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.

Tracking online searches for gambling activities and operators in the United Kingdom during the COVID-19 pandemic: A Google Trends™ analysis

Background

Whilst some research has explored the impact of COVID-19 on gambling behaviour, little is yet known about online search behaviours for gambling during this period. The current study explored gambling-related online searches before, during and after the outbreak of the COVID-19 pandemic in the UK. We also assessed whether search trends were related to Gambling Commission behavioural data over the same period.

Methods

Google Trends™ search data, covering thirty months from January 2020 to June 2022, for five gambling activities and five gambling operators were downloaded. Graphical displays of the weekly relative search values over this period were then produced to visualise trends in search terms, with key dates in COVID-19 policy and sporting events highlighted. Cross-correlations between seasonally adjusted monthly search data and behavioural indices were conducted.

Results

Sharp increases in internet searches for poker, slots, and bingo were evident during the first lockdown in the UK, with operator searches sharply decreasing over this period. No changes in gambling activity searches were highlighted during subsequent lockdowns, although small increases in operator-based searches were detected. Strong positive correlations were found between search data and industry data for sports betting and poker but not for slots.

Conclusions

Google Trends™ data may act as an indicator of population-level gambling behaviour. Substitution of preferred gambling activities for others may have occurred during the first lockdown when opportunities for sports betting were limited. Further research is needed to assess the effectiveness of internet search data in predicting gambling-related harm.

Expenditure on Paid-for Gambling Advertising During the National COVID-19 'Lockdowns': An Observational Study of Media Monitoring Data from the United Kingdom

Changes in gambling advertising during national COVID-19 'lockdowns', when stay-at-home rules restricted participation in certain gambling activities, provides important context to variance in gambling behaviour during these periods. This study describes expenditure on paid-for gambling advertising during three national lockdowns, compares expenditure to pre-pandemic estimates, and compares changes in expenditure by subsector. Data come from an observational study of weekly expenditure on paid-for gambling advertising in the United Kingdom (n = 135 weeks; beginning 2019 to mid-2021), focusing on three COVID-19 lockdowns: (1) March-May 2020; (2) November-December 2020; and (3) January-March 2021. We descriptively analysed how total advertising expenditure in each lockdown (£GBP, inflation-adjusted) compared to the same time points in 2019, both overall and by subsector (bookmakers, lotteries, online bingo, online casino and poker, gaming, pools, mobile content). Gambling advertising expenditure during lockdown one was 38.5% lower than 2019 (£43.5 million[m] vs. £70.7 m, respectively), with decreases across all subsectors (range: -81.7% [bookmakers] to -2.8% [online bingo]). Total advertising expenditure in lockdown two was 49.3% higher than 2019 (£51.7 m vs. £34.6 m), with increases for 5/7 subsectors (range: -31.6% [mobile content] to + 103.8% [bookmakers]). In lockdown three, advertising expenditure was 5.9% higher than 2019 (£91.2 m vs. £86.1 m), with increases for 4/7 subsectors (range: -92.4% [pools] to + 49.2% [mobile content]). Reductions in advertising expenditure in lockdown one are congruent with self-reported reductions in overall gambling also observed during this period. Further research is needed to determine whether increased advertising expenditure in lockdowns two and three correlates with increased gambling, overall and for specific subsectors.

Targeting the next generation of gamblers? Gambling sponsorship of esports teams

BACKGROUND

Esports fans are a target audience for gambling companies wanting to attract the next generation of bettors to their products. As with other sports, professional esports teams have commercial sponsorship arrangements. Our paper seeks to document the level of gambling sponsorship of the world's top esports teams.

METHODS

A systematic review of the commercial arrangements between the top 20 esports clubs across three of the most followed esports titles was undertaken: Dota 2, League of Legends (LoL) and CS:GO. Data were scraped online relating to the top 20 teams competing at their respective major tournaments between October and November 2021.

RESULTS

Half of the esports teams in Dota 2 and CS:GO's world championship events in 2021 were sponsored by gambling companies. Teams sponsored by gambling companies have a combined total of 25 868 912 followers across three major social media channels. No LoL teams were sponsored by gambling companies, yet sibling teams within the CS:GO and Dota 2 competitions were.

