and quarter-pachi players [n = 100]) on dependent variables, namely the number of days players had gambled during the prior month; total time and amount of money spent on gambling; debts caused by gambling; gambling severity; cognitive distortion; depressive symptoms; and problems in work, family, and social life. We demonstrated that the amount of money spent by quarter-pachi players on gambling during the past month was lower than that of normal-pachi players. However, we did not find significant differences with respect to any other gambling-related harms among normal-, half-, and quarter-pachi players. Low-investment pachinko and pachislot players spends less the amount of money spent on gambling. Low-investment pachinko and pachislot would thus partly act as a harm-minimization strategy. Moreover, the results of the present study indicate that the problems at work affect various outcomes for gamblers. Given that 90% of the participants in this study were employed, the results of this study may have important implications for employed gamblers.

A Systematic Review on Intervention Treatment in Pathological Gambling

Over the last century, there has been a growing interest in researching pathological gambling, particularly in industrialized nations. Historically, gambling was widely perceived as morally questionable, condemned by religious groups. However, contemporary concerns have shifted towards the health repercussions of gambling disorders and broader societal impacts like increased crime and money laundering. Governments, aiming to mitigate social harm, often regulate or directly oversee gambling activities. The global surge in legal gambling has resulted in a substantial rise in its prevalence, popularity, and accessibility in the last two decades. This paper provides a comprehensive overview of global research on interventions for pathological gambling. Through a systematic search on platforms such as EBSCO, PubMed, and Web of Science, 13 relevant records were identified. The revised findings indicate a heightened occurrence of behavioral addictions, linking them to the early onset of gambling issues and their severe consequences. The research emphasizes the active role that clients play in the process of self-directed change and therapy. Therapists recognizing clients as both catalysts for change and potential obstacles can enhance their effectiveness. A common source of resistance arises when clients and therapists are in different stages of the change process, underlining the importance of therapists aligning with clients' readiness for change. Recognizing the urgent need for a better understanding of this problem in adolescents, this study emphasizes the necessity to tailor prevention and treatment plans based on gender and age-specific requirements.

Associations of self-regulation strategy use with in-play betting intensity and associated harms: An ecological momentary assessment study

Self-regulation strategies, such as limit setting, can be effective in reducing harms associated with gambling. However, limited research has examined their applicability to in-play sports betting. The current study therefore examined the utility of self-regulation strategies in reducing in-play betting intensity and associated harms. Adults engaging in-play betting (N = 77; Mage = 41.23 years, 71.43 % men) completed 14 days of ecological momentary assessment surveys in which they reported their in-play betting behaviours (number of bets placed, money spent), use of self-regulation strategies for in-play betting (setting monetary limits, setting time limits, stopping betting when no longer fun, taking frequent breaks), and in-play-betting-related harms. Multilevel models revealed that participants with a greater propensity to set monetary limits were overall less likely to experience financial, interpersonal, and health harms. In addition, participants were less likely to experience emotional/psychological harms following in-play betting occasions during which they set monetary limits (versus when they did not). In contrast, participants with a greater propensity to set time limits tended to spend more money on in-play bets, experienced more harms on average, and were overall more likely to experience financial and work/study harms. Results provide preliminary support for the utility of monetary limit setting, but not time limit setting, in reducing in-play-betting-related harms. Findings support the applicability of select self-regulation strategies originally proposed for more traditional forms of gambling to in-play sports betting, and highlight a need for further research investigating whether other responsible gambling strategies may be effective in reducing in-play-betting-related harms.

Perspectives from gambling expert stakeholders in relation to electronic gaming machines in New Zealand

Electronic gaming machines (EGMs) are one of the most addictive and harmful forms of gambling. Gaming machine characteristics, easy accessibility of EGMs and normalisation of gambling behaviour have exacerbated these effects. We conducted a pilot study investigating the perspectives of gambling expert stakeholders on gambling harm and effective harm-minimisation policies regarding EGMs. In-depth individual interviews were undertaken with 14 health professionals working in the addiction sector, academics in the field of gambling and individuals from a range of government and non-government organisations who have an impact on gambling policy making in New Zealand. Five major themes were identified: the need to shift focus from problematic people to the problematic product, the need for a holistic approach to gambling intervention, focus on creating an empowered population, and improving protective factors and refining public health initiatives to gambling harm. The results suggest the need to challenge current narratives of EGM-related gambling harm and have wide-ranging implications for EGM harm minimisation and health promotion policies.

What are the odds? Poor compliance with UK loot box probability disclosure industry self-regulation

Loot boxes are purchased in video games to obtain randomised rewards of varying value and are thus psychologically akin to gambling. Disclosing the probabilities of obtaining loot box rewards may reduce overspending, in a similar vein to related disclosure approaches in gambling. Presently, this consumer protection measure has been adopted as law only in the People's Republic of China (PRC). In other countries, the videogaming industry has generally adopted this measure as self-regulation. However, self-regulation conflicts with commercial interests and might not maximally promote public welfare. The loot box prevalence rate amongst the 100 highest-grossing UK iPhone games was 77% in mid-2021. The compliance rate with probability disclosure industry self-regulation was only 64.0%, significantly lower than that of PRC legal regulation (95.6%). In addition, UK games generally made insufficiently prominent and difficult-to-access disclosures both in-game and on the game's official website. Significantly fewer UK games disclosed probabilities on their official websites (21.3%) when compared to 72.5% of PRC games. Only one of 75 UK games (1.3%) adopted the most prominent disclosure format of automatically displaying the probabilities on the in-game purchase page. Policymakers should demand more accountable forms of industry self-regulation or impose direct legal regulation to ensure consumer protection.

