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

Is further investment in shark management in New South Wales worthwhile? Surfer views on coastal public health issues

OBJECTIVE

To explore the views of surfers on investment in shark management compared to other coastal public health issues.

METHODS

We examined the responses of 672 New South Wales (NSW) resident surfers to the Global Surfer Survey, which collected demographic information and asked surfers about which topics they believe additional funding should be devoted to.

RESULTS

Half of surfers in NSW (50%) are worried about sharks while surfing only a very small proportion (16%) are supportive of additional funding for shark detection and management programs, with most being in favour of funding directed at ocean cleanliness (40%) and drowning prevention (29%).

CONCLUSIONS

Findings indicate surfers are more supportive of investment in ocean cleanliness and drowning prevention measures, as compared to shark mitigation.

IMPLICATIONS FOR PUBLIC HEALTH

Ocean users in general face a significantly greater risk (48 times) of drowning than shark bites. Given the relative public health burden of the two issues, is the significant financial investment in shark mitigation worth it?

Empowerment of individuals in Iranian health systems: a qualitative study using the Z-cognitive map approach

The empowerment of people is considered as one of the most effective approaches in national healthcare systems. Identifying the effective criteria for this empowerment approach can be useful for planning enhancements. Therefore, studying and researching different aspects of people empowerment, and identifying the various relationships among related factors are of great importance. In this study - after identifying and extracting the effective factors in empowering individuals/insured persons, and interviewing health insurance and healthcare experts through content analysis - a causal model examining variables and their impact intensity through cognitive mapping is designed and drawn up. In modeling the concept of empowerment, to cover the ambiguity of expert comments, a combination of the Z-number approach with cognitive mapping has been used. Results demonstrate how various factors relate to insured empowerment. According to the results of empowerment strategies, the insurance participation strategy with the highest central index was determined as the most effective strategy, and the appropriate component for individuals gained the highest score in the centrality index. The results of this article help a lot to policy making in medical insurance.

Towards a conceptual framework for the prevention of gambling-related harms: Findings from a scoping review

The global gambling sector has grown significantly over recent years due to liberal deregulation and digital transformation. Likewise, concerns around gambling-related harms-experienced by individuals, their families, their local communities or societies-have also developed, with growing calls that they should be addressed by a public health approach. A public health approach towards gambling-related harms requires a multifaceted strategy, comprising initiatives promoting health protection, harm minimization and health surveillance across different strata of society. However, there is little research exploring how a public health approach to gambling-related harms can learn from similar approaches to other potentially harmful but legal sectors such as the alcohol sector, the tobacco sector, and the high in fat, salt and sugar product sector. Therefore, this paper presents a conceptual framework that was developed following a scoping review of public health approaches towards the above sectors. Specifically, we synthesize strategies from each sector to develop an overarching set of public health goals and strategies which-when interlinked and incorporated with a socio-ecological model-can be deployed by a range of stakeholders, including academics and treatment providers, to minimise gambling-related harms. We demonstrate the significance of the conceptual framework by highlighting its use in mapping initiatives as well as unifying stakeholders towards the minimization of gambling-related harms, and the protection of communities and societies alike.

Involving lived experience in regional efforts to address gambling-related harms: going beyond 'window dressing' and 'tick box exercises'

BACKGROUND

Lived Experience (LE) involvement has been shown to improve interventions across diverse sectors. Yet LE contributions to public health approaches to address gambling-related harms remain underexplored, despite notable detrimental health and social outcomes linked to gambling. This paper analyses the potential of LE involvement in public health strategy to address gambling-related harms. It focuses on the example of a UK city-region gambling harms reduction intervention that presented multiple opportunities for LE input.

METHODS

Three focus groups and 33 semi-structured interviews were conducted to hear from people with and without LE who were involved in the gambling harms reduction intervention, or who had previous experience of LE-informed efforts for addressing gambling-related harms. People without LE provided reflections on the value and contributions of others' LE to their work. Data analysis combined the Framework Method with themes developed inductively (from people's accounts) and deductively (from the literature, including grey literature).

RESULTS

Four themes were identified: (1) personal journeys to LE involvement; (2) the value added by LE to interventions for addressing gambling-related harms; (3) emotional impacts on people with LE; and (4) collective LE and diverse lived experiences. Two figures outlining LE involvement specific to gambling harms reduction in the UK, where public health efforts aimed at addressing gambling-related harms coexist with industry-funded programmes, are proposed.