CONCLUSION

The relationship between gambling companies' sponsorship in esports should be considered in line with the calls for change in the relationship between football and gambling with gambling as a public health issue at its heart.

Gambling consumption and harm: a systematic review of the evidence

The total consumption model (TCM) postulates a close link between total consumption and levels of harm within the population, which has important implications for prevention. This review aimed to explore evidence relating to the application of the TCM and theoretical elements associated with it (i.e. the distribution of harms; the concentration of consumption) to gambling by reviewing evidence pertaining to the distribution of harms across the population; the concentration of gambling consumption; and evidence of the validity of the TCM in gambling. Systematic literature searches were performed using MEDLINE, PsycINFO, and Web of Science databases, restricted to publications between January 1, 2010, and March 29, 2023. The search identified seven studies examining risk curves for gambling harm, of which only two employed continuous consumption measures. This nascent literature suggests mixed evidence for the relationship between gambling consumption (e.g. losses, frequency, expenditure, and expenditure as a percentage of income) and risk of harm. Five publications found that the concentration of gambling consumption was high among those experiencing gambling harms, with some evidence that spending is more concentrated for certain games (e.g. online casinos) than for others (e.g. lotteries). Finally, four studies assessed the TCM, suggesting close association between gambling consumption and problem gambling, lending empirical support to the validity of the TCM. However, robust evidence is nascent and further research is required to assess these relationships.

Changes in severity of problem gambling and subsequent suicide attempts: a longitudinal survey of young adults in Great Britain, 2018-20

BACKGROUND

Cross-sectional studies identify problem gambling as a risk factor for suicidality. Using an online longitudinal survey, we aimed to examine the association between changes in severity of gambling behaviour and attempted suicide.

METHODS

The Emerging Adults Gambling Survey is a longitudinal survey of people in England, Scotland, and Wales, aged 16-24 years interviewed online between June 25 and Aug 16, 2019 (wave 1) and 1 year later between July 13 and Oct 8, 2020 (wave 2). The Problem Gambling Severity Index (PGSI) was administered at both waves. Multivariable logistic regression models examined wave 1 PGSI score and between-wave change in PGSI score as risk factors for suicide attempts at wave 2, unadjusted and with adjustment for wellbeing, anxiousness, impulsivity, perceived loneliness, and suicide attempts at wave 1.

FINDINGS

3549 participants were interviewed in wave 1 and 2094 were interviewed in wave 2, of whom 1941 were included in this analysis (749 [39%] men; 1192 women [61%]). Prevalence of attempted suicide did not change between waves (wave 1: 3·7% [95% CI 2·9-4·8], n=75; wave 2: 3·3% [2·5-4·3], n=65). 78·9% (95% CI 76·7-80·9, n=1575) of participants had stable PGSI scores between the two waves, 13·7% (11·9-15·6, n=233) of participants had a decrease in PGSI score by 1 or more, and 7·5% (6·2-8·9, n=133) had an increase in PGSI score by 1 or more. An increase in PGSI scores over time was associated with suicide attempt at wave 2, even with adjustment for baseline PGSI score and other factors (adjusted odds ratio 2·74 [95% CI 1·20-6·27]). Wave 1 PGSI score alone was not associated with suicide attempt at wave 2 in fully adjusted models.

INTERPRETATION

Repeated routine screening for changes in gambling harm could be embedded in health, social care, and public service settings to allow effective identification and suicide prevention activities among young adults.

FUNDING

Wellcome Trust.

Debate: We need data infrastructure as well as data sharing - conflicts of interest in video game research

Industry data sharing has the potential to revolutionise evidence on video gaming and mental health, as well as a host of other critical topics. However, collaborative data sharing agreements between academics and industry partners may also afford industry enormous power in steering the development of this evidence base. In this paper, we outline how nonfinancial conflicts of interest may emerge when industry share data with academics. We then go on to describe ways in which such conflicts may affect the quality of the evidence base. Finally, we suggest strategies for mitigating this impact and preserving research independence. We focus on the development of data infrastructure: technological, social, and educational architecture that facilitates unfettered and free access to the kinds of high-quality data that industry hold, but without industry involvement.