Attitude Towards Deposit Limits and Relationship with Their Account-Based Data Among a Sample of German Online Slots Players

Social responsibility and duty of care have become major cornerstones for gambling operators. This has led to the introduction of many different responsible gambling tools such as limit-setting, mandatory play breaks, and personalized messaging. In the present study, the authors were given access to two secondary datasets provided by a German online slots game operator. The first dataset was from an online survey carried out by the gambling operator among 1000 of its players concerning their attitude towards deposit limits as well as self-reported problem gambling. In addition to the survey responses, the authors were given access to a second dataset of account-based data concerning each customer's wagers, wins, monetary deposits, and monetary withdrawals. These datasets were then combined. The majority of players had a positive attitude towards the maximum deposit monthly deposit limit which was introduced by the German State Treaty on Gambling in 2021. Players who disagreed with the maximum monthly deposit limit, deposited significantly more money in the 30 days prior to answering the survey questions compared to players who agreed with the monthly deposit limit. The tracking data found only 7.6% of players had deposited the maximum amount of money allowed in one month. However, 60.5% of players in the survey data said that they did so. Players who said that they continued to gamble after reaching the deposit limit wagered and deposited significantly more money in the 30 days prior to the survey compared to players who said they stopped gambling after reaching the deposit limit. Two-fifths of players said they continued to gamble after reaching the monthly deposit limit (42%). The majority of the players said they chose a personal deposit limit because it helped them to better control their gambling expenditure. A quarter of the players reported gambling problems using the Brief Biosocial Gambling Screen (27%). Self-reported problem gambling was not correlated with depositing, wagering or any other player tracking metric.

Gambling harm prevention and harm reduction in online environments: a call for action

BACKGROUND

Gambling is increasingly offered and consumed in online and mobile environments. The digitalisation of the gambling industry poses new challenges on harm prevention and harm reduction. The digital environment differs from traditional, land-based gambling environments. It increases many risk-factors in gambling, including availability, ease-of-access, but also game characteristics such as speed and intensity. Furthermore, data collected on those gambling in digital environments makes gambling offer increasingly personalised and targeted.

MAIN RESULTS

This paper discusses how harm prevention and harm reduction efforts need to address gambling in online environments. We review existing literature on universal, selective, and indicated harm reduction and harm prevention efforts for online gambling and discuss ways forward. The discussion shows that there are several avenues forward for online gambling harm prevention and reduction at each of the universal, selective, and indicated levels. No measure is likely to be sufficient on its own and multi-modal as well as multi-level interventions are needed. Harm prevention and harm reduction measures online also differ from traditional land-based efforts. Online gambling providers utilise a variety of strategies to enable, market, and personalise their products using data and the wider online ecosystem.

CONCLUSION

We argue that these same tools and channels should also be used for preventive work to better prevent and reduce the public health harms caused by online gambling.

Cooling Off and the Effects of Mandatory Breaks in Online Gambling: A Large-Scale Real-World Study

The prevention of problematic online gambling behavior is a topic of major interest for regulators, the gambling industry, and researchers. Many gambling operators approach this issue by using responsible gambling tools. Among such tools, mandatory play breaks are used to interrupt long online gambling sessions, providing "cooling off" periods for players to take a reflective "time out". The present study investigated the effects of mandatory play breaks in a large-scale experiment with 23,234 online gamblers engaging in more than 870,000,000 gambling transactions on Norsk Tipping's gambling platform over a 1-month period. The gamblers were randomly assigned to several intervention groups with varying duration of mandatory play breaks and one control group with Norsk Tipping's standard play break duration. More specifically, the study analyzed the relationship between the mandatory break received and the gambler's acceptance of this tool, the interaction patterns with the tool, and how quickly they started to gamble again, as well as post-intervention effects on gambling behavior. Results showed that gamblers who were treated with longer mandatory breaks (i) tended to take longer voluntary breaks, and (ii) interacted more frequently with the tool (for instance, by clicking the "logout" button). Furthermore, gamblers appeared to accept longer mandatory play breaks. However, only a fraction of post-intervention effects remained, and mainly only for gamblers who received a substantial number of long mandatory play breaks. Overall, the present study provides actionable insights for both researchers and the gambling industry to improve the effectiveness of mandatory play breaks as a responsible gambling tool.

Predicting self-exclusion among online gamblers: An empirical real-world study

Protecting gamblers from problematic gambling behavior is a major concern for clinicians, researchers, and gambling regulators. Most gambling operators offer a range of so-called responsible gambling tools to help players better understand and control their gambling behavior. One such tool is voluntary self-exclusion, which allows players to block themselves from gambling for a self-selected period. Using player tracking data from three online gambling platforms operating across six countries, this study empirically investigated the factors that led players to self-exclude. Specifically, the study tested (i) which behavioral features led to future self-exclusion, and (ii) whether monetary gambling intensity features (i.e., amount of stakes, losses, and deposits) additionally improved the prediction. A total of 25,720 online gamblers (13% female; mean age = 39.9 years) were analyzed, of whom 414 (1.61%) had a future self-exclusion. Results showed that higher odds of future self-exclusion across countries was associated with a (i) higher number of previous voluntary limit changes and self-exclusions, (ii) higher number of different payment methods for deposits, (iii) higher average number of deposits per session, and (iv) higher number of different types of games played. In five out of six countries, none of the monetary gambling intensity features appeared to affect the odds of future self-exclusion given the inclusion of the aforementioned behavioral variables. Finally, the study examined whether the identified behavioral variables could be used by machine learning algorithms to predict future self-exclusions and generalize to gambling populations of other countries and operators. Overall, machine learning algorithms were able to generalize to other countries in predicting future self-exclusions.

