Gambling control: in support of a public health response to gambling

Public health approaches to gambling: a global review of legislative trends

The public health community has called for governments to recognise the harms associated with gambling, and for gambling policies to include population-based harm prevention approaches. This Health Policy explores the translation of this call into global policy action by systematically reviewing legislation of jurisdictions that introduced major gambling legislation change (ie, restricting or extending gambling provision) between Jan 1, 2018, and Dec 31, 2021. We mapped the global availability of legal gambling and changes in its provision, and conducted critical frame analysis on a sample of 33 jurisdictions introducing major policy change to assess the extent to which the protection of health and wellbeing was embedded within legislation. More than 80% of countries worldwide now legally permit gambling. Harmful gambling was recognised as a health and wellbeing issue in most of the analysed jurisdictions, but near-exclusive focus was given to individual-level harms rather than to wider social and economic harms, or harms to others. Most of the proposed prevention measures focused on individual responsibility. Gambling policies worldwide are changing, but addressing gambling as a public health issue is not yet translating into comprehensive policy action across jurisdictions.

Gut fungal mycobiome: A significant factor of tumor occurrence and development

A variety of bacteria, viruses, fungi, protists, archaea and protozoa coexists within the mammalian gastrointestinal (GI) tract such as that fungi are detectable in all intestinal and colon segments in almost all healthy adults. Although fungi can cause infectious diseases, they are also related to gut and systemic homeostasis. Importantly, through transformation of different forms such as from yeast to hyphae, interaction among gut microbiota such as fungal and bacterial interaction, host factors such as immune and host derived factors, and fungus genetic and epigenetic factors, fungi can be transformed from commensal into pathogenic lifestyles. Recent studies have shown that fungi play a significant role in the occurrence and development of tumors such as colorectal cancer. Indeed, evidences have shown that multiple species of different fungi exist in different tumors. Studies have also demonstrated that fungi are related to the occurrence and development of tumors, and also survival of patients. Here we summarize recent advances in the transformation of fungi from commensal into pathogenic lifestyles, and the effects of gut pathogenic fungi on the occurrence and development of tumors such as colorectal and pancreatic cancers.

The lived experience of financial harm from gambling in Australia

The financial consequences associated with harmful gambling create significant health and social stressors for individuals, their families, and communities. However, there has been limited research exploring how people impacted by gambling harm conceptualise and experience the financial impacts on their lives. To help fill this gap, this study used in-depth qualitative interviews with gamblers harmed by their own gambling and affected others harmed by someone else's gambling. Reflexive thematic analysis was used to interpret the data. The study had three key findings. First, prior to experiencing harm, gamblers and affected others did not consider the financial risks associated with gambling and only recognised the risks once the financial losses negatively impacted other areas of their lives. Second, gamblers and affected others managed the day-to-day financial impacts of gambling by adjusting their financial priorities, reducing spending in other areas, or accruing debt. Finally, the financial impacts of gambling and the associated financial management strategies led to broader and long-term problems for gamblers and affected others. This study demonstrates that financial harms from gambling are complex and contribute to the stigmatisation of people who experience harm. Current educational messages and tools simplify this complex issue and may legitimise gambling as a leisure activity which can be managed by making 'responsible' financial decisions. Public health and health promotion initiatives must recognise this complexity, developing approaches that are independent from the gambling industry and informed by lived experience.

Designing Improved Safer Gambling Messages for Race and Sports Betting: What can be Learned from Other Gambling Formats and the Broader Public Health Literature?

Safer gambling messages are one potential input to a public health approach toward reducing gambling-related harm, and yet there is no strong evidence supporting current messages such as "gamble responsibly" or "keep the fun in the game". Furthermore, sports betting is increasing in popularity in multiple jurisdictions, such as Australia and the US, increasing the need to design effective messaging campaigns for race and sports betting. Compared to other gambling formats, such as electronic gambling machines, the level of potential skill involved in race and sports betting may raise unique issues regarding the design of effective messages. This review first highlights research from the related public health domains of alcohol and tobacco. Then, five potential areas for further messaging-based research in race and sports betting are discussed: teaching safer gambling practices, correcting gambling misperceptions, boosting conscious decision making, norm-based messages, and emotional messages. A broad approach to message design is encouraged, given the potential for individual differences in message receptivity, and for frequently-repeated messages to be ignored or cause negative psychological reactance.