What is the evidence that advertising policies could have an impact on gambling-related harms? A systematic umbrella review of the literature

OBJECTIVE

To summarise the evidence on the impacts of gambling-related advertising that could lead to gambling-related harm, including impacts on vulnerable individuals and inequalities in the distribution of harms.

STUDY DESIGN

An umbrella review of studies investigating the impact of gambling advertising.

METHODS

A review was undertaken of systematic reviews of qualitative, quantitative and mixed method studies reporting outcomes associated with gambling advertising and marketing. The search strategy included database searches (Web of Science, PsycInfo) and website searches. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews 2.

RESULTS

1024 papers were identified by database searches. Eight systematic reviews, including 74 unique studies, met inclusion criteria. Included studies, using quantitative and qualitative methods, consistently support the existence of a causal relationship between exposure to advertising of gambling products/brands and more positive attitudes to gambling, greater intentions to gamble and increased gambling activity at both individual and population level. There is evidence of a 'dose-response' effect; greater advertising exposure increases participation which leads to a greater risk of harm. There was more evidence for the impact on children and young people and for those already at risk from current gambling activity with those most vulnerable more likely to be influenced.

CONCLUSION

Gambling advertising restrictions could reduce overall harm and mitigate the impact of advertising on gambling-related inequalities. Public health harm prevention strategies should include policies which limit exposure to advertising, particularly among children and vulnerable groups.

The relationship between problematic gambling severity and engagement with gambling products: Longitudinal analysis of the Emerging Adults Gambling Survey

AIMS

To measure the association between problem gambling severity and 19 different gambling activities among emerging adults (aged 16-26).

DESIGN

An online non-probability longitudinal survey collecting data in two waves: wave 1, July/August 2019; wave 2, July/October 2020.

SETTING

Great Britain PARTICIPANTS: A total of 2080 young adults participating in both waves.

MEASUREMENTS

Problem gambling scores were collected using the Problem Gambling Severity Index (PGSI). Binary variables recorded past year participation in 19 different gambling forms, ranging from lotteries to online casino and gambling-like practices within digital games (e.g. loot box purchase, skin betting). Controls included socio-demographic/economic characteristics, the Eysenck Impulsivity Scale and the number of gambling activities undertaken.

FINDINGS

Zero inflated negative binomial model lacked evidence of an effect between past year participation in any individual activities and subsequent PGSI scores. However, negative binomial random effects models for current gamblers (n = 497) showed that skin betting (incidence-rate ratio [IRR] = 2.32; 95% CI = 1.69-3.19), fixed odd betting terminals (IRR = 2.21, 95% CI = 1.61-3.05), slot/fruit machines (IRR = 1.43, 95% CI = 1.07-1.91), online betting on horse/dog races (IRR = 1.53, 95% CI = 1.17-2.00) and online betting on non-sports events (IRR = 1.44, 95% CI = 1.11-1.89) were associated with increased PGSI scores. Online casino gambling had a significant interaction by wave; the impact of online casino betting in wave 2 on PGSI scores increased by a factor of 1.61.

CONCLUSIONS

Past year participation of young adults (aged 16-26) in certain forms of gambling does not appear to be associated with future Problem Gambling Severity Index scores. Among young adults who are current gamblers, past year participation in certain land-based (e.g. electronic gaming machines) and online forms (e.g. skin betting) of gambling appears to be strongly associated with elevated Problem Gambling Severity Index scores.

Assessing potential brief screening questions for use within different social care-related contexts to identify individuals experiencing gambling-related harms: A scoping review

Gambling-related harms are increasingly recognised as public health concerns internationally. One response is to improve identification of and support for those affected by gambling-related harms, including individuals who gamble and those close to them, 'affected others'. Adult social care services have been identified as a setting in which screening for gambling-related harms is suitable and desirable. To achieve this, a tool is required which can identify gambling-related harms experienced by individuals and affected others. This scoping review aimed to identify whether any brief (i.e. three questions or less) screening tools are being used and, if so, how brief screening for gambling-related harm is being implemented in health and social care-related contexts. An international English language scoping review of research and grey literature was undertaken between April and July 2021. The search included single-item and brief screening tools which have been developed to identify gambling-related harms for individuals and affected others across a range of health and social care-related contexts. Findings show that screening tools for gambling-related harms have been developed for use in health settings rather than in social care contexts. For example within gambling, mental health or substance misuse support services. We found no evidence of a brief or single-item screening tool for identifying harms to individuals and affected others which is of adequate quality to strongly recommend for use in an adult social care setting. Development of a validated brief or single-item screening tool is recommended to assist adult social care practitioners to effectively screen, identify, support and signpost people affected by gambling-related harms.

