Gambling Harm as a Global Public Health Concern: A Mixed Method Investigation of Trends in Wales

Anticipated Motives for Gambling Treatment in Adults from the U.S

Prior works note that identifying problematic play is a leading barrier to treatment seeking, contributing to low treatment rates in those with gambling problems (e.g., Bijker et al., 2022; Suurvali et al., 2012a). While research has looked at treatment seekers' motives for treatment (Gainsbury et al., 2014; Suurvali et al., 2012b), the situations or signs (anticipated motives) individuals look for that suggest they would need treatment in the future remains unknown. Participants were gamblers (N = 1,791) from a census-matched U.S. sample of adults who reported no concerns about their gambling. Participants completed questions assessing how much money they would have to lose while gambling to think they might have a problem and what factors might motivate them to pursue treatment for gambling problems in the future. Participants reported a wide range of financial loss that would suggest they had a problem, and higher income men who gambled more frequently reported higher necessary losses. There was little variation in endorsement (40-60%) of 14 situations that may lead them to seek treatment in the future (e.g., felt guilty). However, income, gender identity, and problem gambling behavior were linked to the endorsement of some of these anticipated motives, with some differences in endorsement between those engaging in high- and low-level problem gambling. Collectively, results are consistent with the inference that many individuals may not be aware of what problematic gambling would look like for them, though income, gender identity, and problem gambling behavior may impact their consideration of anticipated motives.

Treatment of harmful gambling: a scoping review of United Kingdom-based intervention research

BACKGROUND

Understanding and treating the harm caused by gambling is a growing international psychiatric and public health challenge. Treatment of gambling harm may involve psychological and pharmacological intervention, in conjunction with peer support. This scoping review was conducted to identify, for the first time, the characteristics and extent of United Kingdom (UK) based gambling treatment research. We reviewed studies conducted among people seeking treatment for disordered or harmful gambling in the UK, the settings, research designs, and outcome measures used, and to identify any treatment research gaps.

METHODS

Systematic searches of PsycInfo, PsycArticles, Scopus, PubMed, and Web of Science databases were carried out for gambling treatment research or evaluation studies conducted in the UK. Studies were included if they evaluated the effectiveness of an intervention or treatment designed to improve symptoms of harmful or problematic gambling, reported outcomes of interventions on treatment adherence, gambling symptoms, or behaviours using standardised measures, were conducted in the UK, and were published since 2000.

RESULTS

Eight studies met the inclusion criteria. Four were retrospective chart reviews, two were single-participant case reports, one described a retrospective case series, and one employed a cross-sectional design. None used an experimental design.

CONCLUSION

The limited number of studies included in this review highlights a relative paucity of gambling treatment research conducted in UK settings. Further work should seek to identify potential barriers and obstacles to conducting gambling treatment research in the UK.

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.

Psychological intervention for gambling disorder: A systematic review and meta-analysis

Background and aims

Increasingly, gambling features migrate into non-gambling platforms (e.g., online gaming) making gambling exposure and problems more likely. Therefore, exploring how to best treat gambling disorder (GD) remains important. Our aim was to review systematically and quantitatively synthesize the available evidence on psychological intervention for GD.

Methods

Records were identified through searches for randomized controlled trials (RCTs) evaluating psychological intervention for GD via six academic databases without date restrictions until February 3, 2023. Study quality was assessed with the revised Cochrane risk-of-bias tool for randomized trials (RoB2). Primary outcomes were GD symptom severity and remission of GD, summarized as Hedges' g and odds ratios, respectively. The study was preregistered in PROSPERO (#CRD42021284550).

Results

Of 5,541 records, 29 RCTs (3,083 participants analyzed) were included for meta-analysis of the primary outcomes. The efficacy of psychological intervention across modality, format and mode of delivery corresponded to a medium effect on gambling severity (g = -0.71) and a small effect on remission (OR = 0.47). Generally, risk of bias was high, particularly amongst early face-to-face interventions studies.

Discussion and conclusions

The results indicate that psychological intervention is efficacious in treating GD, with face-to-face delivered intervention producing the largest effects and with strongest evidence for cognitive behavioral therapy. Much remains to be known about the long-term effects, and investigating a broader range of treatment modalities and digital interventions is a priority if we are to improve clinical practice for this heterogeneous patient group.

