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Dobbie F, Miller M, Wardle H, Dahlby L, Weir C, Niven A, Stoddart A, Griffiths D, Lee A, Good S, Noble L, White J. Protocol for a pilot cluster randomised controlled trial of PRoGRAM-A (preventing gambling-related harm in adolescents): a secondary school-based social network intervention. Pilot Feasibility Stud 2024; 10:109. [PMID: 39138530 PMCID: PMC11321010 DOI: 10.1186/s40814-024-01537-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND In the UK, recent evidence of young people and gambling indicates a higher prevalence of gambling in comparison to other addictive behaviours. Engaging in gambling-related behaviour at a young age is associated with short and long-term consequences, including financial, emotional, academic, interpersonal, and physical and mental health detriments; otherwise known as gambling-related harms (GRH). Given the unique vulnerability of this younger group, early interventions aimed at delaying or preventing gambling are critical. PRoGRAM-A (Preventing Gambling-Related Harm in Adolescents) is a school-based, social network intervention to protect young people from future GRH, by delaying or preventing gambling experimentation. METHODS Pilot cluster RCT with an embedded process evaluation and health economic scoping study. PARTICIPANTS PRoGRAM-A will be delivered in four schools, with two control schools acting as a comparator. All are secondary schools in Scotland. Baseline surveys were conducted with students in S3 (ages 13-14). Follow-up surveys were conducted with the same cohort, six months post-baseline. INTERVENTION PRoGRAM-A trainers will deliver a 2-day, out-of-school training workshop to Peer supporters. Peer supporters will be nominated by peers among their school year group (S3, age 13-14). Workshops will provide peer supporters with information on four gambling-related topics: (1) what is gambling? (2) gambling and gaming, (3) gambling marketing, (4) identifying harm and reducing risk. Peer supporters will disseminate the information (message diffusion) they have learned among their friends and family over a 10-week period. After the 2-day workshop, PRoGRAM-A trainers will conduct × 3 in-school follow-up sessions with peer supporters to offer support, encouragement, and advice to Peer Supporters as well as monitor and explore the extent of their message diffusion. PRIMARY OUTCOME The primary outcome of the pilot cluster RCT (cRCT) will be whether progression to a phase III RCT is justified. DISCUSSION This will be the first pilot cluster RCT (cRCT) of an intervention to prevent gambling-related harms among young people within the UK. If findings indicate feasibility and acceptability, funding will be sought for a phase III RCT of effectiveness. TRIAL REGISTRATION Researchregistry8699. Registered 21st February 2023.
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Affiliation(s)
- Fiona Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | | | - Heather Wardle
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Lucia Dahlby
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Angela Niven
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - David Griffiths
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Ashley Lee
- Evidence to Impact, 21B Somerset Square, Nailsea, Bristol, UK
| | - Sally Good
- Evidence to Impact, 21B Somerset Square, Nailsea, Bristol, UK
| | - Leon Noble
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - James White
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
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Pitt H, McCarthy S, Randle M, Arnot G, Daube M, Thomas S. "It's changing our lives, not for the better. It's important that we have a say". The role of young people in informing public health and policy decisions about gambling marketing. BMC Public Health 2024; 24:2004. [PMID: 39060997 PMCID: PMC11282717 DOI: 10.1186/s12889-024-19331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Marketing has a significant impact on the normalisation of gambling for youth across the globe. This has included shaping positive attitudes towards gambling, as well as increasing the social and cultural acceptance of gambling - particularly aligned with valued activities such as sport. Because of this, public health experts argue that gambling marketing poses a significant risk to the health and wellbeing of youth. While young people are increasingly exposed to, and impacted by marketing for gambling products, they are rarely consulted about policy issues and options. This study aimed to explore young Australians' perceptions of current policy responses to gambling advertising, whether they thought young people should be involved in discussions and decisions about gambling marketing regulations, and their perceptions of the duty of governments to protect young people from gambling industry marketing strategies. METHODS Qualitative focus groups (n = 22) were held with n = 64, 12-17 year olds in the Australian states of Victoria and New South Wales. Participants were asked to reflect on current gambling policies, particularly relating to marketing, what they thought should be done about gambling marketing, and if and how young people should be included in public health responses to gambling. An interpretivist 'Big Q' approach to reflexive thematic analysis was used. RESULTS Young people highlighted the need for more effective regulations around the content and frequency of gambling marketing. They also wanted to see more realistic representations of the negative impacts of gambling to counter persistent positive commercial marketing messages. Most thought that young people should be given an opportunity to have a say about responses to gambling due to their unique experiences. Participants identified mechanisms to increase young people's engagement in decision making, such as direct lines of communication to different levels of government, involvement in research, and diversifying ways of engagement. Specific recommendations included more regulatory action such as bans on gambling advertising. CONCLUSIONS Creating formal structures that facilitate the inclusion of young people's perspectives in decisions made about gambling can result in more innovative and effective strategies to prevent the harms from gambling industry products, promotions, and practices.