Case Report: A gambling-related suicide in rural Malawi

Background As in many other countries across sub-Saharan Africa, Malawi's commercial gambling sector has grown considerably in recent years. Driven by the widespread availability of internet through mobile devices, the industry has penetrated both urban and rural settings. In Malawi the model commonly implemented by gambling companies is similar to that used by mobile phone operators. Agents equipped with cellular devices connect to providers' servers to place wagers for customers and print receipts using simple printers attached to their devices. This has produced lucrative returns for providers. While increasing attention is being paid to this trend, most research focusses on sports betting and there is a deficit of papers that document gambling-related harms. Methods Here we present a narrative case report of a 16-year-old boy, 'Wati' (pseudonym), who lived in rural Malawi and took his own life after gambling and losing money that did not belong to him. As his community is part of a demographic surveillance site, a verbal autopsy was conducted, later supplemented with interviews with Wati's close friend and uncle, to whom his mother referred us. We triangulated data from these three sources to create a narrative case report of Wati's suicide and its relationship to his gambling practices. Results We found that the gambling harms leading up to Wati's suicide were recurrent, that his gambling practices were diverse (lottery, football betting, digital games and cards) and that signs of distress were apparent before his suicide. Conclusions From this case report, we learn that underage individuals participate in gambling in Malawi, can develop harmful habits and that their gambling is not confined to sports betting. We also learn that there is a lack of accessible services for people who develop harmful gambling practices. Wati could have benefited from such services and they may have saved his life.

The impact of the initial Covid-19 lockdown upon regular sports bettors in Britain: Findings from a cross-sectional online study

BACKGROUND

In Britain, unprecedented restrictions on daily life associated with the Covid-19 pandemic included the suspension of professional sports events during the initial 'lockdown'. This provides opportunities to observe changes in sports bettors' behaviour when their primary form of activity is removed and assess the impact of Covid-19 related circumstances upon gambling.

METHODS

In July 2020, we conducted an online cross-sectional survey of people who bet regularly (at least monthly) on sports before Covid-19 (n = 3866). Bi-variate analyses compared changes in gambling behaviours before and during the initial lockdown. Multi-variate logistic regression models explored associations between problem gambling (men) and moderate risk or problem gambling (MRPG) (women) with changes in Covid-19 related circumstances and changing gambling behaviours during Britain's initial 'lockdown' (March-June 2020).

RESULTS

29.8% of male sports bettors and 33.4% of female sports bettors stopped gambling altogether during the initial Covid-19 lockdown, though 17.3% of men and 16.5% of women started a new form of gambling during lockdown. Among men, adjusted odds ratios of problem gambling were higher among those starting a new gambling activity during lockdown (OR = 2.50 [95% CI 1.38-4.53]). Among women, adjusted odds ratios of MRPG were higher among those whose frequency of gambling on any activity increased during lockdown (OR = 4.21 [1.99-8.92] and among those shielding for health reasons. Poorer wellbeing was associated with problem gambling for men and MRPG for women.

CONCLUSIONS

Those changing gambling behaviours during the initial Covid-19 lockdown (e.g. increasing gambling frequency or starting a new gambling activity) are potentially vulnerable to gambling harms.

Suicidality and gambling among young adults in Great Britain: results from a cross-sectional online survey

BACKGROUND

Suicide rates in young people have increased in England and Wales since 2010. There are a range of possible explanations for this increase, and problem gambling has been suggested as a potential risk factor. We aimed to examine the association between suicidality (suicidal thoughts and suicide attempts) and problem gambling specifically for young adults in Great Britain, where gambling has become more widely available and normalised in the past two decades.