The impact of responsible gambling framing on people with lived experience of gambling harm

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.

A scoping review of the individual, socio-cultural, environmental and commercial determinants of gambling for older adults: implications for public health research and harm prevention

Gambling is a global public health issue that can cause harm to individuals, families, and communities. Older adults are vulnerable to gambling harm due to life-stage experiences. This study aimed to examine current research relating to individual, socio-cultural, environmental, and commercial determinants of gambling among older adults. A scoping review was conducted (PubMed, PsycInfo, SocIndex, CINAHL Complete, Web of Science, Social Science and Sociology databases available in ProQuest, Google Scholar, citation searching), with peer reviewed studies included that were published between 1 December 1999 and 28 September 2022. Included studies were published in English in peer-reviewed journals that examined the determinants of gambling in adults aged 55 and over. Records were excluded if they were experimental studies, prevalence studies or had a population wider than the required age group. Methodological quality was assessed using JBI critical appraisal tools. Data was extracted using a determinants of health framework and common themes were identified. Forty-four were included. Most literature examined individual and socio-cultural determinants including reasons for gambling, risk management strategies, and social motivations for gambling. Few studies investigated environmental or commercial determinants, and those that did focused on accessibility of venues or promotions as pathways to gambling. Further research is needed to understand the impact of gambling environments and industry, and effective public health responses for older adults.

Regulation of gambling in Sub-Saharan Africa: findings from a comparative policy analysis

OBJECTIVES

Commercial gambling markets have undergone unprecedented expansion and diversification in territories across Sub-Saharan Africa (SSA). This gambling boom has popularised the uptake of gambling products in existing circuits of popular culture, sport and leisure and raised concerns about the extent to which state legislation is equipped to regulate the differentiated impacts of gambling on public health.

STUDY DESIGN

Comparative policy analysis.

METHODS

This article provides a systematic mapping of the regulatory environment pertaining to gambling across SSA. The review was conducted by obtaining and triangulating data from a desk review of online materials, consultation with regulatory bodies in each territory and the VIXIO Gambling Compliance database.

RESULTS

Gambling is legally regulated in 41 of 49 (83.6%) SSA countries, prohibited in 7 (14.3%) and is not legislated for in 1 (2.0%). Of those countries that regulate gambling, 25 (61.0%) countries had dedicated regulators and 16 (39.0%) countries regulated via a government department. Only 2 of 41 (4.9%) countries have published annual reports continuously since the formation of regulatory bodies, and 3 (7.3%) countries have published an incomplete series of reports since the formation. In 36 (87.8%) countries, no reports were published. Enforcement activities were documented by all five regulators that published reports.

CONCLUSION

The review uncovered a lack of coherence in regulatory measures and the need for more transparent public reporting across SSA territories. There are also variations in regulating online products and marketing, with most countries lacking apt guidelines for the digital age. Our findings suggest an urgent need to address the regulatory void surrounding online forms of gambling and the promotion of gambling products. This underlines the importance of a public health approach to protect against an increase in gambling-related harms.

Regulating Gambling-Like Video Game Loot Boxes: a Public Health Framework Comparing Industry Self-Regulation, Existing National Legal Approaches, and Other Potential Approaches

Purpose of Review

Loot boxes are gambling-like monetisation mechanics in video games that are purchased for opportunities to obtain randomised in-game rewards. Gambling regulation is increasingly being informed by insights from public health. Despite conceptual similarities between loot boxes and gambling, there is much less international consensus on loot box regulation. Various approaches to regulating loot boxes are reviewed via a public health framework that highlights various trade-offs between individual liberties and harm prevention.

