The Role of Virtual Communities in Gambling and Gaming Behaviors: A Systematic Review

Depression, anxiety, and stress in young adult gamers and their relationship with addictive behaviors: A latent profile analysis

BACKGROUND

There is limited research examining latent profiles of gamers based on emotional variables, which has implications for prevention efforts. The study sought to identify young adult gamer profiles based on depression, anxiety, and stress, and to examine differences between the latent profiles in other addictive behaviors (i.e., tobacco, alcohol, cannabis, illegal substance use, gaming, and gambling).

METHODS

A total of 1209 young adults (Mage = 19.37, SD = 1.62; 55.3%males) reported past-year gaming. A latent profile analysis (LPA) was performed to identify distinct profiles, and a set of ANOVA and chi-square analyses characterized the profiles in terms of sociodemographic, addictive behaviors, and emotional variables.

RESULTS

LPA suggested a three-profile solution: profile 1 (n = 660, 'low emotional distress'), profile 2 (n = 377, 'moderate emotional distress'), and profile 3 (n = 172, 'high emotional distress'). Participants with 'moderate' and 'high emotional distress' were mostly women, showed greater gaming severity, higher prevalence of past-month substance use (i.e., tobacco and illegal drugs), and greater consequences of alcohol use.

LIMITATIONS

The cross-sectional nature of the study and sample being university students.

CONCLUSION

Findings revealed three distinct profiles of gamers, which differed in emotional, gaming, and substance use severity. Transdiagnostic prevention programs have the potential to provide significant benefits to college students by addressing the core processes (e.g., emotion regulation) that underlie substance use and gaming.

Colliding harms of gambling and gaming: A four-wave longitudinal population study of at-risk gambling and gaming in Finland

Aims: Both gambling and digital gaming are growing in popularity and there is ongoing discussion about their convergence. This population-based longitudinal survey study investigated how gambling and digital gaming types contribute to at-risk gambling and gaming. Methods: The study was based on a representative sample of 18-75-year-olds from mainland Finland. Survey data were collected at 6-month intervals in 2021-2022, starting in April 2021. Of original T1 respondents, 58.95% took part in all four time points. In total, 3,608 observations from 902 individuals were analysed. Outcome measures were at-risk gambling and gaming based on the Problem Gambling Severity Index and the Internet Gaming Disorder Test. Various types of gambling and gaming were investigated. Results: Population-averaged models showed that different forms of gambling were associated with a higher risk of at-risk gaming. Online casino games were associated with the highest likelihood of at-risk gambling and gaming. Prevalence of digital gaming problems was low. Hybrid models were used to investigate the longitudinal within-person and between-person effects of gambling and gaming activities. Online casino games and offline slot machines increased at-risk gambling. Microtransactions within digital games increased at-risk gambling and gaming over time, but the amount of money spent on digital gaming was small compared to gambling. Conclusions: Our results underline the risks of EGMs and online gambling for the participants. Although gambling and gaming are converging, harm is mostly based on gambling.

Associations between Marketing Exposure, In-game Purchases, Problem Gaming, Simulated Gambling, and Psychological Distress among Adolescents

This study examined the relationships between marketing exposure, in-game purchase, problem gaming, online simulated gambling game playing, and psychological distress. Data were obtained from a sample of 2,595 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted in 2020. The results indicated that 94% of adolescents engage in online gaming, with 38% making in-game purchases, and 9% playing online simulated gambling games. The multiple regression results showed that adolescents who are exposed to higher levels of gaming marketing, influenced by advertising effects, involved in in-game purchases, and have lower levels of active parental mediation were more likely to experience problem gaming. Adolescents who have increased exposure to gambling game marketing, are influenced by advertising effects, are involved in in-game purchases, and who are experiencing problem gaming were more likely to engage in online simulated gambling game playing and token purchasing. Involvement in in-game purchases, problem gaming, and playing online simulated gambling games were associated with higher levels of psychological distress and poor sleep quality. In conclusion, the results of this study link adolescents' exposure to marketing with their involvement in in-game purchases, problem gaming, and engaging in online simulated gambling.