Voluntary Self-Exclusion and Contingency Management for the Treatment of Problematic and Harmful Gambling in the UK: An Exploratory Study

Research into self-directed methods for reducing problematic and harmful gambling is still in its infancy. One strategy that individuals use to prevent gambling involves voluntary self-exclusion (VSE) programs. For example, VSE programs can make it challenging to access betting sites or enable banks to block gambling-related transactions. Although individual VSEs can be helpful when used alone, it is unclear whether their efficacy is enhanced when combined. Furthermore, it is unknown how VSE compliance can be improved. We propose that contingency management (CM), an evidence-based strategy to incentivise abstinence, could encourage continued VSE use, promoting long-lasting recovery from problematic or harmful gambling. Here, we conducted exploratory analyses on VSE use and CM for gambling in two populations (members of the UK general population recruited and students). Participants responded favourably regarding combined VSE use. They felt that providing vouchers exchangeable for goods/services could incentivise gambling abstinence during VSE. However, some were concerned about people potentially "gaming" the system. Participants believed supplementing VSE and CM with social support could encourage abstinence. These attitudes, and recent research on treatment providers' opinions on CM for gambling, suggest that experimental evidence should be sought to determine the efficacy of combined VSE use and CM for gambling.

Examining the Gambling Behavior of University Students: A Cross-Sectional Survey Applying the Multi-Theory Model (MTM) of Health Behavior Change in a Single Institution

Gambling among college students can start as a pastime activity. However, this pastime can lead to problem gambling and pathological gambling. This cross-sectional study aimed to identify and explain the initiation and sustenance of quitting gambling among university students who had participated in gambling during the past month and those who had not using a novel fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from a sample of 1474 university students at a large southwestern university in the U.S. between January 2023 and February 2023, utilizing a validated 39-item survey. The statistical analyses employed in this study encompassed descriptive statistics, independent samples t-tests, and hierarchical regression modeling. Among students who had engaged in gambling in the past month, the constructs of participatory dialogue (β = 0.052; p < 0.05), behavioral confidence (β = 0.073; p < 0.0001), changes in the physical environment (β = 0.040; p = 0.0137), and demographic variables accounted for 27.7% of the variance in the likelihood of initiating the behavior change. Furthermore, the constructs of emotional transformation (β = 0.104; p = 0.0003) and practice for change (β = 0.060; p = 0.0368), and demographic variables accounted for 22.6% of the variance in the likelihood of sustaining quitting gambling behavior. The Multi-Theory Model (MTM) can be employed to design interventions aimed at reducing problem gambling among college students.

Gambling problems predict suicidality in recently transitioned military veterans

OBJECTIVE

This study investigated associations between gambling problems and suicidality in Australian veterans.

METHODS

Data drawn from n = 3,511 Australian Defence Force veterans who had recently transitioned to civilian life. Gambling problems were assessed using the Problem Gambling Severity Index (PGSI) and suicidal ideation and behaviour were assessed using items adapted from the National Survey of Mental Health and Wellbeing.

RESULTS

At-risk gambling and problem gambling were associated with increased odds of suicidal ideation [at-risk gambling: odds ratio (OR), 1.93; 95% confidence interval (CI), 1.47‒2.53; problem gambling: OR, 2.75; 95% CI 1.86‒4.06] and suicide planning or attempts (at-risk gambling: OR, 2.07; 95% CI, 1.39‒3.06; problem gambling: OR 4.22, 95% CI, 2.61‒6.81). The association with total scores on the PGSI and any suicidality was substantially reduced and became non-significant when controlling for the effects of depressive symptoms, but not financial hardship or social support.

CONCLUSIONS

Gambling problems and harms are important risk factors for suicide in veterans, and should be recognised in veteran-specific suicide prevention policies and programs, along with co-occurring mental health problems.

IMPLICATIONS FOR PUBLIC HEALTH

A comprehensive public health approach to reducing gambling harm should feature in suicide prevention efforts in veteran and military populations.

Protecting children and young people from contemporary marketing for gambling

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.

Social norms and goal-setting interventions to promote responsible gambling in low-to-moderate online gamblers: protocol for a four-arm randomised controlled feasibility study

INTRODUCTION

Gambling is increasingly recognised as an important public health issue. Problem gambling is associated with highly negative impacts on physical, psychological and social well-being, not only for those who gamble but also for those around them. There has been a rapid expansion of internet gambling and attributes such as continuous play and instant rewards, and enhanced privacy may lead to a greater likelihood of gambling-related harms. In this randomised controlled feasibility study, we are testing (1) the acceptability and feasibility of three online responsible gambling interventions targeting people with low-to-moderate risk of online problem gambling and (2) the feasibility of a future full-scale randomised controlled trial (RCT) to test their effectiveness and cost-effectiveness.