Recent Findings

Many countries have considered regulation, but as yet only a few countries have taken tangible actions. Existing regulatory approaches vary greatly. More restrictively, Belgium has effectively ‘banned’ paid loot boxes and prohibits their sale to both children and adults. In contrast, more liberally, China only requires disclosure of the probabilities of obtaining potential rewards to provide transparency and perhaps help players to make more informed purchasing decisions. Most other countries (e.g., the UK) have adopted a ‘wait-and-watch’ approach by neither regulating loot box sales nor providing any dedicated consumer protection response. Industry self-regulation has also been adopted, although this appears to elicit lower rates of compliance than comparable national legal regulation.

Summary

Many potential public health approaches to loot box regulation, such as expenditure limits or harm-reducing modifications to loot box design (e.g., fairer reward structures), deserve further attention. The compliance and clinical benefits of existing interventions (including varying degrees of regulation, as adopted by different countries, and industry self-regulation) should be further assessed. The current international variation in loot box regulation presents opportunities to compare the merits of different approaches over time.

"Drugs and alcohol get talked about, why not betting?" Young men's qualitative insights about strategies to prevent gambling harm

ISSUES ADDRESSED

Research is needed to understand young people's perspectives about public health promotion strategies relevant for their health and wellbeing. This study provides suggestions from young male gamblers about sports betting harm prevention and reduction strategies.

METHODS

In-depth interviews were conducted with sixteen young men aged 18 to 24 years, from Melbourne, Victoria, who regularly engaged in sports betting. A critical qualitative inquiry approach, using methods of constructivist grounded theory guided the study. Reflexive thematic analysis was used to interpret and construct themes from the data.

RESULTS

Participants indicated three main harm prevention strategies. These were: online consumer protection and regulatory strategies; public education campaigns that highlighted sports betting risks and harms; and the creation of formal and informal support networks to reduce stigma and encourage help seeking. They also supported being engaged in the development of harm prevention strategies and suggested ways to help reduce barriers to engagement.

CONCLUSION

Young men recognise the need for regulatory, education, and engagement responses to counter the risks posed by new gambling products. Young men may be difficult to engage in formal prevention activities, however youth-led and informal interactive mechanisms may help to overcome this barrier, and contribute to a comprehensive public health approach to gambling harm prevention. SO WHAT?: Young men can draw upon their lived experiences of gambling to provide insights relevant for public health promotion. Mechanisms should be developed to engage young people in the co-production of strategies and policies aimed at gambling harm prevention and reduction.

House-edge information and a volatility warning lead to reduced gambling expenditure: Potential improvements to return-to-player percentages

Cost-of-play information is one public health intervention recommended to help reduce gambling-related harm. In the UK, this information is given on electronic gambling machines in a format known as the "return-to-player", e.g., "This game has an average percentage payout of 90%." However, previous evidence suggests that this information could be improved by equivalently restating it in terms of the "house-edge", e.g., "This game keeps 10% of all money bet on average." A "volatility warning," stating that this information applies only in the statistical long-run, has also been recommended to help gamblers understand cost-of-play information. However, there is no evidence comparing these information provisions' effect on gamblers' behavior. An experiment tested US gamblers'(N = 2433) incentivized behavior in an online slot machine, where this information was manipulated between-participants along with a counter showing the total amount bet. Preregistered analyses showed that participants gambled significantly less when house-edge information or a volatility warning were shown compared to standard return-to-player information, with no effect of the total amount bet counter, and no significant interaction effects. However, these significant findings had small effect sizes, suggesting that a public health approach to gambling should not rely on informational provisions only. Subject to supportive evidence from more ecologically-valid designs such as field studies, these results suggest that improved cost-of-play information could lead to reduced rates of gambling expenditure and therefore benefit a public health approach to gambling.

Gamblers' perceptions of responsibility for gambling harm: a critical qualitative inquiry

BACKGROUND

Gambling has traditionally been conceptualised as an issue of addiction and personal responsibility. While there are now clear public health models that recognise that gambling harm is caused by a range of socio-cultural, environmental, commercial and political determinants, government and industry messages about gambling are still largely personal responsibility focused. Given the well-recognised issues associated with personal responsibility paradigms, this study sought to understand how gamblers themselves conceptualised responsibility for gambling harm.