Online communities come with real-world consequences for individuals and societies

Online communities have become a central part of the internet. Understanding what motivates users to join these communities, and how they affect them and others, spans various psychological domains, including organizational psychology, political and social psychology, and clinical and health psychology. We focus on online communities that are exemplary for three domains: work, hate, and addictions. We review the risks that emerge from these online communities but also recognize the opportunities that work and behavioral addiction communities present for groups and individuals. With the continued evolution of online spheres, online communities are likely to have an increasingly significant role in all spheres of life, ranging from personal to professional and from individual to societal. Psychological research provides critical insights into understanding the formation of online communities, and the implications for individuals and society. To counteract risks, it needs to identify opportunities for prevention and support.

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.

Gambling Motives and Offshore Gambling: A Finnish Population Study

The rise of online gambling has drawn attention towards offshore gambling. Currently there is lack of evidence on reasons and motivations to gamble on offshore gambling sites. This study investigated the general gambling motives of onshore and offshore gamblers, and the reasons to gamble on offshore gambling sites. The study used binary logistic regression model to analyze the data from Finnish Gambling 2019 population survey including adult past-year online gamblers (n = 1,422). The validated measure for problem gambling severity (PGSI, Problem Gambling Severity Index) was used. Furthermore, data-driven qualitative analysis was used to form categories for the reasons to gamble on offshore gambling sites. Offshore gambling was more common among men and younger age groups than among women or older age groups. Offshore gamblers gambled less often for money or worthy causes than onshore gamblers. Furthermore, offshore gamblers had more different types of motives to gamble, they gambled more frequently and had higher problem gambling severity scores (PGSI) than onshore gamblers. Finally, the most common reasons to gamble offshore were: (1) larger game supply and game features, (2) benefits, bonuses, and the usability of the website, and (3) inner motivation. Offshore gambling is characterized with intensity and diversity of gambling behavior and motives, and it poses a risk especially for young men.

Two for the GOES: Exploring Gambling Outcome Expectancies Scores Across Mixed and Offline-Only Gamblers in Relation to Problem Gambling Risk Status

As online gambling becomes more prevalent, understanding the motives of online gamblers has become a key focus for research and practice. The aim of this study was to understand differences in gambling-related outcome expectancies between mixed (both online and offline) gamblers and offline-only gamblers, by incorporating gambling harm risk categories from the problem gambling severity index (PGSI). This study comprised a secondary data analysis of the 2015 Northern Territory Gambling Prevalence and Wellbeing Survey. A sample of 1207 individuals in the Northern Territory who had reported gambling at least once in the previous 12 months were used in the analyses. General linear and structural equation modelling were used to ascertain differences in gambling outcome expectancies, in relation to gambling modality (i.e., mixed, offline-only) and PGSI scores. Mixed gamblers tended to score higher on all outcome expectancies than their offline-only counterparts. Outcome expectancy scores were higher in individuals in higher-risk PGSI categories. The escape outcome expectancy was dependent on both modality and risk category. Invariance testing of a low and problem gambling risk subsample revealed differential relationships for both the escape and excitement outcome expectancies for mixed and offline-only gamblers. The results provide an important contribution to the existing literature regarding motivation and outcome expectancies in relation to gambling modality and problem gambling severity. The findings highlight the importance of considering both gambling outcome expectancies and modality when considering problem gambling.