METHODS AND ANALYSIS

Four-arm randomised controlled feasibility study with qualitative substudy. One-hundred and forty UK residents with low-to-moderate risk of online gambling recruited via gambling operators and social media will be randomised (1:1:1:1) to either (1) goal setting, (2) descriptive norms messages (challenge perceptions of peer behaviours), (3) injunctive norms messages (challenge perceptions of peer attitudes) and (4) control (delayed intervention). Interventions will be delivered over 6 weeks and individually tailored. Outcomes, administered online, will be measured at baseline, 7 weeks, and 3 and 6 months post randomisation (including gambling risk behaviours and cognitions, anxiety and depression, quality of life, health use and productivity). Analyses will be descriptive, focusing on feasibility and acceptability of the interventions and study procedures. Telephone/online interviews, with a subsample of approximately 30 participants, will elicit experiences of participating in the study. Prespecified progression criteria will guide decisions around whether to progress to a definitive RCT.

ETHICS AND DISSEMINATION

Ethical approval obtained from Bournemouth University Research Ethics Committee (reference number 33247). Participants will be given a participant information sheet plus a 'Key Facts' summary and will provide informed online consent. Findings will be published in peer-reviewed journals and presented at conferences and public engagement events.

TRIAL REGISTRATION NUMBER

ISRCTN37874344.

Experience of LGBTQIA2S+ populations with gambling during the COVID-19 pandemic: protocol for a mixed-methods study

INTRODUCTION

Research undertaken since the beginning of the COVID-19 pandemic has provided us information about the impact of the pandemic on the gambling habits of the general population. However, very little is known about certain subgroups at increased risk of developing gambling disorder, such as the LGBTQIA2S+ population. The purpose of this study is to describe the impact of the COVID-19 pandemic on gambling behaviours among LGBTQIA2S+ individuals. In addition, we want to understand the experiences of the LGBTQIA2S+ population with gambling disorder and identify interventions that LGBTQIA2S+ people have found to be effective in addressing problem gambling during the COVID-19 pandemic.

METHODS AND ANALYSIS

This study has a sequential explanatory mixed-method design in two phases over 2 years. The first phase is a correlational study. We will conduct a cross-sectional survey using a stratified random sampling among Canadian residents who are 18 years of age or older, self-identify as sexually and gender-diverse (ie, LGBTQIA2S+) and have gambled at least once in the previous 12 months. This survey will be administered online via a web panel (n=1500). The second phase is a qualitative study. Semistructured interviews will be conducted with LGBTQIA2S+ people with problematic gambling (n=30).

ETHICS AND DISSEMINATION

This research project has been ethically and scientifically approved by the Research Ethics Committee and by the CIUSSS de l'Estrie-CHUS scientific evaluation committee on 3 March 2022 (reference number: 2022-4633-LGBTQ-JHA). Electronic and/or written informed consent, depending on the data collection format (online survey and online or in-person interviews), will be obtained from each participant. A copy of the consent form and contact information will be delivered to each participant.

18 Years of Changing Trends: Swiss Data on the Clinical Characteristics and Game Types Associated with Problem Gambling

Recent changes in the Swiss gambling context include the introduction of a new gambling policy (Swiss Federal Act on Gambling; GA), and the associated opening of the online gambling market. Within this context it is important to observe evolving trends in gambling behavior. This study therefore aims to identify the gambling behavior and clinical characteristics of a treatment-seeking population over an 18-year period (2001 to 2018). Specifically, the proportion of referrals relating to the three most popular game-types; VLT play, slot machines and online gambling, and associated socio-demographic characteristics, gambling-related spending and clinical features. The results indicate the high addictive potential for VLT and slot-machine use, over the 18-year period with an increasing use of online gambling from 2012 to 2018 (even before the official opening of the market). Problem-gambling vulnerability factors such as low income, unemployment and debts as well as self-reported suicidal ideation, were also over-represented in the sample. This longitudinal overview provides a detailed picture of treatment-seeking referrals, for future comparisons and can be used to tailor clinical interventions.