CONCLUSIONS

Integrating a range of LE perspectives in a public health approach to gambling harms reduction requires local access to involvement for people with LE via diverse routes that are free from stigma and present people with LE with options in how they can engage and be heard in decision-making, and how they operate in relation to industry influence. Involving LE in gambling harms reduction requires enabling people to develop the affective and critical skills necessary to navigate complex emotional journeys and a challenging commercial and policy environment.

Aboriginal Health Practitioners obtaining, possessing and administering fluoride varnish: self-determination driven regulation amendment for integrated oral health care for Aboriginal children

Self-determination informed policies are key to improved outcomes for Aboriginal health. Aboriginal leadership must be reflected throughout any public health reform process that affects Aboriginal communities. This paper presents a body of oral health policy work, undertaken under Loddon Mallee Aboriginal Reference Group's (LMARG's) leadership, as an exemplar of a self-determination informed change, that led to an amendment of an Australian state (Victoria) regulation - The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners [AHPs]) Regulations 2022. A summary of activities undertaken by LMARG, from advocacy to leading the submission, to amend the regulation, is provided. The amendment, now in place, authorises registered AHPs to obtain, possess, and administer fluoride varnish (FV) as a part of health services they provide. FV is a concentrated form of fluoride applied to tooth surfaces to prevent tooth decay. The practical implication of this amendment is delivery of a culturally appropriate integrated oral health promotion FV model that addresses mainstream dental access barriers commonly experienced by Aboriginal people. The model aims at upskilling an Aboriginal workforce to facilitate timely FV application to Aboriginal children.

Australian young people's perspectives about the political determinants of the climate crisis

ISSUE ADDRESSED

There has been little focus on young people's views about the political determinants of the climate crisis. As young people are likely to be the group most impacted by political decisions relating to the climate crisis, it is essential to understand their views about government decision-making.

METHODS

A qualitatively-led online survey of n = 500 young Australians aged 15-24 years. Open text questions sought young people's views about current government climate policies, perceptions about policy effectiveness, and how governments could improve their climate responses. Reflexive thematic analysis was used to interpret and construct themes from the data.

RESULTS

Young people perceived that governments were not taking serious action on the climate crisis. They stated that climate policies were largely influenced by economic imperatives, rather than concern for the wellbeing of current and future generations. They perceived that governments had a duty of care to protect them from the climate crisis, and needed to engage young people in climate discussions and decision-making.

CONCLUSIONS

Young people's perspectives about the political determinants of the climate crisis provides information about their understanding of government policies and their recommendations for action. There is a need for collaboration between young people and decision-makers to urgently develop effective climate policies. SO WHAT?: Young people understand key issues relating to the political determinants of the climate crisis. The health promotion community has a role in advocating for structural changes in policymaking processes to ensure young people have a seat at the decision-making table.

A step change model analysis of the establishment of pill testing in one Australian jurisdiction

This paper applies the theory of change model (Kotter in Harv Bus Rev 2:59-67, 1995; Moore et al. in Viet Nam J Public Health 1(1):66-75, 2013) to describe the pathway that lead to Australia's first pill testing/drug checking services in Canberra, in the Australian Capital Territory. The paper takes each step of the model and illustrates the key activities that largely occurred over an approximately 24 month period resulting in the service being operational on 29 April 2018. The paper demonstrates that leadership, advocacy and activism are key components, alongside evidence, to bringing about public policy change. It provides a unique insight to the extensive efforts undertaken to achieving the first legally sanctioned pill testing at festivals in Australia and provides a positive case study for those seeking to introduce contested harm reduction services in the drug and alcohol field.

What works in advocating for food advertising policy change across an english region - a realist evaluation

BACKGROUND

With increasing recognition of the role of commercial determinants of health, local areas in England have sought to restrict the advertising of products high in fat, salt and sugar (HFSS) on council-owned spaces, as part of wider strategies to reduce obesity. While there is some evidence of the impact of such policy change on behaviour, little is known about what works in the process of implementing this policy change.

METHODS

Guided by a realist evaluation framework that explores the interaction between context, mechanism and outcomes, this study aims to investigate the factors that influence the restriction of outdoor advertising of HFSS products in one region in England. It refines a programme theory co-produced with stakeholders from 14 local authorities within a region and uses multiple data sources from each area with an in-depth examination of four case study sites. Data sources include longitudinal realist interviews, focus groups and surveys with policy advocates and policy stakeholders. Data were analysed retroductively to understand the causal link between context, mechanism and outcomes.