METHODS

We analysed data from the Emerging Adults Gambling Survey: a cross-sectional, online, non-probability sample survey of young adults aged 16-24 years living in Great Britain, who were selected from a YouGov online panel. Participants were eligible if they had not taken part in any other YouGov survey on gambling in the past year. We examined associations between problem gambling (defined as a score of 8 or higher on the Problem Gambling Severity Index [PGSI]) and suicidal thoughts and suicide attempts in the year before survey completion in a series of regression models, with and without adjustment for sociodemographic factors, alcohol use, video gaming, anxiety, loneliness, and impulsivity.

FINDINGS

3549 eligible participants completed the survey between June 25 and Aug 16, 2019. 24 (37·0% [95% CI 25·6-50·2]) of 62 men who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 38 (3·6% [2·6-5·0]) of 1077 men who had not attempted suicide or had suicidal thoughts in the past year. 13 (14·5% [8·5-23·6]) of 85 women who had attempted suicide in the past year had survey scores that were indicative of problem gambling, compared with 25 (2·0% [1·4-3·0]) of 1184 women who had not attempted suicide or had suicidal thoughts in the past year. The adjusted odds ratio for attempted suicide was 9·0 (4·1-19·7) in men with scores that indicated problem gambling and 4·9 (2·0-12·0) in women with scores that indicated problem gambling, compared with participants of the same gender with PGSI scores of 0.

INTERPRETATION

Problem gambling appears to be associated with suicide attempts in both young men and young women. This association persisted after adjusting for anxiety, impulsivity, life satisfaction, and other factors, which suggests that other mechanisms, such as the severity and multiplicity of harms experienced, or gambling to cope with life stressors, might underpin this relationship. Young people with problem-gambling behaviours should be considered at risk for suicidality.

FUNDING

Wellcome Trust.

Protocol for a Mixed-Method Investigation of the Impact of the COVID-19 Pandemic and Gambling Practices, Experiences and Marketing in the UK: The "Betting and Gaming COVID-19 Impact Study"

The COVID-19 pandemic led to unprecedented restrictions on people’s movements and interactions, as well as the cancellation of major sports events and social activities, directly altering the gambling landscape. There is urgent need to provide regulators, policy makers and treatment providers with evidence on the patterns and context of gambling during COVID-19 and its aftermath. This protocol describes a study addressing the following three questions: (1) How has COVID-19 changed gambling practices and the risk factors for, and experience of, gambling harms? (2) What is the effect of COVID-19 on gambling marketing? (3) How has COVID-19 changed high risk groups’ gambling experiences and practices? This mixed-method study focuses on two groups, namely young adults and sports bettors. In workpackage-1, we will extend an existing longitudinal survey of gambling in young adults (aged 16–24 years) (first wave conducted June–August 2019), adding COVID-19-related questions to the second wave (July–August 2020) and extending to a third wave in 2021; and undertake a survey of sports bettors in the UK (baseline n = 4000, ~July–August 2020), with follow-ups in ~October–November 2020 and ~February-March 2021. In workpackage-2, we will examine changes in expenditure on paid-for gambling advertising from January 2019 to July 2021 and undertake a mixed-method content analysis of a random sample of paid-for gambling advertising (n ~ 200) and social media marketing (n ~ 100) during the initial COVID-19 “lockdown”. Workpackage-3 will involve qualitative interviews with a purposive sample of (a) young adults (aged 18–24 years) and (b) sports bettors.

Loot Boxes, Gambling, and Problem Gambling Among Young People: Results from a Cross-Sectional Online Survey

With the introduction of gambling-like features within video games (e.g., loot boxes) new forms of hybrid-gambling products have emerged, yet little is known about their relationship to gambling and problem gambling among those most likely to engage: young people. This article examines the relationship between the purchase of loot boxes, gambling behavior, and problem gambling among young people ages 16–24. Cross-sectional data were analyzed from wave 1 of the Emerging Adults Gambling Survey, an online survey of 3,549 people, aged 16–24. Data were weighted to reflect the age, sex, and regional profile of Great Britain. Measured included past-year purchase of loot boxes, engagement in 17 different forms of gambling (weekly, yearly, and weekly spend); and problem gambling status. Other covariates include impulsivity and sociodemographic status. Young adults who purchase loot boxes are more likely to be gamblers and experience problem gambling than others. In unadjusted regression models, the odds of problem gambling were 11.4 (95% confidence interval [CI] 7.6 to 16.9; p < 0.001) times higher among those who purchased loot boxes with their own money. This relationship attenuated but remained significant (odds ratio 4.5, 95% CI 2.6–7.9) when gambling participation, impulsivity, and sociodemographic factors were taken into account. The purchase of loot boxes was highly associated with problem gambling, the strength of this association being of similar magnitude to gambling online on casino games or slots. Young adults purchasing loot boxes within video games should be considered a high-risk group for the experience of gambling problems.