The Effects of the Presence of Others on Risky Betting in a Laboratory Gambling Task Among High-Risk Gamblers: A Cross-over Randomized Controlled Trial

We explored the effects of the presence of and cooperation with others on risky betting in a laboratory-based gambling task among high-risk gamblers. Specifically, we compared risky betting under solo, parallel, and cooperation conditions using a stratified randomized, cross-over design. Stratification was conducted according to participant age and gender. The participants were 40 Japanese adults (20 women, 20 men; mean age = 46, SD = 12.80). In the experiment, each participant conducted the Game of Dice Task (GDT) individually (solo condition), in parallel with another participant (parallel condition), and working together with another participant (cooperation condition). Linear mixed modeling results showed that when we controlled for previously specified covariates, there were no significant differences among the solo, parallel, and cooperation conditions regarding risky betting (parallel: estimates = 0.10, SE = 0.79, p = .900; cooperation: estimates = 0.95, SE = 0.79, p = .232). However, post-hoc analysis showed a significant difference between the solo and cooperation conditions regarding the number of times participants chose the riskiest bet (parallel: estimates = 0.18, SE = 0.52, p = .739; cooperation: estimates = 1.13, SE = 0.53, p = .035). Thus, we found that neither the presence of nor cooperation with others decreased risky betting in the GDT among high-risk gamblers. However, we did observe that participants displayed the riskiest betting behavior (i.e., selecting the single choice) in the GDT during the cooperation condition, compared with the solo condition.

The Effect of a Mandatory Play Break on Subsequent Gambling Behavior among British Online Casino Players: A Large-Scale Real-World Study

In recent years, various novel responsible gambling (RG) tools have been implemented to aid harm-minimization. One such RG tool has been the implementation of enforced mandatory play breaks. Despite many responsible gambling operators using mandatory play breaks, only three previous studies have examined their efficacy and the findings were mixed. Therefore, the present investigation was a large-scale real-world study which was designed to see whether a 60-minute mandatory play break influenced subsequent depositing and wagering. The authors were given access to 27 days of player data prior to the introduction of a mandatory play break and 27 days of player data after the mandatory play break was introduced. The study comprised British online gamblers from Skillonnet (a European online gambling operator). Between July 23 and September 15 (2021), 2,021 players deposited at least ten times or more on a calendar day, at least once. The 2,201 players generated 2,994 corresponding events (i.e., the depositing of money at least 10 times in one day). The percentage of players who stopped depositing money as a consequence of the mandatory play break rose from 27% to 68% on the day of a play break. Moreover, the percentage of players who stopped wagering as a consequence of the mandatory play break rose from 0.1% to 45% on the day of a play break. The findings of the present study demonstrated that a 60-minute mandatory play break impacts players' depositing and wagering immediately after the play break. This means that a mandatory hour-long play break in an online casino setting appears to prevent overspending during a short period of time. The effects of a 60-minute mandatory break on the next day's behavior were inconclusive.

The Impact of Personalized Feedback Interventions by a Gambling Operator on Subsequent Gambling Expenditure in a Sample of Dutch Online Gamblers

Player protection has become an important area for the gambling industry over the past decade. A number of gambling regulators now require gambling operators to interact with customers if they suspect they are gambling in a problematic way. The present study provided insight on the impact of personalized feedback interventions (PFIs) on subsequent gambling behavior among a Dutch sample of real-world gamblers. Nederlandse Loterij (the national Dutch Lottery operator) provided access to a secondary dataset comprising tracking data from online casino and sports betting gamblers (N = 2,576) who were contacted either by e-mail or telephone between November 2021 and March 2022 if they showed signs of problematic gambling as identified using behavioral tracking software. Compared to matched controls (n = 369,961 gamblers), Dutch gamblers who received a PFI (via e-mail [n = 1876] or a telephone call [n = 700]) from the gambling operator had a significant reduction in amount of money deposited, amount of money wagered, number of monetary deposits, and time spent gambling in the 30 days after being contacted. Gambling frequency as measured by the number of gambling days did not change significantly after a PFI. Telephone calls did not lead to a significant larger reduction with respect to the aforementioned behavioral metrics. High-intensity players reduced their gambling behavior as frequently as low-intensity players, which means that the intervention’s success was independent of gambling intensity. The impact on subsequent gambling was the same across age groups and gender. The results of the present study are of use to many different stakeholder groups including researchers in the gambling studies field and the gambling industry as well as regulators and policymakers who can recommend or enforce that gambling operators utilize responsible gambling tools such as using PFIs to those who may be displaying problematic gambling behaviors as a way of minimizing harm and protecting gamblers.

Development and validation of a prediction model for online gambling problems based on players' account data

BACKGROUND AND AIMS

Gambling disorder is characterized by problematic gambling behavior that causes significant problems and distress. This study aimed to develop and validate a predictive model for screening online problem gamblers based on players' account data.

METHODS

Two random samples of French online gamblers in skill-based (poker, horse race betting and sports betting, n = 8,172) and pure chance games (scratch games and lotteries, n = 5,404) answered an online survey and gambling tracking data were retrospectively collected for the participants. The survey included age and gender, gambling habits, and the Problem Gambling Severity Index (PGSI). We used machine learning algorithms to predict the PGSI categories with gambling tracking data. We internally validated the prediction models in a leave-out sample.

RESULTS

When predicting gambling problems binary based on each PGSI threshold (1 for low-risk gambling, 5 for moderate-risk gambling and 8 for problem gambling), the predictive performances were good for the model for skill-based games (AUROCs from 0.72 to 0.82), but moderate for the model for pure chance games (AUROCs from 0.63 to 0.76, with wide confidence intervals) due to the lower frequency of problem gambling in this sample. When predicting the four PGSI categories altogether, performances were good for identifying extreme categories (non-problem and problem gamblers) but poorer for intermediate categories (low-risk and moderate-risk gamblers), whatever the type of game.

CONCLUSIONS

We developed an algorithm for screening online problem gamblers, excluding online casino gamblers, that could enable the setting of prevention measures for the most vulnerable gamblers.