RESULTS

Outcomes were driven by five dominant mechanisms: a strategic and staggered approach to stakeholder engagement, gathering intelligence, identifying policy champions, building relationships, reframing the issue; and two secondary mechanisms of amplifying the issue and increasing public will. These led to varied outcomes with no changes in formal policy position within the evaluation period but draft policy guidance in place and changes in political will demonstrated. Dominant context factors influencing change included having a named and resourced policy advocate in place supported by an external Community of Improvement and having existing aligned local objectives. Organisational complexity and change, financial concerns, lack of local examples, ideological positions and the pandemic were also influencing contextual factors.

CONCLUSION

Effecting policy change in this area requires the commitment of an extended period and the valuing of short-term policy outcomes, such as increasing political will. The importance of a resourced and well-supported policy advocate to lead this work is fundamental and the commercially sensitive nature of this policy change means that a complex interplay of mechanisms is required which may be dominated by a strategically staggered approach to stakeholder engagement.

Public health practitioners as policy advocates: skills, attributes and development needs

Effecting policy change is a key strategy in tackling wider determinants of health. In England, public health sits within Local Authorities (LAs) and responsibility for ensuring health is considered across directorates increasingly falls to public health practitioners. While international professional standards expect competence in understanding policy processes, the advocacy role has been under-explored. This paper explores the professional skills, role characteristics and learning needs of practitioners advocating for the restriction of advertising high-fat, salt and sugar products in a region of England. A series of three interviews were conducted at three time points over 10 months with policy advocates leading this policy change from four LAs. Three focus groups were also held with 12 public health advocates from 10 LAs at the end of the 10-month period of data collection. Data were transcribed and analysed retroductively. Data showed that practitioners felt inexperienced as policy advocates and saw this work as different from other public health approaches. Successful advocates required interpersonal skills, knowledge of policy-making and local governance, determination, resilience, confidence, belief in their work's value and leadership. These skills were difficult to acquire through formal education, but advocacy training, mentorship and role modelling were seen as important for professional development. To successfully implement a Health in all Policies approach and address wider determinants of health, public health practitioners need to be equipped and supported as policy advocates. The advocacy role and the complex skills required need to be more fully understood by the public health profession and prioritized within workforce development at both local and national levels.

Social Connectedness and Associations with Gambling Risk in New Zealand

Multiple factors are associated with disordered gambling, with some populations having a greater risk for developing disordered gambling than others. The present study, utilising data previously collected for a New Zealand (NZ) national gambling survey, explored the associations of social connectedness and leisure activities with risky gambling behaviour and quality of life. Poorer social connectedness and leisure activities were found to be associated with increased gambling risk and poorer quality of life, respectively. Social connectedness and leisure activities strongly predicted type of gambling activities and quality of life. Furthermore, Māori (NZ's indigenous population) had lower social connectedness and fewer leisure activities, and a greater gambling risk, as well as higher psychological distress, than the NZ European/Other population. These findings indicate that the risk of progressing from recreational gambling to risky gambling is relatively higher for Māori, and that social connectedness and leisure activities could be contributing factors for this increased risk. It is, therefore, important that social connectedness and leisure activities are seriously considered in public health and treatment efforts to reduce gambling harm for vulnerable populations.

Welcome back Kotter-Developing a National Allergy strategy for Australia

Background

Allergic diseases have become an increasing health issue worldwide, being one of the fastest growing chronic diseases in Australia and other westernized countries. In 2013, allergic diseases were reported to affect 20% of the Australian population. Despite the high prevalence there was no national strategy to address these complex health issues, to enable the health system to manage the increasing number of patients. This project aimed to develop and implement a national strategy to improve allergy management in Australia, with a view of improving the quality of life of people living with or caring for someone with allergic diseases.

Methods

The need for a national strategy to improve allergy management was identified. The Australasian Society of Clinical Immunology and Allergy (ASCIA) and Allergy & Anaphylaxis Australia (A&AA) worked together as partners to progress a national strategy using a theoretical model to underpin its development. Unrestricted education grants were sought to fund engagement with stakeholder organizations for both development and implementation summits. Several stages of advocacy were undertaken.