A critical qualitative inquiry of the social practices of older adult gamblers: implications for public health risk prevention

Older adults' participation in gambling is increasing internationally. Due to their lifestage, older adults may be vulnerable to gambling-related harm. When investigating older adults' gambling, researchers have mostly focused on the individual characteristics of ‘problem gamblers’. Less is known about the socio-cultural, environmental and commercial factors that may influence older adults' gambling behaviours. Utilising Social Practice Theory, this critical qualitative inquiry of N = 40 Australian older adults (aged 55 and over) explored how social practices influenced gambling participation. Using a Constructivist Grounded Theory approach, data were interpreted using a reflexive thematic analysis. Theme 1 identified how gambling practices fulfilled older adults' social needs. Gambling was embedded in social activities and created a sense of belonging. Theme 2 highlighted how gambling became an everyday part of some participants' lives, with a range of routines constructed around gambling. While social factors influenced routinised gambling behaviours, the accessibility of gambling products in everyday settings contributed to engagement with gambling. This study demonstrates that a range of social, environmental and commercial factors may influence and routinise the gambling practices of older adults. Interventions aimed at preventing and reducing routine gambling participation among older adults should acknowledge the interplay between agency and social structure. Public health responses should aim to disrupt routine behaviours associated with gambling for older adults.

Gambling and Gambling Problem Perception Questionnaire as a tool to evaluate professionals’ attitudes towards problem gamblers and training programmes in Japan

Aim: To develop and measure the psychometric properties of the Gambling and Gambling Problem Perception Questionnaire (GGPPQ); a scale to evaluate professionals’ attitudes towards people with problem gambling in the Japanese context. Data collection: We held 12 workshops in Japan targeted at mental health professionals who consult people with gambling problems. Participants completed the survey before the workshop. Some were also asked to complete the survey after the workshop to measure workshop influence. Setting: Public and private healthcare facilities in all 47 prefectures of Japan. Participants: Medical doctors, nurses, social workers, clinical psychologists, and other professionals working in the aforementioned facilities ( n = 653, response rate = 98.5%). Measurements: licence; knowledge about gambling and gambling problems (questionnaire); self-rating of knowledge and general confidence for helping problem gamblers; years of practice; frequency of working with clients; experience in attending workshops; overall satisfaction with the workshop. Results: A five-factor structure extracted by exploratory factor analysis showed a good fit by confirmatory factor analysis (CFI = .973, TLI = .967, RMSEA = .060, AIC = 28913.6, BIC = 29110.8). The GGPPQ showed good internal consistency and good concurrent validity with participants’ self-rating of their knowledge, general confidence, frequency of working with clients who have gambling problems, and experience in attending workshops. The workshop had a positive influence on participants’ attitudes. Japan's unique gambling industry and lack of training opportunities on problem gambling were assumed to have influenced the psychometric properties of the measurement tool. Conclusion: The GGPPQ is a valid tool to measure the attitudes of healthcare professionals towards people with gambling problems, as well as workshop effectiveness in Japan.

Gender- and age-stratified analyses of gambling disorder in Finland between 2011 and 2020 based on administrative registers

Aim: Prevalence studies on gambling have largely relied on survey samples. Little is known about the diagnosed prevalence of gambling disorder (GD) based on register data. This study examines the annual prevalence rate of GD between 2011 and 2020 among Finns by gender and age. Methods: Aggregated data on the diagnosis of GD (corresponding to pathological gambling, code F63.0 in the ICD-10) were retrieved from the following national registers: Register of Primary Health Care Visits, and Care Register for Health Care, including specialised outpatient and inpatient health care, and inpatient Care Register for Social Welfare. Primary and secondary diagnoses of adults were included. Average population during a calendar year (4,282,714–4,460,177 individuals) was utilised to calculate annual prevalence. Results: The annual prevalence of diagnosed GD in the population increased from 0.005% ( n = 196) to 0.018% ( n = 804) within nine years. In 2011, the annual prevalence rate was 0.006% for men and 0.003% for women, compared to rates in 2020 of 0.025% and 0.011%. Gender discrepancy was relatively stable across years: 27.2–33.8% of the diagnoses were for women. The prevalence of GD varied between age groups within genders. GD was most prevalent among 18–44-year-olds. The prevalence rates increased the most among 30–44-year-old women. Conclusion: The extremely low prevalence rate of GD implies that the problem remains under-diagnosed, yet, it has increased among all age groups across genders, except for women aged 60 years or older. Active efforts are needed to increase awareness of GD among both primary and specialised healthcare professionals and the public for better recognition and early detection.