Defining the esports bettor: evidence from an online panel survey of emerging adults

Competitive video gaming (esports) is a growing multi-national, billion-dollar industry. Esports cultures replicate traditional sports cultures, involving elite athletes, teams, league sponsorships, large viewing audiences, high profile leagues and championships, and opportunities to bet on outcomes. However, little is known about people who bet on esports, it is generally considered a niche practice. Using data from the Emerging Adults Gambling Study, a non-probability survey of 3549 people aged 16-24 living in Great Britain, the profile of esports bettors was compared with those who bet on other sports and non-gamblers. Those who bet on esports were more likely to be male, to be from nonwhite ethnic groups, to be heavily involved in playing digital games themselves, and to have higher rates of gambling involvement and problem gambling. Multivariate analysis showed a strong relationship between engaging in gambling-like practices within digital games and esports betting (for example, the purchase of loot boxes for money, or betting skins on external websites). Frequency of playing digital games was not associated with esports betting, suggesting it is not how often someone engages with digital games that is correlated with esports betting, but rather the different type of practices they undertake when playing video games.

The Emerging Adults Gambling Survey: study protocol

The Emerging Adults Gambling Survey is a longitudinal survey of young adults aged 16-24 living in Great Britain. It aims to explore a range of gambling behaviours and harms among young adults and examine how this changes over time. It is part of a broader project funded by Wellcome into the gambling behaviours of young people and its relationship with technological change. Funding is currently available for two waves of data collection: the first collected in June/August 2019 (n=3549) and the second to be collected in June/August 2020. The second wave of data collection will also obtain information about the immediate impact of coronavirus on gambling behaviours. With a sample size of 3549 for Wave 1, this is one of the largest study of gambling behaviours among young adults to be conducted in Great Britain and is a resource for other researchers to draw on. Data will be deposited in the UK Data Archive upon completion of Wave 2 data collection and analysis.  This protocol is intended to support other researchers to use this resource by setting out the study design and methods.

The Same or Different? Convergence of Skin Gambling and Other Gambling Among Children

There is increasing attention on the introduction of gambling-like practices within video games. Termed convergence, this has been explored from the viewpoint of the product, examining similarities in game/gambling mechanics. Understanding convergence of practice is essential to map the epidemiology of these behaviours, especially among children. This paper focuses on the betting of skins within video games to explore co-occurrence with other forms of gambling among British children aged 11–16. Analysing the British Youth Gambling Survey showed that 39% of children who bet on skins in the past month had also gambled on other activities. Betting on skins and other forms of gambling increased with age and concordance of skin gambling/betting was greatest for those who also gambled online. Among gamblers, those who bet skins had higher rates of at-risk and problem gambling than those who did not (23% vs. 8%), though they had a greater breath of gambling involvement. Skin gambling alone was not significantly associated with at-risk gambling when other forms of gambling activity were taken into account. Skin betting and gambling on other activities cluster together, especially where the medium underpinning the behaviours is the same. Children who engage in both skin gambling/betting and other forms of gambling should be considered at-risk for the experience of harms because of their heightened engagement in gambling and gambling-like activities.

Gambling and public health: we need policy action to prevent harm

Prevention of harms related to gambling requires investment in population based approaches, say Heather Wardle and colleagues

Perceptions, people and place: Findings from a rapid review of qualitative research on youth gambling