METHODS

A qualitatively led online panel survey was conducted with 363 adult gamblers in New South Wales and Victoria, Australia. Participants were asked to respond to what they thought were the causes of gambling harm, and what could be done to prevent harm. A reflexive thematic analysis was conducted.

RESULTS

Six common tropes were constructed from gamblers' responses: (1) Gambling in moderation; (2) Personal responsibility for rational behaviour; (3) Character flaws; (4) Personal responsibility to seek help; (5) More education is needed; and (6) Governments are responsible for action - but motivation and efficacy are questioned. Gamblers primarily understood gambling harm as being a matter of personal responsibility, and government responsibility was generally seen as limited to providing information to facilitate informed gambling choices.

CONCLUSIONS

This study demonstrates that gamblers' perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from 'responsible gambling' messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.

Gambling and the COVID-19 pandemic: A scoping review

BACKGROUND

The impact of COVID-19 on mental health is tremendous. Since the beginning of the pandemic, several actors have raised concerns about the impact of the pandemic on gambling. Many actors fear a switch to online gambling in the context of the closure of many land-based gambling activities due to the restrictions imposed by public health authorities, such as physical distancing and lockdowns. This switch is worrisome because online gambling is considered a high-risk game. In that context, we need to know more about the impacts of the pandemic on gambling. This scoping review aims to summarize the literature that addresses the impacts of the COVID-19 pandemic on gambling. To our knowledge, this is the first review to focus on this subject.

METHODS

An electronic literature search involving a strategy using keywords related to COVID-19 and gambling was conducted using MEDLINE, Academic Search Complete, CINAHL, PsychINFO, Social Works Abstract, and Socio Index databases on February 25th 2021. This search was combined with a manual search in Google Scholar. To be included, studies had to discuss gambling and COVID-19 as a primary theme, be written in English, and be published in a peer-reviewed journal. After collecting the information, we collated, summarized, and reported the results using narrative synthesis.

RESULTS

The search identified 181 articles. After the removal of duplicates and screening, 24 full-text articles were reviewed and included in this study: 14 original articles, 8 commentaries or editorials, and 2 protocols. Contrary to expectations, preliminary evidence suggested that gambling behavior often either decreased or stayed the same for most gamblers during the pandemic. However, for the minority who showed increased gambling behavior, there was frequently an association with problem gambling.

CONCLUSION

The available literature on COVID-19 and gambling is limited and the impact of the COVID-19 pandemic on gambling behavior and gambling problems is still unclear. Therefore, there is a need for more research on this topic, both qualitative and mixed methods studies, to better understand the impact of the pandemic on gambling. Considering the results, we need to be careful, particularly with problem gamblers and other subgroups of the population who seem to be more vulnerable to increased gambling habits during this pandemic period.

"When the Fun Stops, Stop": An analysis of the provenance, framing and evidence of a 'responsible gambling' campaign

When the Fun Stops, Stop, is a prominent 'responsible gambling' campaign in the UK, originally funded and delivered by the industry-initiated and funded Senet Group. Since the Senet Group's dissolution in 2020, the campaign has been overseen by the Betting and Gambling Council (BGC), the main gambling industry trade body. There has been no prior analysis of the activities, ideas and framing adopted by the Senet Group, who claimed to be acting as an industry 'watchdog' and oversaw what they characterised as a major public education campaign. We collated written and image-based material related to the Senet Group and its When the Fun Stops, Stop campaign from multiple sources. Guided by Entman's four functions of framing, we analysed the Senet Group's framing of the issues it sought to address, particularly harmful gambling, as well as its causes, and the solutions, focusing on the group's main activity: the delivery of the When the Fun Stops, Stop campaign. We also critically appraised an evaluation of the campaign funded by the Senet Group, using the findings to interrogate the stated claims about the campaign's effectiveness. The analysis showed that the Senet Group's framing of the problem, its causes, and proposed responses resemble those adopted by other industries and industry-funded groups. This involves portraying any harms caused by their products as limited to an atypical minority, rejecting upstream determinants of harm, and promoting individually-targeted voluntary measures, all contrary to the evidence of what works in health promotion, and what would characterise a public health approach. Neither the existing evidence base nor the evidence presented by the Senet Group support their claims about the campaign's effectiveness. These findings add to concerns about industry-funded campaigns in other areas. To minimise conflicts of interest, interventions intended to address gambling-related harms, such as public education campaigns, should be evidence-based and developed, implemented and evaluated completely independent of the industry and industry-funded organisations.