Preventive Interventions and Harm Reduction in Online and Electronic Gambling: A Systematic Review

Gambling possess both entertaining and potentially harmful aspects. It remains a challenge for public health authorities and gambling operators to recommend and implement effective evidence-based interventions to reduce gambling-related harm and prevent problematic gambling behavior. This systematic review examined studies on randomized controlled trials in this field, aiming to describe and evaluate the effect of preventive and harm-reducing interventions for online gambling and electronic gaming machines. A systematic literature search was performed in PsycINFO, PubMed, Embase, and SCOPUS. Study selection, risk of bias assessment, and data extraction were conducted by two reviewers independently, and a synthesis was performed. A total of 18 studies were included, of which the majority were limited by quality issues. The applied interventions focused on restraining gambling, providing feedback, delivering therapeutic and informative content, and priming analytical thinking. The studies varied greatly in terms of specific intervention content, study setting, participants, and outcome measures, and no consistent patterns could be detected between study characteristics and related effects. Although research in the field is growing, there is still a need for further methodologically rigorous investigation and consensus on outcome measures sensitive to effects of preventive and harm-reducing interventions.

Analyzing Consumer Protection for Gamblers Across Different Online Gambling Operators: A Replication Study

Online gambling is a growing business with many stakeholders. Due to the fact that a small proportion of gamblers develop problems, responsible gambling (RG), player protection, and harm minimization have become core areas for gambling regulators. The present study replicated a previous one carried out by Bonello and Griffiths in 2017 to determine whether there had been any significant changes by leading gambling operators due to increased regulatory pressures over the past few years. Fifty leading online gambling operators were audited in relation to their RG practices as well as engaging with their customer services by posing as a problem gambler. Results indicated that overall RG practices appeared to have improved in the past 3 years based on the information in dedicated RG webpages, the increase in RG tool availability, and the communication with customer services. Despite the fact that RG practices appear to have improved, there were still areas for improvement.

The Effect of Mandatory Play Breaks on Subsequent Gambling Behavior Among Norwegian Online Sports Betting, Slots and Bingo Players: A Large-scale Real World Study

In order to protect gamblers, gambling operators have introduced a wide range of responsible gambling (RG) tools. Mandatory play breaks (i.e., forced termination of a gambling session) and personalized feedback about the gambling expenditure are two RG tools that are frequently used. While the motivation behind mandatory play breaks is simple (i.e., gambling operators expect gamblers to reduce their gambling significantly as a result of an enforced break in play), empirical evidence supporting the efficacy of the mandatory breaks is still limited. The present study comprised a real-world experiment with the clientele of Norwegian gambling operator Norsk Tipping. On the Norsk Tipping gambling website, which offers slots, bingo and sports-betting, forced termination occurs if gamblers have played continuously for a one-hour period. The study tested the effect of different lengths of mandatory play breaks (90 s, 5 min, 15 min) on subsequent gambling behavior, as well as the effect of combined personalized feedback concerning money wagered, won, and net win/loss. In total 21,129 online players (61% male; mean age = 47.4 years) experienced at least one play break between April 17 and May 21 (2020) with 156,989 mandatory play breaks in total. Results indicated that a 15-min mandatory play break led to a disproportionately longer voluntary play pause compared to 5-min and 90-s mandatory play breaks. Personalized feedback appeared to have no additional effect on subsequent gambling and none of the mandatory play breaks appeared to affect the increase or decrease in money wagered once players started to gamble again.

Responsible Gambling in Canada: An Analysis of the RG Check Patron Surveys

This study analyzed the Responsible Gambling Check patron survey data from Canadian casinos and racinos collected from 2011-2019 (18,580 patrons and 75 venues). The results indicated increasing awareness and use over time of harm minimization tools among more frequent patrons. Despite these promising trends, it is concerning that a substantial percentage of gamblers are still unaware of the harm minimization tools available. Further, the actual impact of this awareness on responsible gambling behaviour is largely unknown. We suggest greater efforts are needed nation-wide to promote the awareness, utilization, and evaluation of these harm minimization tools.

Concurrent Disorders and Decision-Making in Electronic Gaming Machine Gamblers

This study aimed to investigate the self-reported measures of concurrent disorders (stress, social anxiety, anxiety, depression and alcohol use) among electronic gaming machine (EGM) gamblers with varying levels of gambling severity and to examine its relationship to decision-making. This cross-sectional study in New Zealand involved an online survey that utilised validated questionnaires to assess self-reported measures of concurrent disorders and the Iowa gambling task (IGT) to analyse decision-making. The study comprised of active EGM gamblers (n = 153) who were divided into two groups: non-problem gambling (NPG, n = 71) and problem gambling (PG, n = 82) based on the cut-off point of the South Oaks Gambling Screen (SOGS). Multiple logistic regression models were performed to analyse co-occurring disorders separately and simultaneously, and a log-linear model was developed to define the associations between significant variables. The first model showed a strong correlation between gambling severity and measures for depression (p < 0.01), anxiety (p < 0.05), stress (p < 0.05) and alcohol use (p < 0.01), however only depression (p < 0.05) and alcohol use (p < 0.01) remained significant in the second model. Further, no association between social anxiety scores and problem gambling was found in this sample of EGM gamblers in both models. On the IGT, EGM gamblers in the PG group performed significantly worse. Further, the presence of poor decision-making was more pronounced with higher depression scores (p < 0.01) across both NPG and PG groups and higher alcohol use scores (p < 0.05) scores in the PG group. The presence of high levels of co-occurring disorders and its link to poor decision-making are important considerations in the treatment paradigm of EGM problem gamblers.

Responsible product design to mitigate excessive gambling: A scoping review and z-curve analysis of replicability

Objectives

Systematic mapping of evaluations of tools and interventions that are intended to mitigate risks for gambling harm.

Design

Scoping Review and z-curve analysis (which estimates the average replicability of a body of literature).