Exploring perceptions, experiences and determinants of youth gambling is crucial for understanding both the impact of youth gambling now and the antecedents of future behaviour. Qualitative research plays an important role in exploring these processes, yet to date, there has been no systematic review of qualitative scientific literature of youth gambling behaviour. A rapid review of three databases (PubMed, Scopus, Web of Science) and grey literature was conducted to map what qualitative research has been conducted, to identify gaps and discern emerging theories or themes about youth gambling behaviour. Peer-reviewed studies were included if they qualitatively explored youth experiences or perceptions of gambling. Narrative and thematic synthesis identified key descriptive and analytical themes covered by the studies. From 75 studies, 21 papers were included. Studies focused on youth perceptions of gambling (including advertising) and/or the factors shaping behaviour. Those which examined perceptions highlighted the normalcy of gambling in the minds of youth and its embeddedness in everyday life but also ambiguity and nuance around their differing perceptions of what gambling is. Studies emphasised the relationship between people (family, peers), place, technology and advertising as key facilitators of behaviour. This review shows young people's perceptions of gambling differs from legal and legislative definitions, which risks underestimating the nature and extent of youth gambling behaviour. There are also notable gaps in knowledge, specifically around the role of technology in shaping gambling behaviours beyond consideration of access and availability. There is a pressing need to better understand the whole techno-ecosystem in which gambling is situated and young people's relationship with it to understand youth gambling.

'Risky places?': mapping gambling machine density and socio-economic deprivation

The aims of this project were to map the location and density of gambling machines in Britain; to explore whether geographic areas with higher densities of machines exist and to examine the socio-economic characteristics of these areas relative to others. Using geospatial analysis of premises records, we identified 8861 Machine Zones which were areas with a 400 meter radius around gambling machine venue and 384 High Density Machine Zones (HDMZ) with 1 or more gambling machine per hectare. There was a significant correlation between machine density and socio-economic deprivation. HDMZs had greater levels of income deprivation, more economically inactive people and a younger age profile than other areas; 37 % of those living in HDMZs were economically inactive compared with 33 % of those in non-machine areas. HDMZs were in seaside locations but also New Towns or satellite towns to major urban areas. Area affluence explains some of this pattern; of the New Towns with HDMZs, 78 % were in New Towns with a high proportion of low income areas. We therefore concluded that the distribution of gambling machines in Great Britain, in line with other international jurisdictions, displays a significant association with areas of socio-economic deprivation. The profile of the resident population living in HDMZs mirrors the profile of those most at-risk of experiencing harm from gambling. This spatial pattern has important implications for assessing the relationship between gambling availability and gambling-related harm, and for the future development of policy, harm-prevention and treatment strategies.

Fruit and vegetable consumption and sports participation among UK Youth

OBJECTIVES

UK guidelines for youth recommend daily physical activity and five portions of fruit and vegetables per day. This study examined the prevalence and clustering of meeting recommendations among 10- to 15-year old.

METHODS

Data for 3,914 youth, from the first wave of Understanding Society: the UK Household Longitudinal Study, were analysed. Clustering was assessed using the observed/expected ratio method.

RESULTS

A minority of youth met both recommendations, and these behaviours were clustered. The odds of meeting both recommendations were lower for older youth and for Pakistani and Bangladeshi youth; boys in lower income households were less likely to meet both recommendations.

CONCLUSIONS

Most youth met neither recommendation and the behaviours clustered with variations by ethnicity and socioeconomic conditions.

Did smokefree legislation in England reduce exposure to secondhand smoke among nonsmoking adults? Cotinine analysis from the Health Survey for England

BACKGROUND

On 1 July 2007, smokefree legislation was implemented in England, which made virtually all enclosed public places and workplaces smokefree.

OBJECTIVES

We examined trends in and predictors of secondhand smoke exposure among nonsmoking adults to determine whether exposure changed after the introduction of smokefree legislation and whether these changes varied by socioeconomic status (SES) and by household smoking status.

METHODS

We analyzed salivary cotinine data from the Health Survey for England that were collected in 7 of 11 annual surveys undertaken between 1998 and 2008. We conducted multivariate regression analyses to examine secondhand smoke exposure as measured by the proportion of nonsmokers with undetectable levels of cotinine and by geometric mean cotinine.

RESULTS

Secondhand smoke exposure was higher among those exposed at home and among lower-SES groups. Exposure declined markedly from 1998 to 2008 (the proportion of participants with undetectable cotinine was 2.9 times higher in the last 6 months of 2008 compared with the first 6 months of 1998 and geometric mean cotinine declined by 80%). We observed a significant fall in exposure after legislation was introduced--the odds of having undetectable cotinine were 1.5 times higher [95% confidence interval (CI): 1.3, 1.8] and geometric mean cotinine fell by 27% (95% CI: 17%, 36%) after adjusting for the prelegislative trend and potential confounders. Significant reductions were not, however, seen in those living in lower-social class households or homes where smoking occurs inside on most days.