The influencing factors of game brand loyalty

Our research aims to investigate the impact mechanism of brand loyalty among gamers during the gaming process within the framework of brand loyalty theory and cognitive theory. We surveyed game players from Zhejiang Province, China. The research methods include a questionnaire survey and structural equation modelling. Results show that game experience, interaction, and impression are positively correlated with game trust, while game trust is positively correlated with game brand loyalty. Game trust, as a mediator variable, plays a complete mediation role. The clustering results of player gender and age as moderating effects are not significant. Based on the analysis results, we have suggested corresponding policy recommendations and reflections. Our research contributes to the analysation of impact mechanism of brand loyalty during the gaming process through the establishment of a structural equation model and provides suggestions and reflections on the development of the gaming industry.

Screened realities: a Grounded Theory exploration of gaming disorder dynamics among Iranian male adolescents

Introduction

The increasing prevalence of gaming Disorder (GD) among adolescents has become a global concern. Despite the rising number of studies investigating GD, the cultural and socio-economic factors influencing GD with a qualitative approach are scarce. This study aims to explore the underlying factors, processes, and consequences of GD among Iranian male adolescents and contextual factors related to GD within Iran's unique socio-cultural and psychological tapestry.

Methods

The study used a qualitative design based on the Grounded Theory Method (GTM). The researchers conducted semi-structured interviews with 13 male adolescents aged 15-18 who Dignasoed according to DSM-5 and ICD-11 criteria. The interviews were transcribed and analyzed using the GTM approach, which involves open, axial, and selective coding.

Results

The study revealed nine main themes and a core category: (1) interaction seeking, (2) encounter and familiarize with games, (3) games attraction, (4) Socialization, (5) game careerism, (6) dexterity, (7) lack and compensation, (8) physical harm, territorial-cultural barrier, (9) second life, and ''life crafting'' as the core category.

Discussion

The study's findings provide valuable insights into the cultural and socio-economic factors influencing GD among Iranian male adolescents. For example, Iran's economic conditions make adolescents choose gaming as their job and try to earn money in this way, which makes them more dependent on gaming. On the other hand, communities related to games play an essential role in the identity development of adolescents with GD.

Keeping you connected or keeping you addicted? Weekly use of social media platforms is associated with hazardous alcohol use and problem gambling among adults

AIMS

A wide variety of social media platforms exist, each offering tailored solutions to attract specific target audiences based on their social media needs and interests. This diversity may pose a risk factor for the development or perpetuation of harmful behaviors. Research has established a connection between social media use and increased health risk behaviors. This six-wave exploratory longitudinal study investigated the associations between active social media use, hazardous alcohol use, and problem gambling among adult social media users.

METHODS

Data were collected via surveys in 6-month intervals, starting in March-April 2021 (T1: N = 1530; Mage = 46.67; SD = 16.42; 50.33% male). Of the T1 respondents, 58.10% participated in T6 (n = 889). Measures included the frequency of use of different social media platforms, the 3-item Alcohol Use Disorders Identification Test (AUDIT-C), and the Problem Gambling Severity Index (PGSI). Hybrid multilevel regression models were used for analyses.

RESULTS

We found positive within-person effects of weekly Facebook use and between-person effects of weekly use of Facebook, TikTok, and gambling-related online communities on drinking. These results suggest an increase in hazardous alcohol consumption over time among the platforms' active users. Weekly Instagram use had a negative between-person effect on hazardous alcohol use. Individuals using TikTok or gambling communities weekly were more prone to problem gambling compared to non-weekly users.

CONCLUSIONS

There are risks involved in the active use of some social media services among adult users. Prevention work, including digital health interventions, should be targeted according to the appropriate user group.