Search strategy

We searched 7 databases. We also examined reference lists of included studies, as well as papers that cited included studies. Included studies described a quantitative empirical assessment of a game-based (i.e., intrinsic to a specific gambling product) structural feature, user-directed tool, or regulatory initiative to promote responsible gambling. At least two research assistants independently performed screening and extracted study characteristics (e.g., study design and sample size). One author extracted statistics for the z-curve analysis.

Results

86 studies met inclusion criteria. No tools or interventions had unambiguous evidence of efficacy, but some show promise, such as within-session breaks in play. Pre-registration of research hypotheses, methods, and analytic plans was absent until 2019, reflecting a recent embracement of open science practices. Published studies also inconsistently reported effect sizes and power analyses. The results of z-curve provide some evidence of publication bias, and suggest that the replicability of the responsible product design literature is uncertain but could be low.

Conclusion

Greater transparency and precision are paramount to improving the evidence base for responsible product design to mitigate gambling-related harm.

Links between problem gambling and spending on booster packs in collectible card games: A conceptual replication of research on loot boxes

Loot boxes are digital containers of randomised rewards present in some video games which are often purchasable for real world money. Recently, concerns have been raised that loot boxes might approximate traditional gambling activities, and that people with gambling problems have been shown to spend more on loot boxes than peers without gambling problems. Some argue that the regulation of loot boxes as gambling-like mechanics is inappropriate because similar activities which also bear striking similarities to traditional forms of gambling, such as collectable card games, are not subject to such regulations. Players of collectible card games often buy sealed physical packs of cards, and these 'booster packs' share many formal similarities with loot boxes. However, not everything which appears similar to gambling requires regulation. Here, in a large sample of collectible card game players (n = 726), we show no statistically significant link between in real-world store spending on physical booster and problem gambling (p = 0.110, η2 = 0.004), and a trivial in magnitude relationship between spending on booster packs in online stores and problem gambling (p = 0.035, η2 = 0.008). Follow-up equivalence tests using the TOST procedure rejected the hypothesis that either of these effects was of practical importance (η2 > 0.04). Thus, although collectable card game booster packs, like loot boxes, share structural similarities with gambling, it appears that they may not be linked to problem gambling in the same way as loot boxes. We discuss potential reasons for these differences. Decisions regarding regulation of activities which share structural features with traditional forms of gambling should be made on the basis of definitional criteria as well as whether people with gambling problems purchase such items at a higher rate than peers with no gambling problems. Our research suggests that there is currently little evidence to support the regulation of collectable card games.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

"Show Me the Money": Preliminary Lessons from an Implementation of Intervention Tools at the Payment Gateway Level

Traditional approaches that seek to study Responsible Gambling (RG) mainly focus on evaluating platform-based intervention tools applied on gambling operator sites. This paper reports on the implementation, at the payment-solution level, of an intervention tool that gambling customers used to deposit their bets. The approach pre-commits customers to set a single-point spending limit on their payment gateway account, effectively enabling them to apply their budget setting on all gambling platforms on which they choose to play. Ten users who have used the provision for at least six months and on two different gambling platforms were selected for an in-depth interview. Based on the findings from content analysis, the article argues that payment-level intervention approach can potentially (1) provide the overall gambling population with better financial literacy regarding their gambling habits, which promotes responsible spending behaviour, (2) elevate the strain on users to set up intervention tools on every individual platform, and (3) serve as a preventive measure regardless of the existence or absence of intervention tools at gambling sites. Furthermore, the results affirm a gap in existing research and a need for comprehensive guidelines and strategies for financial institutions to positively contribute towards the agenda of RG. The findings of this study highlight the need for revisiting theoretical and philosophical foundations of intervention tool studies and gambling policymaking as well as calls for reassessing how we problematised harmful gambling. The paper contributes to the research on gambling intervention tools.

Understanding Online Voluntary Self-Exclusion in Gambling: An Empirical Study Using Account-Based Behavioral Tracking Data

Online gambling has continued to grow alongside new ways to analyze data using behavioral tracking as a way to enhance consumer protection. A number of studies have analyzed consumers that have used voluntary self-exclusion (VSE) as a proxy measure for problem gambling. However, some scholars have argued that this is a poor proxy for problem gambling. Therefore, the present study examined this issue by analyzing customers (from the gambling operator Unibet) that have engaged in VSE. The participants comprised of costumers that chose to use the six-month VSE option (n = 7732), and customers that chose to close their Unibet account due to a specific self-reported gambling addiction (n = 141). Almost one-fifth of the customers that used six-month VSE only had gambling activity for less than 24 h (19.15%). Moreover, half of the customers had less than seven days of account registration prior to six-month VSE (50.39%). Customers who use VSE are too different to be treated as a homogenous group and therefore VSE is not a reliable proxy measure for problem gambling. The findings of this research are beneficial for operators, researchers, and policymakers because it provides insight into gambling behavior by analyzing real player behavior using tracking technologies, which is objective and unbiased.

An Analysis of Consumer Protection for Gamblers Across Different Online Gambling Operators in Ireland: A Descriptive Study

The aim of the present study was to evaluate the responsible gambling tools which are available to online gamblers at Irish online gambling websites. The present study used a similar methodology to a recent study carried out on the world’s most popular websites (Bonello and Griffiths Gaming Law Review and Economics, 21, 278–285, 2017), where 50 of the most advertised online gambling websites were evaluated in relation to their responsible gambling (RG) practices. The present study evaluated 39 gambling websites with either a “.ie” or “.com/ie” domain. Each website was evaluated by checking for a number of RG practices, including presence of a dedicated RG page; age verification; access to gambling account history; the availability of RG tools, such as limit setting facilities and exclusion settings; and links to limit-setting options on the deposit page. Descriptive statistics were then performed on the results from each website. Of the 39 online gambling operators identified, 22 redirected gamblers to a “.com” domain, while 17 operators remained as a “.ie” domain. Thirty-five websites (89.7%) visited had a dedicated RG page. Responsible gambling features were evaluated and demonstrated to be available in an inconsistent manner across online gambling websites. Irish websites were shown to perform poorly in comparison with non-Irish counterparts in the provision of RG tools. The researchers of the present study are not aware of any similar studies conducted to date in Ireland.