Moving Away from Individual Responsibility: A Comment

In this comment, we suggest there has been a crusade among some gambling stakeholders to move the field away from personal responsibility influences and toward social setting effects. This perspective disproportionally attributes gambling-related negative consequences to the social setting rather than the gambler. We argue that personal responsibility is a pivotal issue during the emotional maturation of healthy adults and remains essential to understanding intemperate gambling. This comment explores this movement away from personal responsibility and briefly discusses some of the iatrogenic consequences that this position might create in a clinical setting.

Young people's reflections on the factors contributing to the normalisation of gambling in Australia

OBJECTIVES

To explore young people's perceptions of the factors that may normalise gambling, and their opinions about the messages they see about gambling in their environments.

METHODS

An analysis of qualitative data from a mixed methods study of n=111 young people aged 11-16 years in Victoria, Australia. Questions investigated: i) the normalisation of gambling in sport; ii) the impact of advertising on young people; and iii) potential strategies to alert young people about the risks associated with gambling. An inductive approach was used to analyse the data.

RESULTS

Participants perceived that gambling was a regular and everyday activity and that gambling was becoming normalised in sport. However, some directly challenged this alignment. They were particularly critical that gambling advertising may influence young people's current and future gambling-related attitudes and intentions. Most participants supported public health interventions, including more advertising restrictions.

CONCLUSION

Young people's awareness of gambling and gambling marketing may be increasing their perceptions of the alignment between gambling and sport. Implications for public health: Strategies should be developed to increase young people's awareness of the risks associated with gambling. Young people's voices and views should be considered by policy makers in responding to this new public health issue.

The association between gambling and financial, social and health outcomes in big financial data

Gambling is an ordinary pastime for some people, but is associated with addiction and harmful outcomes for others. Evidence of these harms is limited to small-sample, cross-sectional self-reports, such as prevalence surveys. We examine the association between gambling as a proportion of monthly income and 31 financial, social and health outcomes using anonymous data provided by a UK retail bank, aggregated for up to 6.5 million individuals over up to 7 years. Gambling is associated with higher financial distress and lower financial inclusion and planning, and with negative lifestyle, health, well-being and leisure outcomes. Gambling is associated with higher rates of future unemployment and physical disability and, at the highest levels, with substantially increased mortality. Gambling is persistent over time, growing over the sample period, and has higher negative associations among the heaviest gamblers. Our findings inform the debate over the relationship between gambling and life experiences across the population.

Charting a path towards a public health approach for gambling harm prevention

Aim

Gambling harm is a serious public health issue affecting the health, financial security, and social well-being of millions of people and their close relations around the world. Despite its population health implications, gambling harm is not typically viewed and treated as a public health policy issue. This paper critically reviews the evolution of the public health perspective on gambling harm. It also considers how gambling harm can be operationalized within a public health model.

Methods

A critical historical review of the emerging public health perspective on gambling harm was conducted. Key documents covering three decades of development were reviewed and appraised through a process of deliberation and debate over source impact in the fields of research, policy, and programming internationally.

Results

The first decade mainly focused on identifying gambling harm and framing the public health issue. The second decade featured the expansion of health assessment and emerging areas of policy and program development. The third decade saw an increased focus on public health frameworks that advanced understanding of harm mechanics and impact. As reflected by the essential functions of a general public health model, gambling harm prevention efforts emphasize health promotion over other key functions like health assessment and surveillance.

Conclusion

Gambling harm is a public health issue requiring greater attention to health assessment and surveillance data development.

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.

A framework for indirect elicitation of the public health impact of gambling problems

Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.

Moderator effect of sex in the clustering of treatment-seeking patients with gambling problems

BACKGROUND

There are no studies based on a person-centered approach addressing sex-related differences in the characteristics of treatment-seeking patients with gambling disorder (GD). The main objective of the current study is to identify empirical clusters of GD based on several measures of the severity of gambling behavior, and considering the potential role of patient sex as a moderator.