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Affiliation(s)
- Hannah Pitt
- Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia.
| | - Simone McCarthy
- Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Melanie Randle
- Faculty of Business and Law, School of Business, University of Wollongong, Wollongong, Australia
| | - Grace Arnot
- Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Samantha Thomas
- Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
- Curtin School of Population Health, Curtin University, Perth, Australia
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Burgess RC, Nyhan K, Dharia N, Freudenberg N, Ransome Y. Characteristics of commercial determinants of health research on corporate activities: A scoping review. PLoS One 2024; 19:e0300699. [PMID: 38669229 PMCID: PMC11051660 DOI: 10.1371/journal.pone.0300699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/04/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Business practices have influenced human health for centuries, yet an overarching concept to study these activities across nations, time periods, and industries (called 'the commercial determinants of health' (CDH)) has emerged only recently. The purpose of this review was to assess the descriptive characteristics of CDH research and to identify remaining research gaps. METHODS We systematically searched four databases (Scopus, OVID Medline, Ovid Embase, and Ovid Global Health) on Sept 13, 2022 for literature using CDH terms that described corporate activities that have the potential to influence population health and/or health equity (n = 116). We evaluated the following characteristics of the literature: methods employed, industries studied, regions investigated, funders, reported conflicts of interest, and publication in open-access formats. RESULTS The characteristics of the articles included that many were conceptual (50/116 articles; 43%) or used qualitative methods (37; 32%). Only eight articles (7%) used quantitative or mixed methods. The articles most often discussed corporate activities in relation to the food and beverage (51/116; 44%), tobacco (20; 17%), and alcohol industries (19; 16%), with limited research on activities occurring in other industries. Most articles (42/58 articles reporting a regional focus; 72%) focused on corporate activities occurring in high-income regions of the world. CONCLUSIONS Our findings indicate that literature that has used CDH terms and described corporate practices that influence human health has primarily focused on three major industries in higher-income regions of the world. Qualitative methods were the most common empirical method for investigating these activities. CDH-focused investigations of corporate practices conducted by less-studied industries (e.g., social media) and in lower-income regions are recommended. Longitudinal quantitative studies assessing the associations between corporate practices and a range of health outcomes is also a necessary next step for this field.
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Affiliation(s)
- Raquel C. Burgess
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, United States of America
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Naisha Dharia
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nicholas Freudenberg
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health & Health Policy, New York City, New York, United States of America
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
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van Schalkwyk MCI, Hawkins B, Petticrew M, Maani N, Garde A, Reeves A, McKee M. Agnogenic practices and corporate political strategy: the legitimation of UK gambling industry-funded youth education programmes. Health Promot Int 2024; 39:daad196. [PMID: 38234277 PMCID: PMC10794875 DOI: 10.1093/heapro/daad196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Agnogenic practices-designed to create ignorance or doubt-are well-established strategies employed by health-harming industries (HHI). However, little is known about their use by industry-funded organizations delivering youth education programmes. We applied a previously published framework of corporate agnogenic practices to analyse how these organizations used them in three UK gambling industry-funded youth education programmes. Evidential strategies adopted previously by other HHI are prominent in the programmes' practitioner-facing materials, evaluation design and reporting and in public statements about the programmes. We show how agnogenic practices are employed to portray these youth education programmes as 'evidence-based' and 'evaluation-led'. These practices distort the already limited evidence on these educational initiatives while legitimizing industry-favourable policies, which prioritize commercial interests over public health. Given the similarities in political strategies adopted by different industries, these findings are relevant to research and policy on other HHI.