Results

The National Allergy Strategy was developed as a partnership between ASCIA and A&AA. The Kotter's Change Management Model provided the basis for the steps undertaken to develop and implement the National Allergy Strategy. Two Allergy Summits, one for development and the other for implementation, were held. Several events were held to advocate for federal government funding. Five individual funding grants were achieved to implement National Allergy Strategy projects addressing the most urgent issues.

Conclusion

The development of the National Allergy Strategy, a partnership between ASCIA and A&AA, was important in enabling successful advocacy for funding and implementation of important Australia-wide projects. The partnership has also helped facilitate engagement with key stakeholders to help advocate for funding and provide guidance and expertise in project implementation and resource development. The National Allergy Strategy has been successful in attracting funding to implement projects and develop resources urgently needed. The National Allergy Strategy has also provided a framework and a collaborative approach, for advocacy for further funding and future work to be undertaken.

"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.

A Theoretically Derived Approach to Impact: Implementing Policy Influence Strategies

Advocacy is an intentional act of influencing government and an important precondition for successful policy change in society. Drawing from an existing framework on policy influence, we propose an approach to quantifying the impact of policy influence efforts, specifically within the context of European Public Health (EPH) advocacy. The analysis hinges on the article "Moving from tokenism" which provides a starting point to conceptualize strategies to quantify impact. An exploratory case study approach allowed to integrate literature on advocacy evaluation in parallel with the internal documentation of a EPH advocacy organization We provide recommendations to advocacy organizations that aim to create an infrastructure towards quantifying the impact of their efforts. The framework is mostly tailored to the needs of EPH advocacy, but it can also have resonance beyond the scope of a specific sector.

Norms, rules and policy tools: understanding Article 5.3 as an instrument of tobacco control governance

INTRODUCTION

Article 5.3 of the WHO Framework Convention on Tobacco Control, elaborated via its implementation guidelines, can be understood as a policy instrument comprising norms, rules and policy tools designed to shape practices of policy making and minimise tobacco industry interference.

METHODS

This qualitative research is based on in-depth interviews with officials from diverse government sectors and non-governmental organisations across countries (Ethiopia, India, Uganda) that have adopted measures to implement Article 5.3.

RESULTS

The data highlight varied perceptions and knowledge of Article 5.3 norms between health and non-health sectors. Health officials typically link its core norm of a fundamental conflict between public health and industry interests to the governance norm of protecting public health policies from industry interference. While officials in sectors beyond health broadly endorsed this core norm, they exhibited more limited awareness of Article 5.3 and its model of governance. The results examine how rules to implement Article 5.3 have been codified, but identify the absence of policy tools necessary to operationalise rules and norms. This limitation, alongside restricted awareness beyond health departments, suggests that political commitments to implement Article 5.3 will have limited impact on practices of stakeholder consultation and policy engagement with the tobacco industry.

CONCLUSION

Conceptualising Article 5.3 as a policy instrument helps to explain how its rules and policy tools interact with each other and with broader governance processes. This framework has the potential to enhance understanding of Article 5.3 and help identify opportunities and constraints in its implementation.

Emergent gambling advertising; a rapid review of marketing content, delivery and structural features

BACKGROUND

Gambling advertising is well-funded and has become increasingly sophisticated in recent years. As the presence and pervasiveness of gambling advertising increases, there is a corresponding need for empirical understanding of the characteristics and trends associated with emergent gambling advertisements and marketing. However, there is limited data on this rapidly evolving phenomenon.

METHODS

A rapid review was undertaken of the empirical research (2015-2020) that focused upon the content, delivery and structural features incorporated within emerging gambling advertising.

RESULTS

Twenty-five studies were included in the review. The majority of these studies were conducted in either the UK or Australia; two jurisdictions that have unique and particularly liberal gambling environments. The literature suggests that emergent gambling advertising content is targeted, positively framed and in some instances, may overrepresent riskier bets. The sporting and social media spheres are densely populated with such advertisements that involve both direct and indirect marketing strategies. In relation to the online environment, there is evidence to suggest the emergence of more interactive advertisements that prompt user engagement. In addition, financial incentivisation has diversified and is often subject to strict and esoteric conditions. Despite these emergent trends, little provision is devoted to adequately displaying harm reductive or responsible gambling content within gambling advertising.