METHODS

An agglomerative hierarchical clustering method was applied to an adult sample of 512 treatment-seeking patients (473 men and 39 women) by using a combination of the Schwarz Bayesian Information Criterion and log-likelihood function.

RESULTS

Three clusters were identified in the subsample of men: cluster M1 (low-mild gambling severity level, 9.1%), cluster M2 (moderate level, 60.9%), and cluster M3 (severe level, 30.0%). In the women subsample, two clusters emerged: cluster W1 (mild-moderate level, 64.1%), and cluster W2 (severe level, 35.9%). The most severe GD profiles were related to being single, multiple gambling preference for nonstrategic plus strategic games, early onset of the gambling activity, higher impulsivity levels, higher dysfunctional scores in the personality traits of harm avoidance, and self-directedness, and higher number of lifespan stressful life events (SLE). Differences between the empirical men and women clusters were found in different sociodemographic and clinical measurements.

CONCLUSIONS

Men and women have distinct profiles regarding gambling severity that can be identified by a clustering approach. The sociodemographic and clinical characterization of each cluster by sex may help to establish specific preventive and treatment interventions.

Gambling harm is everybody's business: A public health approach and call to action

There is a growing consensus that gambling is a public health issue and that preventing gambling related harms requires a broad response. Although many policy decisions regarding gambling are made at a national level in the UK, there are clear opportunities to take action at local and regional levels to prevent the negative impacts on individuals, families and local communities. This response goes beyond the statutory roles of licencing authorities to include amongst others the National Health Service (NHS), the third sector, mental health services, homelessness and housing services, financial inclusion support. As evidence continues to emerge to strengthen the link between gambling and a wide range of risk factors and negative consequences, there is also a strong correlation with health inequalities. Because the North of England experiences increasing health inequalities, it offers an opportunity as a specific case study to share learning on reducing gambling-related harms within a geographic area. This article describes an approach to gambling as a public health issue identifying it as needing a cross-cutting, systemwide multisectoral approach to be taken at local and regional levels. Challenges at national and local levels require policy makers to adopt a ‘health in all policy’ approach and use the best evidence in their future decisions to prevent harm. A whole systems approach which aims to reduce poverty and health inequalities needs to incorporate gambling harm within place-based planning and draws on the innovative opportunities that exist to engage local stakeholders, builds local leadership and takes a collaborative approach to tackling gambling-related harms. This whole systems approach includes the following: (1) understanding the prevalence of gambling related harms with insights into the consequences and how individuals, their family and friends and wider community are affected; (2) ensuring tackling gambling harms is a key public health commitment at all levels by including it in strategic plans, with meaningful outcome measures, and communicating this to partners; (3) understanding the assets and resources available in the public, private and voluntary sectors and identifying what actions are underway; (4) raising awareness and sharing data, developing a compelling narrative and involving people who have been harmed and are willing to share their experience; (5) ensuring all regulatory authorities help tackle gambling-related harms under a ‘whole council’ approach.

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This piece presents the case for why gambling is a particularly unique public health issue which requires a cross-cutting, systemwide multisectoral approach.

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It explores opportunities for action at national and local level, using examples of work underway.

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It concludes with a call to action using lesson learnt from managing harms from similar public health threats.

On the normalisation of online sports gambling among young adult men in the UK: a public health perspective

OBJECTIVES

Online sports gambling has become an increasingly popular feature of male youth culture and fandom in recent decades. Fuelled by advances in mobile app technologies and the liberalisation of state regulations on advertising, this 'gamblification' of sport has given rise to a global industry promoting gambling as a knowledge-based, risk-free leisure activity. This study examined how the growth of online sports gambling has impacted on gambling behaviours among young adult men in the UK and how it may pose new risks concerning the normalisation of gambling behaviours.

STUDY DESIGN

The study used a multiphased qualitative research design.