Perspective of Internet Poker Players on Harm-Reduction Strategies: A Cross-Sectional Study

Background: Internet gambling may increase rates of gambling harm. This current study aimed to assess Internet poker players’ views on various harm-reduction (HR) strategies. It also examined differences in these views according to the games played (poker only vs. poker plus other gambling activities), indebtedness, and problem gambling severity. Methods: Internet poker players (n = 311; 94.2% Male) recruited online between 2012 and 2014 were included in the analyses and completed a survey on indebtedness, problem gambling severity index, and ten statements regarding HR features. Results: Among the whole sample, the most frequently endorsed HR strategy was setting money limits, specialized online help, and peer support forums. People who play poker only (70%) are less prone to endorse the utility of information on excessive gambling and specialized healthcare centers. No differences were found between those people with debt versus those without regarding HR assessment. Participants with severe problem gambling were more skeptical about HR strategies based on information on specialized healthcare centers. Conclusion: Setting money limits, online help, and peer support forums are the most commonly endorsed strategies. Future research is needed to evaluate the effectiveness of online harm reduction strategies.

Use of Consumer Protection Tools on Internet Gambling Sites: Customer Perceptions, Motivators, and Barriers to Use

Internet gambling has been widely legalised in recognition of its capacity to, and the importance of, providing consumer protection tools to prevent and minimise gambling-related harms. Most licensed Internet gambling sites are required to provide consumer protection tools, including activity statements, deposit limits, and time-outs (temporary self-exclusion). However, few Internet gambling customers engage with the tools. An online survey of 564 customers of Australian Internet gambling sites aimed to understand the extent to which consumer protection tools are used, characteristics of those using these tools, and the perceptions and attitudes towards tool use, including barriers to use. Most participants were aware of the tools and had accessed activity statements; few had used deposit limits (24.5%) or time-outs (8.1%) but use of these restrictive tools was higher among those at-risk of gambling problems. Satisfaction with tools was generally high among users and tools were mostly used as intended; however, only moderate changes in behaviour were reported. Participants predominately did not use the restrictive tools as they did not see these as relevant for them, and they were perceived to be intended for people with gambling problems. The findings are important to drive necessary improvements to consumer protection efforts including efforts to encourage perception that tools are relevant for all customers. Changes to current practice, including terminology and promotion of tools, are needed by Internet gambling operators and policy makers to improve the utilisation and effectiveness of consumer protection tools to enable sustainable gambling among the broader cohort of Internet gamblers.

Gambling Industry Employees' Experiences with an Onsite Responsible Gambling Program

We examined gambling venue employees' experiences with GameSense, an onsite responsible gambling information center designed to be a resource for casino employees as well as patrons. Participants included 492 employees who reported on their engagement with, and opinions and knowledge of, the GameSense information center and its staff (i.e., GameSense Advisors), as well as their own employment department and gambling involvement. A minority of participants (33.5%) reported having spoken with a GameSense Advisor about responsible gambling or problem gambling; the remaining 66.5% either did not ever speak to a GameSense Advisor or only had a casual conversation with one. Most participants (88.9%) indicated that casino patrons could use the GameSense program, but less than half (37.9%) believed that casino staff/employees could do the same. Participants generally had positive opinions about the program, endorsing positive potential impacts (e.g., "It helps people avoid gambling beyond their limits") more often than negative potential impacts (e.g., "It encourages people to gamble beyond their limits"). However, gambling venue employees with more extensive gambling histories were less likely to endorse positive potential impacts. Participants' department also was associated with GameSense experiences: those in security/surveillance were the most likely to report having interacted with GameSense Advisors (83.3%) and those in food/beverage/retail were least likely to have done so (28.6%). Some of these findings have implications for improving casino employees' experiences with the GameSense program.

Visibility of age restriction warnings, harm reduction messages and terms and conditions: a content analysis of paid-for gambling advertising in the United Kingdom

OBJECTIVE

The inclusion and design of age restriction warnings, harm reduction messages and terms and conditions (T&Cs) in gambling advertising is self-regulated in the United Kingdom. Our study examines the visibility and nature of this information in a sample of paid-for gambling adverts.

STUDY DESIGN

A content analysis of a stratified random sample of gambling adverts (n = 300) in the United Kingdom from eight paid-for advertising channels (March 2018).

METHODS

For each advert, we assessed whether any age restriction warnings, harm reduction messages and T&Cs were present. If so, visibility was scored on a five-point scale ranging from very poor (≤10% of advert space) to very good (≥26% of advert), which had high inter-rater reliability. Descriptive information on position, design and tone of language was recorded.

RESULTS

One in seven adverts (14%) did not feature an age restriction warning or harm reduction message. In adverts that did, 84% of age restriction warnings and 54% of harm reduction messages had very poor visibility. At least one in ten adverts did not contain T&Cs. In adverts that did, 73% had very poor visibility. For age restriction warnings, harm reduction messages and T&Cs, most appeared in small fonts and outside the main advert frame. Most harm reduction messages did not actually reference gambling-related harms.

CONCLUSION

Age restriction warnings, harm reduction messages and T&Cs do not always appear in paid-for gambling advertising. When they do, visibility is often very poor and the messaging not clear. The findings do not support a self-regulatory approach to managing this information in gambling adverts.