CONCLUSIONS

Overall, there is a paucity of research and lack of methodological diversity concerning the characteristics of advertising within the literature. The barriers to investigating emerging gambling advertising are discussed alongside future research priorities. It is important for this research area to expand in order to appropriately inform ethical industry marketing and effective harm-reduction strategies. [Pre-registered online via Prospero: CRD42020184349].

Public Perceptions of Harm for Nine Popular Gambling Products

Gambling causes significant levels of harm globally and is recognised as a serious public health issue. To reduce gambling-related harm, various strategies and policies have been recommended, including decreasing the availability of gambling products, restricting gambling advertising, and implementing public education campaigns. Government willingness to implement such strategies will be influenced by levels of public support, which in turn will be dependent on public perceptions of the harm caused by gambling products. The aim of the present study was to assess public perceptions of the harm associated with individual gambling products to inform future gambling reform. A sample of 2112 Australian adults provided perceived harm ratings for nine popular gambling products that are known to be associated with gambling-related harm: electronic gambling machines, casino table games, sports betting, bingo, scratch tickets, private betting, horse/dog races, keno, and the lottery. Binary logistic regressions were used to identify factors associated with harm perceptions. Only electronic gambling machines (70%), casino table games (64%), betting on horse/dog races (59%), and sports betting (53%) were perceived by a majority of respondents as being harmful. Less frequent gambling and experiencing greater levels of gambling-related harm were associated with higher harm perceptions. Many potentially harmful gambling products may not be recognised as such by the public, which is likely to reduce support for recommended harm-reduction strategies and policies. Efforts are needed to ensure Australians in general and gamblers in particular understand the levels of harm associated with popular gambling products.

Non-invasive brain stimulation targets and approaches to modulate gambling-related decisions: A systematic review

INTRODUCTION

Despite intense neuroscience research on the neurobiological underpinnings of Gambling Disorder (GD) and gambling-related decision-making, effective treatments targeting these dysfunctions are still lacking. Non Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS), selectively modulate activity of brain circuits and have the potential to reverse alterations sustaining GD symptoms. Therefore, the aim of this systematic review was to determine the impact of different NIBS interventions on gambling-related decision processes.

METHODS

We conducted a comprehensive and translational search in three online databases (MEDLINE via PubMed, Scopus, Web of Science), in accordance with the PRISMA guidelines. We included studies applying neuromodulation (TMS, tDCS) techniques in GD patients or assessing gambling-related decision-making in healthy subjects. In addition, we explored the potential impact of NIBS in drug-induced GD (e.g., Parkinson's Disease).

RESULTS

Twenty-seven studies have been included. We summarized results to detect the impact of different targets and stimulation/inhibition protocols in terms of gambling-related decision-making. The majority of both tDCS and TMS studies targeted the dorsolateral prefrontal cortex. Although heterogeneous in protocols and parameters, results from tDCS and TMS studies converge in indicating that the stimulation (instead of inhibition) of prefrontal regions could be beneficial to contrast dysfunctional gambling-related decision processes.

CONCLUSION

NIBS interventions show promise to be further tested in controlled clinical settings for the treatment of behavioral addictions. Further studies are also necessary to investigate connectivity changes and laterality issues (unilateral versus bilateral; left versus right) of NIBS application in GD.

Prerequisites for stakeholder framework: Consumer advocacy and health protection in the digital industry. •

The World Health Organization (WHO) included gaming disorders in International Classification of Disease-11th (ICD-11) on May 25, 2019. Since then, some academics and the gaming industry have continued to argue over the health system's response to online addictive behaviors. Under these circumstances, a framework involving groups representing various interests is needed to derive a reasonable solution to the dispute over the inclusion of gaming disorders in ICD-11. For this framework to work effectively, it is necessary to agree on consistent and advanced research findings that harms related to the excessive use of digital devices or content continue to occur empirically all over the world and that addictive use constitutes a primary addictive disorder. The problematic risk taking involving emerging technologies may include not only health risks from addictive use, but also more general harms associated with digital ethics and norms such as privacy and transparent money transactions. An understanding of a public health model of addiction is required to reduce harms associated with online addictive behavior that exist behind risk taking. Such harms are also mediated by excessive use, excessive money spending, and exposure to addictive content such as violence and pornography. Major stakeholders and their roles can be derived more effectively based on these conceptual models and parameters of harms. In conclusion, the context of the proposed stakeholder framework should be further optimized on the basis of two principles: (1) advocating consumer rights as a general and standard approach to digital products; and (2) protecting consumers' health from harms related to addictive behaviors.