METHODS

The study was conducted with 32 adult men (aged 18-35 years) across two sites, Derry, Northern Ireland, and Bristol, England. It comprised three phases of data collection: participatory focus groups, a 30-day gambling diary and semistructured interviews.

RESULTS

Four main themes emerged. First, data suggest that gambling has become a normalised aspect of sports fandom for male youth demographics, many of whom view the casual wagering of money as vital to their enjoyment of sport. Second, the perceived 'facelessness' of sports gambling platforms via mobile app technologies was reported to increase inclination to engage in sports betting. Third, 'free bet' incentives and in-play promotions play a significant role as a mechanism of inducement towards sports gambling practices. Fourth was the potential role of online sports gambling as a gateway to gambling-related harms, including financial precarity, indebtedness, mortgage defaults, family breakdown, loss of employment and mental health struggles.

CONCLUSION

Online sports gambling has significant public health implications, particularly for male youth demographics. Policymakers in the UK should consider stronger regulation of gambling-related advertising and sponsorship in sport, independent risk assessments of sports gambling products and a commitment to safeguarding youth demographics from gambling-related harm in a digital age.

The growth of sports betting in Malawi: corporate strategies, public space and public health

OBJECTIVES

Gambling is increasingly positioned as a public health issue, with links to a wide range of harms for individuals, communities and societies. Malawi has experienced a rapid rise in the availability of high street and online sports betting services, situated in a context of extreme inequality and poverty. We aim to document the strategies through which a leading sports betting firm have established a market worth MK2.1bn, to inform future initiatives to mitigate gambling-related harm.

STUDY DESIGN

A case study of strategies deployed by a leading firm to grow a sports betting market in Malawi.

METHODS

We undertook a qualitative media analysis of articles from six major Malawian news outlets and combined this with photographic evidence relating to company advertising and presence in Malawian public space. Data were analysed thematically and triangulated to generate a typology of corporate strategies.

RESULTS

We collected 39 articles and 15 photographs. After we screened the articles, we analysed 27 and identified seven corporate strategies: adopt a mobile network franchise model; use media coverage; purchase high-visibility advertising; sponsor locally; build association with (European) football; appeal to aspects of hegemonic masculinity; construct narratives of individual and collective benefit.

CONCLUSION

Malawi has been exposed to a sophisticated set of corporate strategies aimed at growing a sports betting market. These strategies have been successful, and it is likely that a range of foreseeable gambling-related harms are affecting Malawi. We offer suggestions for how policy-makers and public health professionals might respond.

A public health advocacy approach for preventing and reducing gambling related harm

OBJECTIVE

To develop a framework to guide the application of public health advocacy strategies aimed at preventing and reducing gambling-related harm.

METHODS

A narrative review of theories of change and public health advocacy literature.

RESULTS

An eight-step public health advocacy framework was created, which outlines the critical steps and considerations when developing and implementing successful change efforts. Implications for public health: To date, a clear public health advocacy approach to gambling harm prevention and reduction has not been well established. This study proposes a gambling-specific framework to guide future public health advocacy efforts to prevent and reduce gambling harm.

Gambling Research and Industry Funding

This paper discusses the relationship between investigative credibility and the sources of funding associated with gambling research. Some researchers argue against accepting funding from gambling industry sources; similarly, they decline to participate in activities directly or indirectly sponsored by gambling industry sources. In contrast, these anti-industry investigators evidence less resistance toward accepting funds from sources other than industry, for example, governments, because they believe that they have greater independence, reliability, and validity, and less undue influence and/or interference. We organize this article, around six primary issues: (1) researchers making a priori judgments that restrict positions towards industry associated research; (2) the potential negative impacts of holding such a position; (3) a description of the different sources of funding available to support gambling-related research; (4) an examination of the extant empirical support associated with the sources of funding and whether such support evidences bias; (5) a description of six cases illustrating how refusing to participate in any project funded by the industry can adversely influence the advancement of science and, at times, be itself unethical; and finally, (6) we suggest some remedies to advance solutions to this problem by stimulating the participation of reluctant researchers to work towards a greater harmony, keeping in mind that the pivotal goal of our work is to increase our knowledge in different area of science and to harness it to public goods.