Power, intersectionality and stigma: Informing a gender- and spatially-sensitive public health approach to women and gambling in Great Britain

In Britain more men participate in gambling than women, although the gender gap is narrowing; and online gambling is increasing among women and men. Gambling practices differ between men and women but also between different groups of women, with evidence that younger women are diversifying to gamble in different ways from older women. Complex and powerful spatial, socio-cultural and economic forces shape women's experiences of gambling, the problems gambling may cause, and wider societal efforts to minimise these harms. This paper presents the findings of a Rapid Evidence Assessment (REA) of research on women and gambling and conceptual reflections on these findings to argue for greater attention to the gendered and spatial dimensions of gambling in three ways. First, we discuss the geographical focus and scope of the research we reviewed on women and gambling; second, we analyse the changing geographies of where women gamble; and finally, we consider how qualitative notions of space as experiential and co-constitutive can offer a more nuanced conceptual framework for understanding women's lived experience of gambling and gambling harm. We identify areas for further research on gambling and gambling harm that attends to gendered and spatial dimensions of gambling, including online spaces; the intersectional dynamics that shape gambling practice and gambling harms; and the experiences of those affected by others' gambling.

Loot box purchasing and indebtedness: The role of psychosocial factors and problem gambling

Introduction

Loot boxes are increasingly common random-reward monetization mechanisms in digital games. They are popular among gamblers and pose various risks due to their gambling-like nature, but little is known about psychosocial vulnerabilities and financial consequences of purchasing them. This article examined psychosocial associations with self-reported increase in loot box purchasing and indebtedness among past-year gamblers during the COVID-19 pandemic.

Methods

Cross-sectional survey data were collected in April 2021 from Finnish, Swedish, and British past-year gamblers aged 18 to 75 (n = 2,022). Measures of loneliness, psychological resilience, and problem gambling were studied in relation to loot box purchasing and indebtedness. Structural equation modeling was used as an analytical technique.

Results

Loneliness was positively associated with self-reported increase in loot box purchasing. No evidence was found regarding the protective role of psychological resilience in loot box purchasing. Increased loot box purchasing was associated with problem gambling. Problem gambling mediated the relationship between loot box purchasing and indebtedness.

Conclusions

The findings bring valuable insight into the psychosocial vulnerabilities and financial consequences in loot box purchasing. Loot box purchasing can add to one's financial strain particularly among vulnerable individuals such as problem gamblers, making it crucial to regulate such monetization practices.

Psychosocial Perspective on Problem Gambling: The role of Social Relationships, Resilience, and COVID-19 Worry

The COVID-19 pandemic has amplified several psychosocial risks and problem behaviors among vulnerable individuals. Given that gambling has high addictive potential, it is important to consider the underlying mechanisms of problem gambling. This study examined psychosocial factors associated with pandemic-time problem gambling.Cross-sectional data were gathered via an online survey of 18-75-year-old Finnish, Swedish, and British respondents (n = 2,022) who reported having gambled at least occasionally during the pandemic. Measures included problem gambling, loneliness, COVID-19 worry, social support, and psychological resilience. Control variables included gender, age, and education. Structural equation modeling was used as an analytical technique.Loneliness was found to be associated with problem gambling. While COVID-19 worry was not directly associated with problem gambling, it predicted higher loneliness, which in turn was associated with problem gambling. Evidence was not found regarding the protective role of resilience or social support in problem gambling. However, social support was found to be associated with higher problem gambling severity. Male gender and younger age were associated with problem gambling.The results bring insight into underlying vulnerabilities regarding problem gambling during the pandemic. More focus should be placed on the quality and sources of social support, as well as on how psychosocial risk and protective factors might work differently among different populations of gamblers.

Gambling and gaming during COVID-19: The role of mental health and social motives in gambling and gaming problems

BACKGROUND

The uncertain and stressful global situation caused by the COVID-19 pandemic has the potential to cause anxiety and impact people's mental health. Simultaneously, social distancing policies have isolated people from their normal social interactions. These societal changes have inevitably influenced gambling and gaming practices, and many people may have turned to betting or gaming as a means of social exchange. This study examined the influence of COVID-19 anxiety on increased mental health problems and their relationship to gambling and gaming problems. The mediating role of social motives for gambling and gaming was also investigated.