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Affiliation(s)
- May C I van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, UK
| | - Benjamin Hawkins
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambrdige CB2 0SL, UK
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, UK
| | - Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh Chrystal Macmillan Building 15a George Square, Edinburgh EH8 9LD, UK
| | - Amandine Garde
- Law & NCD Unit, School of Law and Social Justice, University of Liverpool, Liverpool L69 7ZR, UK
| | - Aaron Reeves
- Department of Social Policy and Intervention, Barnett House, 32 -37 Wellington Square, University of Oxford, Oxford OX1 2ER, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, UK
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Pitt H, McCarthy S, Arnot G. Children, young people and the Commercial Determinants of Health. Health Promot Int 2024; 39:daad185. [PMID: 38294037 PMCID: PMC10828929 DOI: 10.1093/heapro/daad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
The commercial determinants of health (CDoH) have a significant impact on the health and well-being of children and young people (subsequently referred to as young people). While most research has focused on the influence of harmful industry marketing on young people, more recent CDoH frameworks have emphasized that a range of commercial systems and practices may influence health and well-being. Focusing on the impact of traditional and digital media, contemporary marketing strategies and corporate production and consumption processes, the following article outlines the impact of the CDoH on the health and wellbeing of young people. The article also provides evidence about how young people conceptualize the impact of corporate actors on health, and their involvement in advocacy strategies to respond. The article recommends that when collaborating with young people to understand the impacts of and responses to the CDoH, we should seek to diversify investigations towards the impact of a range of corporate tactics, systems and structures, rather than simply focusing on the impacts of advertising. This should include considering areas and priorities that young people identify as areas for action and understanding why some young people are more vulnerable to commercial tactics than others. Youth are powerful allies in responding to the CDoH. Public health and health promotion stakeholders could do more to champion the voices of young people and allow them to be active participants in the decisions that are made about harmful commercial practices and health.
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Affiliation(s)
- Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Simone McCarthy
- Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Grace Arnot
- Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
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van Schalkwyk MC, Cassidy R. How we can solve the crisis in UK gambling policy. BMJ 2024; 384:q16. [PMID: 38176726 DOI: 10.1136/bmj.q16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
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van Schalkwyk MCI, Thomas S, McKee M, Fell G, Daube M. Statutory levy on gambling may do more harm than good. BMJ 2023; 381:e075035. [PMID: 37024135 DOI: 10.1136/bmj-2023-075035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
| | - Samantha Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Greg Fell
- Association of Directors of Public Health, London, UK
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Australia
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Thomas S, van Schalkwyk MCI, Daube M, Pitt H, McGee D, McKee M. Protecting children and young people from contemporary marketing for gambling. Health Promot Int 2023; 38:7080461. [PMID: 36932993 PMCID: PMC10024482 DOI: 10.1093/heapro/daac194] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Around the world, children are being exposed to intensive marketing for gambling products. This normalizes perceptions that gambling is essentially a harmless form of entertainment, despite mounting evidence of the harms it causes. Young people and their parents are supportive of strategies to protect children from being exposed to gambling marketing. Yet existing regulatory efforts are inconsistent and inadequate, and have not protected children from exposure to the many forms of marketing now being developed and exploited by the gambling industry. We outline existing knowledge about strategies used by the gambling industry to market its products, with a specific focus on the potential impact of gambling marketing on young people. We provide a definition of gambling marketing and outline the different forms of promotion that are currently used to market gambling, current regulatory responses, and the impact of marketing on children and young people. We then argue that a comprehensive public health approach to gambling is urgently required, which must include effective action to limit the influence of marketing for gambling products, while recognizing that it is never possible to insulate children entirely from their reach.