Dopaminergic signaling of uncertainty and the aetiology of gambling addiction

Although there is increasing clinical recognition of behavioral addictions, of which gambling disorder is the prototype example, there is a limited understanding of the psychological properties of (non-substance-related) behaviors that enable them to become 'addictive' in a way that is comparable to drugs of abuse. According to an influential application of reinforcement learning to substance addictions, the direct effects of drugs to release dopamine can create a perpetual escalation of incentive salience. This article focusses on reward uncertainty, which is proposed to be the core feature of gambling that creates the capacity for addiction. We describe the neuro-dynamics of the dopamine response to uncertainty that may allow a similar escalation of incentive salience, and its relevance to behavioral addictions. We review translational evidence from both preclinical animal models and human clinical research, including studies in people with gambling disorder. Further, we describe the evidence for 1) the effects of the omission of expected reward as a stressor and to promote sensitization, 2) the effect of the resolution of reward uncertainty as a source of value, 3) structural characteristics of modern Electronic Gaming Machines (EGMs) in leveraging these mechanisms, 4) analogies to the aberrant salience hypothesis of psychosis for creating and maintaining gambling-related cognitive distortions. This neurobiologically-inspired model has implications for harm profiling of other putative behavioral addictions, as well as offering avenues for enhancing neurological, pharmacological and psychological treatments for gambling disorder, and harm reduction strategies for EGM design.

Studying Gambling Behaviors and Responsible Gambling Tools in a Simulated Online Casino Integrated With Amazon Mechanical Turk: Development and Initial Validation of Survey Data and Platform Mechanics of the Frescati Online Research Casino

Introduction: Online gambling, popular among both problem and recreational gamblers, simultaneously entails both heightened addiction risks as well as unique opportunities for prevention and intervention. There is a need to bridge the growing literature on learning and extinction mechanisms of gambling behavior, with account tracking studies using real-life gambling data. In this study, we describe the development and validation of the Frescati Online Research Casino (FORC): a simulated online casino where games, visual themes, outcome sizes, probabilities, and other variables of interest can be experimentally manipulated to conduct behavioral analytic studies and evaluate the efficacy of responsible gambling tools. Methods: FORC features an initial survey for self-reporting of gambling and gambling problems, along with several games resembling regular real-life casino games, designed to allow Pavlovian and instrumental learning. FORC was developed with maximum flexibility in mind, allowing detailed experiment specification by setting parameters using an online interface, including the display of messages. To allow convenient and rapid data collection from diverse samples, FORC is independently hosted yet integrated with the popular crowdsourcing platform Amazon Mechanical Turk through a reimbursement key mechanism. To validate the survey data quality and game mechanics of FORC, n = 101 participants were recruited, who answered an questionnaire on gambling habits and problems, then played both slot machine and card-draw type games. Questionnaire and trial-by-trial behavioral data were analyzed using standard psychometric tests, and outcome distribution modeling. Results: The expected associations among variables in the introductory questionnaire were found along with good psychometric properties, suggestive of good quality data. Only 6% of participants provided seemingly poor behavioral data. Game mechanics worked as intended: gambling outcomes showed the expected pattern of random sampling with replacement and were normally distributed around the set percentages, while balances developed according to the set return to player rate. Conclusions: FORC appears to be a valid paradigm for simulating online gambling and for collecting survey and behavioral data, offering a valuable compromise between stringent experimental paradigms with lower external validity, and real-world gambling account tracking data with lower internal validity.

A Perspective on Age Restrictions and Other Harm Reduction Approaches Targeting Youth Online Gambling, Considering Convergences of Gambling and Videogaming

Internet gambling has become a popular activity among some youth. Vulnerable youth may be particularly at risk due to limited harm reduction and enforcement measures. This article explores age restrictions and other harm reduction measures relating to youth and young adult online gambling. A systematic rapid review was conducted by searching eight databases. Additional articles on online gambling (e.g., from references) were later included. To place this perspective into context, articles on adult gambling, land-based gambling, and substance use and other problematic behaviors were also considered. Several studies show promising findings for legally restricting youth from gambling in that such restrictions may reduce the amount of youth gambling and gambling-related harms. However, simply labeling an activity as "age-restricted" may not deter youth from gambling; in some instances, it may generate increased appeal for gambling. Therefore, advertising and warning labels should be examined in conjunction with age restrictions. Recommendations for age enforcement strategies, advertising, education, and warning labels are made to help multiple stakeholders including policymakers and public health officials internationally. Age restrictions in online gambling should consider multiple populations including youth and young adults. Prevention and harm reduction in gambling should examine how age-restriction strategies may affect problem gambling and how they may be best enforced across gambling platforms. More research is needed to protect youth with respect to online gambling.

Predicting Limit-Setting Behavior of Gamblers Using Machine Learning Algorithms: A Real-World Study of Norwegian Gamblers Using Account Data

Player protection and harm minimization have become increasingly important in the gambling industry along with the promotion of responsible gambling (RG). Among the most widespread RG tools that gaming operators provide are limit-setting tools that help players limit the amount of time and/or money they spend gambling. Research suggests that limit-setting significantly reduces the amount of money that players spend. If limit-setting is to be encouraged as a way of facilitating responsible gambling, it is important to know what variables are important in getting individuals to set and change limits in the first place. In the present study, 33 variables assessing the player behavior among Norsk Tipping clientele (N = 70,789) from January to March 2017 were computed. The 33 variables which reflect the players’ behavior were then used to predict the likelihood of gamblers changing their monetary limit between April and June 2017. The 70,789 players were randomly split into a training dataset of 56,532 and an evaluation set of 14,157 players (corresponding to an 80/20 split). The results demonstrated that it is possible to predict future limit-setting based on player behavior. The random forest algorithm appeared to predict limit-changing behavior much better than the other algorithms. However, on the independent test data, the random forest algorithm’s accuracy dropped significantly. The best performance on the test data along with a small decrease in accuracy in comparison to the training data was delivered by the gradient boost machine learning algorithm. The most important variables predicting future limit-setting using the gradient boost machine algorithm were players receiving feedback that they had reached 80% of their personal monthly global loss limit, personal monthly loss limit, the amount bet, theoretical loss, and whether the players had increased their limits in the past. With the help of predictive analytics, players with a high likelihood of changing their limits can be proactively approached.