MATERIAL AND METHODS

Finnish adults (N = 1530; Mage = 46.67; 50.33% male) were recruited from a volunteer participant panel to participate in a survey study. COVID-19 anxiety was assessed using a scale adapted from the Spielberger State-Trait Anxiety Inventory. Mental health problems were evaluated with the five-item Mental Health Inventory. Gambling problems were measured using the Problem Gambling Severity Index, and gaming problems were measured with the Internet Gaming Disorder Test. Social motives for gaming were evaluated using a single-item measure. Analyses used generalised structural equation modelling.

RESULTS

COVID-19 anxiety predicted increased mental health problems, which were associated with heightened gambling and gaming problems. Social motives for gambling and gaming were a significant mediator, suggesting that gambling and gaming problems are emphasized markedly among those who are socially motivated by and involved in such games.

CONCLUSIONS

Mental health problems experienced during the pandemic and the social properties of games might accentuate gambling and gaming problems.

Online Communities and Gambling Behaviors — a Systematic Review

Purpose of Review

The internet and virtual environments have enabled the formation of online communities around a variety of interests. Online communities focused on gambling are increasingly popular and attract users to interact and share ideas and experiences with likeminded others. This study reviews evidence from the latest research examining the role of online communities in gambling behaviors and gambling problems.

Recent Findings

A systematic literature search resulted in 17 studies. Research shows that online communities are used for diverse reasons like discussing gambling experiences and problems, sharing tips, and celebrating winnings with others. These reasons of online community use can have both adaptive and maladaptive implications. Online gambling communities often grow through social means by inviting friends or social media contacts to join. Active users of online gambling communities are more likely at-risk or problem gamblers.

Summary

Online communities have an increasingly central role in learning about gambling, continuing, and spreading of gambling behaviors. Participation in communities that support harmful gambling habits involves risks for problem gambling.

Life Satisfaction and Online-Gambling Communities: A Cross-National Study of Gambling Activities Among Young Finnish, American, South Korean and Spanish People

Gambling is a potential hazard to life satisfaction, yet peer relationships online might buffer this risk. This study analyzed the ways problem gambling is associated with life satisfaction as well as the extent to which the use of online-gambling community participation and, alternatively, offline belonging affect this association. A web-based survey was conducted among people aged 15–25 in Finland (n = 1,200), the United States (n = 1,212), South Korea (n = 1,192), and Spain (n = 1,212). The main variables included life satisfaction, problem gambling measured by the South Oaks Gambling Screen, online-gambling community participation, and offline belonging. Controls included compulsive internet use, hazardous drinking, psychological distress, income, age, and gender. Linear regression models were employed with country interactions. Results showed problem gambling had a negative relationship with life satisfaction, but the association was explained by control variables. Online-gambling community participation had a positive relationship with life satisfaction, especially among pathological gamblers who had poor offline relationships. Country comparisons revealed that the direct effect of excessive gambling and the compensating effect of online-gambling communities were most prominent in Finland.

The Use of Social Media in Research on Gambling: a Systematic Review

Purpose of Review

Social media enables a range of possibilities in the way gamblers and gambling operators interact and content communicate with gambling. The purpose of this systematic review was to synthesise the extant literature to identify the ways in which social media has been investigated in the context of gambling.

Recent Findings

A systematic review of the literature identified 41 papers that collected primary data pertinent to gambling and social media from multiple disciplines. These papers broadly fell into three themes: communication, community and calculation (of sentiment). Papers on communication focused on the content of gambling advertising on social media and the impact on people exposed to it. Studies of gambling communities studied the activity and structures of discussion groups on social media concerning recreational or problematic gambling. Papers on calculation collated social media data to assess sentiment and compared it against betting odds.

Summary

There is an emerging multidisciplinary literature that has looked at the use of social media in relation to gambling. There is preliminary evidence that the content and the reach of gambling advertising on social media is a source of concern, particularly for younger people. The themes discussed on gambling support forums appear to be common across communities, focusing on negative emotions, recovery, addictive products and financial support. Using social media to assess sentiment appears to be particularly effective at identifying potential upsets in sporting matches. Future suggestions for research are explored.