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Affiliation(s)
| | - May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | | | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Marko S, Thomas SL, Pitt H, Daube M. The impact of responsible gambling framing on people with lived experience of gambling harm. FRONTIERS IN SOCIOLOGY 2023; 8:1074773. [PMID: 36960306 PMCID: PMC10028136 DOI: 10.3389/fsoc.2023.1074773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The framing of health issues influences how people think about and respond to these topics. Gambling has largely been framed as an issue of personal responsibility, with the gambling industry, governments and some researchers promoting responsible gambling strategies as a way to address gambling harm. While there is evidence that the internalization of personal responsibility can negatively impact gamblers, this study aimed to explore how people who have experienced gambling harm interpret and apply personal responsibility frames and 'gamble responsibly' messages in their lives. METHODS In-depth semi-structured interviews were conducted via Zoom and telephone with 15 gamblers who had been harmed by their own gambling and six affected others who had been harmed by someone else's gambling. This study was informed by public health and critical qualitative approaches to inquiry. The data were analyzed using reflexive thematic analysis. RESULTS Four themes were constructed from the data. First, gamblers and affected others generally conceptualized gambling and gambling harm as being the responsibility of the individual because it was perceived as the outcome of individual behavior. Second, they attempted to apply responsibility to their own experience either as gamblers who tried to stop or reduce their gambling, or affected others who felt responsible for helping the gambler in their lives. Third, gamblers and affected others were negatively impacted when it was perceived the gambler could not 'control' their gambling or had not done enough to take responsibility. Finally, gamblers and affected others recommended responsible gambling strategies be reframed to be more effective at addressing gambling harm. CONCLUSION This study provides evidence further supporting research demonstrating that personal responsibility frames may have unintended or negative consequences for gamblers and affected others. It underscores the need to reframe public messages about gambling away from responsible gambling, and toward research-based messages that can complement broader legislative changes and other measures to protect individuals.
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Affiliation(s)
- Sarah Marko
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Samantha L. Thomas
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Hannah Pitt
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Bhuptani S, Boniface S, Severi K, Hartwell G, McGill E. A comparative study of industry responses to government consultations about alcohol and gambling in the UK. Eur J Public Health 2023; 33:305-311. [PMID: 36850047 PMCID: PMC10066481 DOI: 10.1093/eurpub/ckad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND There is growing evidence that common strategies are used across unhealthy commodity industries (UCIs) to influence policy decisions in line with their commercial interests. To date, there have been relatively few studies comparing corporate political activity (CPA) across UCIs, especially comparing the alcohol and gambling industries. METHODS A comparative and inductive thematic analysis of alcohol and gambling industry submissions to two House of Lords (HoL) inquiries in the UK was conducted. Themes in the framing, arguments and strategies used by the alcohol and gambling industries in CPA were compared. RESULTS Alcohol and gambling industry responses largely used the same framings, both in terms of the problems and solutions. This included arguing that harms are only experienced by a 'minority' of people, emphasising individual responsibility and shifting blame for harms to other industry actors. They promoted targeted or localised solutions to these harms, in place of more effective population level solutions, and emphasised the perceived harms of introducing regulation not in the industries' interests. CONCLUSIONS These findings are consistent with previous literature suggesting that UCIs use the same framing and arguments to shape the narrative around their harms and solutions to those harms. This study also identified novel strategies such as shifting blame of harms to other industry actors. Policy makers should be aware of these strategies to avoid undue industry influence on policy decisions and understanding commonalities in strategies may help to inform more effective public health responses across all UCIs.
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Affiliation(s)
| | - Sadie Boniface
- Institute of Alcohol Studies, London, UK.,Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | | | - Greg Hartwell
- LSHTM, Faculty of Public Health and Policy, London, UK
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A Longitudinal Examination of Young People's Gambling Behaviours and Participation in Team Sports. J Gambl Stud 2022; 39:541-557. [PMID: 36527539 PMCID: PMC9758668 DOI: 10.1007/s10899-022-10175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
This paper develops and expands upon social identity theory as an explanation for gambling among youth engaged in team sport. Analysing longitudinal data for over 4500 20-year-olds from the Growing Up in Ireland study, reveals that online gambling increased from 2.6 to 9.3% between 17 and 20 years in the cohort, with the increase driven by males. A statistically significant positive association is uncovered between playing team sports and regularly gambling, as well as online gambling behaviour, independent of socio-demographic and other risk factors for males but not for females. The findings provide support for a dose-response like effect for males, where a longer period of participation in team sports is associated with a higher likelihood of engaging in gambling behaviour compared to shorter periods. Implications of the findings for policy and practice are discussed.
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Tompson AC, Mulrenan C, Hartwell G, Petticrew M, van Schalkwyk MCI, Maani N. Commercial determinants of mental health. BMJ 2022; 378:o2034. [PMID: 35995433 DOI: 10.1136/bmj.o2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alice C Tompson
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Claire Mulrenan
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Greg Hartwell
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | | | - Nason Maani
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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