How many children are exposed to at-risk parental gambling in Australia? Results from a representative national sample

Children of problem gamblers are at risk of harm, however, there are no population level estimates as to how many children are currently exposed to parental problem- and at-risk gambling. The current study analysed data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, a nationally representative survey, to derive the first ever national estimates of the proportion of problem, moderate, and low risk gamblers (as measured by PGSI) in the Australian parent population. It also reports how many children under 15 years of age in Australia are exposed to parental gambling across the gambling risk categories. The results show that 13.7% of all Australian families with dependent children are currently exposed to some level of gambling risk due to parental gambling, and nearly 4% of families with children are exposed to parental moderate risk or problem gambling. This corresponds to almost 200,000 children each year. The results and approach of this study will guide future examination of child wellbeing in families where parents experience problems with gambling. The results are discussed in the context of public health approaches to familial gambling harm.

Young people in Australia discuss strategies for preventing the normalisation of gambling and reducing gambling harm

Background

The normalisation of gambling for young people has received considerable recent attention in the public health literature, particularly given the proliferation of gambling marketing aligned with sport. A range of studies and reports into the health and wellbeing of young people have recommended that they should be consulted and engaged in developing public health policy and prevention strategies. There are, however, very few opportunities for young people to have a say about gambling issues, with little consideration of their voices in public health recommendations related to gambling. This study aimed to address this gap by documenting young people’s perceptions about strategies that could be used to counter the normalisation of gambling and prevent gambling related harm.

Methods

This study took a critical qualitative inquiry approach, which acknowledges the role of power and social injustice in health issues. Qualitative interviews, using a constructivist approach, were conducted with 54 young people (11–17 years) in Australia. Reflexive thematic analysis was used to interpret the data.

Results

Five overall strategies were constructed from the data. 1) Reducing the accessibility and availability of gambling products; 2) Changing gambling infrastructure to help reduce the risks associated with gambling engagement; 3) Untangling the relationship between gambling and sport; 4) Restrictions on advertising; and 5) Counter-framing in commercial messages about gambling.

Conclusions

This study demonstrates that young people have important insights and provide recommendations for addressing factors that may contribute to the normalisation of gambling, including strategies to prevent gambling related harm. Young people hold similar views to public health experts about strategies aimed at de-normalising gambling in their local communities and have strong opinions about the need for gambling to be removed from sport.

Increasing harms for bingo players: digitisation, commercialisation and regulatory inadequacy: a multi-site case study

BACKGROUND

Bingo is often understood as a low-harm form of gambling. This view has been challenged by a growing body of literature identifying gambling harm to bingo players in a range of countries. In this study, we aimed to identify which conditions enabled, facilitated, intensified or mitigated gambling harm for bingo players in three populations in Victoria in the context of corporate, technological and regulatory changes.

METHODS

Our qualitative study investigated experiences of bingo-related gambling harm in three populations in Victoria, Australia where bingo was popular and structural disadvantage common: Indigenous people in the east, Pacific people in the state's north and older people on low or fixed incomes in the capital. Data was generated through interviews with 53 bingo players and 13 stakeholders as well as 12 participant observations of bingo sessions.

RESULTS

We found that while bingo is overwhelmingly positive for many players, a minority of bingo players and their families experience notable harm. Harm was generated through traditional paper-based bingo games, new technologies such as tablet-based bingo and by the widespread tactic of placing bingo sessions in close proximity to harmful electronic gambling machines. Overall, the risk of harm to bingo players appears to be escalating due to commercial, technological and regulatory changes.

CONCLUSIONS

These changes can be better managed by regulators: reforms are needed to safeguard bingo's distinct character as a lower-risk form of gambling at a time when it, and its players, are under threat. Significantly, we found that harm to bingo players is intensified by factors external to gambling such as racialised poverty and adverse life events. Strategies that recognise these factors and grapple with gambling harm to bingo players are needed.

Young men's perceptions about the risks associated with sports betting: a critical qualitative inquiry

BACKGROUND

Gambling is an inherently risky activity. New technologies have led to the development of new, online forms of gambling such as sports betting, with round the clock availability and accessibility. While young men have been identified as a group that may be particularly vulnerable to the harms associated with these new online products, few studies have qualitatively explored young men's perceptions of the risks associated with these products. Using concepts associated with the sociology of risk, this paper sought to explore the range of factors that may influence how 18-24 year old young Australian men conceptualise the risks associated with sports betting.