Online betting intensity is linked with Extraversion and Conscientiousness

INTRODUCTION

Extraversion and Conscientiousness are well-studied personality traits associated with reward processing and goal prioritization, respectively, and bear on individual differences in financial risk-taking. Using unique large datasets, we investigated the link between these traits and male online gamblers' actual betting participation and intensity.

METHOD

We combined datasets containing online horse betting data (during 2015-2016) from the Finnish monopoly betting company, administrative registry data from Statistics Finland, and personality trait measures from the Finnish Defence Forces corresponding to Extraversion and Conscientiousness as defined in the five-factor model. We modelled associations between these traits and betting participation (n = 471,968) and intensity (n = 11,217) among male horse bettors (age = 36-53).

RESULTS

Controlling for demographics and IQ, individuals scoring high on Conscientiousness (or Extraversion) were less (or more) likely to bet and less (or more) intensive bettors-even when personality was measured 16-34 years before betting occurred. One SD personality score increase represented an annual decrease (Conscientiousness) or increase (Extraversion) of €570-754 in spending.

CONCLUSIONS

Extraversion and Conscientiousness are implicated in real-life financial behavior with tangible consequences for individuals. These effects are stronger than for many known demographic variables used in gambling studies and persist up to 34 years after personality has been measured.

Social Ecological Model of Problem Gambling: A Cross-National Survey Study of Young People in the United States, South Korea, Spain, and Finland

Problem gambling among young people is an emerging trend globally. The online environment in particular offers various possibilities for gambling engagement. This is the first cross-national survey study using the social ecological model to analyze problem gambling, especially in the online context. The study aimed to analyze how different social ecological spheres explain problem gambling. Participants were young people aged 15–25 in the United States (n = 1212), South Korea (n = 1192), Spain (n = 1212), and Finland (n = 1200). The South Oaks Gambling Screen (SOGS) instrument measured problem gambling. The regression models analyzed problem gambling with measures of intrapersonal, interpersonal, organizational, and societal spheres. Spanish participants had the highest SOGS score for problem gambling. In all countries, the variations in problem gambling were best explained by the organizational sphere measures (26%) when compared to the intrapersonal (11%), interpersonal (5%), and societal (3%) spheres. In the full model, the organizational sphere measures had strong associations with problem gambling. These included consumer debt, online gambling community participation, online casino participation, and exposure to online pop-up advertisements. Problem gambling was also associated with conformity to group norms in the interpersonal sphere, and male gender and impulsivity in the intrapersonal sphere. Cross-national results were similar in different countries. Within the final model, gambling community participation had the strongest association with problem gambling (β = 0.23, p < 0.001). The online context plays a major role in problem gambling behavior. The social ecological model is a useful tool for tackling problem gambling and developing preventative measures.

Online Relationships and Social Media Interaction in Youth Problem Gambling: A Four-Country Study

The objective of this study was to examine if belonging to online communities and social media identity bubbles predict youth problem gambling. An online survey was administered to 15–25-year-old participants in the United States (N = 1212), South Korea (N = 1192), Spain (N = 1212), and Finland (N = 1200). The survey measured two dimensions of online behavior: perceived sense of belonging to an online community and involvement in social media identity bubbles. Belonging to an online community was examined with a single item and involvement in social media identity bubbles was measured with the six-item Identity Bubble Reinforcement Scale. The South Oaks Gambling Screen was used to assess problem gambling. Statistical analyses utilized linear regression modeling. According to the analyses, strong sense of belonging to an online community was associated with higher problem gambling, but the association was observed mainly among those young individuals who were also involved in social media identity bubbles. For those youths who did not indicate identity bubble involvement, online relationships appeared to function as those offline. Some differences across the four countries were observed but overall, the results indicate that social media identity bubbles could partly explain the harmful influence that some online relations have on youth behavior.

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.