The effects of a mandatory play break on subsequent gambling among Norwegian video lottery terminal players

BACKGROUND AND AIMS

Responsible gambling (RG) tools and initiatives have been introduced by social RG operators as a means to help prevent problem gambling. One such initiative is the use of mandatory play breaks (i.e., forced session terminations). Recommendations by RG experts for gambling operators to implement mandatory play breaks appear to be intuitively sensible but are not evidence-based.

METHODS

The present authors were given access by the Norwegian gambling operator Norsk Tipping to data from 7,190 video lottery terminal (VLT) players who gambled between January and March 2018. This generated 218,523 playing sessions for further analysis. Once a gambling session reaches a 1-hr play duration, a forced session termination of 90 s comes into effect. This study evaluated the effect of mandatory play breaks on subsequent gambling.

RESULTS

Compared to similar sessions identified using a matched-pairs design, results demonstrated that there was no significant effect of the forced termination regarding the amount of money staked in the subsequent gambling session or on the time duration of the subsequent gambling session.

CONCLUSIONS

Although expenditure was higher in the subsequent 24 hr for terminated sessions, this is likely due to higher intensity gamblers being more likely to trigger mandatory breaks. Implications of these findings are discussed.

Effectiveness of At-Risk Gamblers' Temporary Self-Exclusion from Internet Gambling Sites

To prevent risks associated with online gambling, many jurisdictions propose self-exclusion strategies as a part of a responsible gambling policy. To protect online gamblers, French law provides for a 7-day temporary non-reducible and voluntary self-exclusion measure that applies only to select websites. The objective of our study was to evaluate the effectiveness of this self-exclusion measure for at-risk online gamblers. It was an experimental randomized controlled trial targeted at risk prevention. The main outcomes were the money wagered and time spent gambling assessed 15 days (short-term) and 2 months (medium-term) after the implementation of the self-exclusion measure. The effectiveness of self-exclusion was also compared according to the gambling type (pure chance games, such as lottery or scratch tickets, skill and chance bank games such as sports betting or horserace betting, and skill and chance games such as poker). Sixty participants were randomly assigned to the experimental condition (n = 30; with the implementation of a self-exclusion measure) or control condition (n = 30). The randomization was stratified according to their favorite game [pure chance games (n = 20), skill and chance bank games (n = 20), and skill and chance social games (n = 20)]. The results revealed that self-exclusion had no short-term impact-but did have a medium-term impact-on gambling habits. After 2 months, the gambling-related cognitions ("illusion of control" and "the perceived inability to stop gambling") and the subscale "desire" of the Gambling Craving Scale (GACS) have decreased. Participants' opinions about the impact and effectiveness of self-exclusion were discussed. To conclude, it appeared that temporary self-exclusion is an interesting tool to protect online gamblers from excessive practices, but several modifications have to be made to improve its effectiveness and use.

Is there a need for personal gambling licences?

Licensing is currently the most popular option among regulators for controlling gambling operations. However, approximately 20% of operators are still public monopolies. Many forms of gambling (especially lotteries) are government operated even in countries with a licensing system. This creates an inherent conflict of interest, given that government is supposed to protect the well-being of its citizenry and to reap the benefits of gambling at the same time. At least in the gambling monopoly, however, addressing the unavoidable harm that results from gambling should be a priority. Industry self-regulation and reliance on "responsible gambling" rely too much on individuals to control their own gambling. It is suggested in this contribution that it is possible to provide more comprehensive consumer protection, recognising both the duty of governments to take care of their own citizens and the fact that industry self-regulation is not enough. Pre-commitment cards have been tested in various contexts, and have shown promise in terms of providing tools for individuals to restrict their own gambling. However, given the known shortcomings such as allowing the use of other cards that are not one's own, and other venues, it is clear that in themselves they do not guarantee effective prevention. Personal licensing is therefore explored as a move forward in this literature-based discussion. Although the system may be applicable to other contexts, the focus is on the Nordic countries. Given that the underlying justification for gambling monopolies is to control gambling-related harm, in the cases of Finland and Norway licensing could be combined with loyalty cards introduced by monopoly operators. This would provide a feasible alternative to current practices of responsible gambling.

Effects of prevention and harm reduction interventions on gambling behaviours and gambling related harm: An umbrella review

BACKGROUND

Harms related to gambling have been found not only to affect problem gamblers, but also to occur amongst low- and moderate-risk gamblers. This has resulted in calls for a public health approach to address a possible 'prevention paradox' in gambling related harm. The aim of this study was to evaluate the systematic review evidence base on the effects of prevention and harm reduction interventions on gambling behaviours, and gambling related harm. We also aimed to examine differential effects of interventions across socio-demographic groups.

METHODS

Systematic methods were used to locate and evaluate published systematic reviews of prevention and harm reduction interventions. We designed the review using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Equity extension Guidelines. Four databases were searched from their start date until May 2018. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2).

RESULTS

Ten systematic reviews were identified reporting 55 unique relevant primary studies. Much of the review evidence-base related to pre-commitment and limit setting (24%), self-exclusion (20%), youth prevention programmes (20%), and machine messages/feedback (20%). The effectiveness of harm reduction interventions are limited by the extent to which users adhere to voluntary systems. Less than half of studies examining youth prevention programmes demonstrated positive effects on behaviour. No review extracted data or reported on the differential effects of intervention strategies across sociodemographic groups. The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted.

CONCLUSIONS

The evidence base is dominated by evaluations of individual-level harm reduction interventions, with a paucity of research on supply reduction interventions. Review conclusions are limited by the quality and robustness of the primary research. Future research should consider the equity effects of intervention strategies.