METHODS

Using a critical qualitative inquiry approach, in-depth interviews were conducted with sixteen participants in Victoria, Australia, who engaged in sports betting at least monthly. The data interpreted for this study included questions relating to awareness of gambling, the contexts associated with early gambling experiences; the factors that influenced current gambling behaviours, and why they engaged in gambling. A reflexive approach to thematic analysis was used to interpreted themes from the data.

RESULTS

Four key themes were constructed from the data relating to the factors that influenced risk perceptions. These included: 1) 'The role of early experiences', including exposure to gambling advertising in sport, and the gambling behaviours of social networks; 2) 'The influence of peer rivalry and competition', in which sports betting was used to form connections within and across peer groups; 3) 'The normalisation of gambling', including the embedding of gambling in everyday activities; and 4) 'The influence of perceptions of knowledge, skill, and control', including the belief that they could engage in responsible behaviours and stop gambling if they needed to.

CONCLUSION

This study indicated that a range of factors may influence how young men conceptualise the risks and benefits associated with sports betting. Current public health strategies for gambling that focus on individual determinants and responsibility paradigms must be broadened to target the social and commercial factors that influence young men's attitudes towards, and engagement in sports betting.

"They loved gambling more than me." Women's experiences of gambling related harm as an affected other

BACKGROUND

Gambling poses a global threat to public health due to its far-reaching impacts. Research has demonstrated a ripple effect of harmful gambling on social network members and broader communities. While researchers have documented extreme harms associated with an affected other, limited research has qualitatively investigated how women describe their concerns about the gambling of a social network member, and any subsequent negative impacts on their own lives.

METHODS

Online panel survey with women aged 18 years and older, who gambled at least once in the last 12 months, and resided in the Australian states of Victoria and New South Wales. This paper focused on the open text responses of a subsection of the sample (n = 136) who reported being negatively impacted by someone else's gambling. The study utilised thematic analysis to interpret the data.

RESULTS

Results indicated that women were concerned about the gambling behaviours of a broad range of social network members. Open text responses regarding the nature of these concerns mostly related to individualised paradigms of gambling behaviour - including whether the participant perceived their network member could afford to gamble, was being responsible with their gambling, or were gambling too frequently. Participants experienced a range of negative impacts including significant financial issues, relationship difficulties and poorer emotional wellbeing as a result of worrying about the gambler and loss of trust, with some describing the negative experiences associated with growing up with a problem gambler parent.

CONCLUSION

The research demonstrates the far-reaching impacts of gambling on affected others. This study enhances our understanding of how women are harmed by gambling and considers the complexities of their experiences and relationships with the gambler. This extends knowledge beyond quantitative descriptors of harm among affected others and provides a critical reflection on the nuances of women's experiences with gambling and gambling harm.

Gambling and the COVID-19 pandemic in the province of Quebec (Canada): protocol for a mixed-methods study

INTRODUCTION

The COVID-19 pandemic has major collateral impacts on mental health. Gambling is among the major public health issues that seems to have been transformed by the pandemic. In the province of Quebec in Canada, gambling is an important leisure activity. About two out of three adults are in Quebec gamble. The objective of this study is to draw a portrait of the impacts of the COVID-19 pandemic on gamblers and to learn more about their experiences during the pandemic in the province of Quebec.

METHOD AND ANALYSIS

This study has a sequential explanatory mixed-method design in two phases. The first phase is a cross-sectional online survey with Quebec residents who are 18 years of age or older and have gambled at least once in the previous 12 months. The second phase will be a qualitative study. Semistructured interviews will be conducted with gamblers, family members, addiction counsellors and state representatives selected through purposing sampling.

ETHICS AND DISSEMINATION

This study is one of the first mixed-methods studies on the impacts of the COVID-19 pandemic on gambling. This study will generate new scientific knowledge on a worrisome public health issue, that is, gambling, and provide a better understanding of the experiences and gambling behaviours of gamblers during the pandemic. This study is funded by the Ministry of Health and Social Services of the Government of Quebec and was approved on 27 October 2020 by the Scientific and Research Ethics Committee of the CIUSSS de l'Estrie-CHUS. This is a 2-year study that will be completed in June 2022.

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].