CONCLUSIONS

We found that the impact of England's smokefree legislation on secondhand smoke exposure was above and beyond the underlying long-term decline in secondhand smoke exposure and demonstrates the positive effect of the legislation. Nevertheless, some population subgroups appear not to have benefitted significantly from the legislation. This finding suggests that these groups should receive more support to reduce their exposure.

Sociodemographic correlates of internet gambling: findings from the 2007 british gambling prevalence survey

This study provides the first analysis ever made of a representative national sample of Internet gamblers. Using participant data from the 2007 British Gambling Prevalence Survey (n = 9,003 adults aged 16 years and over), all participants who had gambled online, bet online, and/or used a betting exchange in the last 12 months (n = 476) were compared with all other gamblers who had not gambled via the Internet. Overall, results showed a number of significant sociodemographic differences between Internet gamblers and non-Internet gamblers. When compared to non-Internet gamblers, Internet gamblers were more likely to be male, relatively young adults, single, well educated, and in professional/managerial employment. Further analysis of DSM-IV scores showed that the problem gambling prevalence rate was significantly higher among Internet gamblers than among non-Internet gamblers. Results suggest that the medium of the Internet may be more likely to contribute to problem gambling than gambling in offline environments.

Under-reporting of tobacco use among Bangladeshi women in England

BACKGROUND

This study investigates the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group.

METHODS

The 1999 and 2004 Health Survey for England included 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without. The main outcome measure was the prevalence of under-reported tobacco use.

RESULTS

Fifteen per cent of Bangladeshi women with a saliva sample under-reported their personal tobacco use. Under-reporters were very similar to self-reported users except for being much more likely to report chewing paan without tobacco (47% versus 9%, P < 0.001). Under-reporters differed significantly from cotinine-validated non-users in most respects. Regression analyses confirmed that under-reporters and self-reported users were similar in age, education level and exposure to passive smoking. Under-reporters were older and less educated than cotinine-validated non-users. Both self-reported users [odds ratio (OR): 0.11, 95% confidence interval (CI): 0.04-0.30] and cotinine-validated non-users (OR: 0.42, 95% CI: 0.20-0.89) were far less likely to report chewing paan without tobacco compared with under-reporters.

CONCLUSIONS

Contrary to our a priori hypothesis, under-reporters were not young, British-born, English-speaking women likely to be concealing smoking but resembled self-reported tobacco users except for being much more likely to report chewing paan without tobacco.

Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012

BACKGROUND

This study aims to project the prevalence of adult obesity to 2012 by age groups and social class, by extrapolating the prevalence trends from 1993 to 2004. Repeated cross-sectional surveys were carried out of representative samples of the general population living in households in England conducted annually (1993 to 2004).

METHODS

Participants were classified as obese if their body mass index was over 30 kg/m(2). Projections of obesity prevalence by 2012 were based on three scenarios: extrapolation of linear trend in prevalence from 1993 to 2004; acceleration (or slowing down) in rate of change based on the best fitting curve (power or exponential); and extrapolation of linear trend based on the six most recent years (1999 to 2004).

RESULTS

The prevalence of obesity increased significantly from 1993 to 2004 from 13.6% to 24.0% among men and from 16.9% to 24.4% among women. If obesity prevalence continues to increase at the same rate, it is projected that the prevalence of obesity in 2012 will be 32.1% (95% CI 30.4 to 34.8) in men and 31.0% (95% CI 29.0 to 33.1) in women. The projected 2012 prevalence for adults in manual social classes is higher (43%) than for adults in non-manual social classes (35%).

CONCLUSION

If recent trends in adult obesity continue, about a third of all adults (almost 13 million individuals) would be obese by 2012. Of these, around 43% are from manual social classes, thereby adding to the public health burden of obesity-related illnesses. This highlights the need for public health action to halt or reverse current trends and narrow social class inequalities in health.

Gregory Bateson's lost world: the anthropology of Haddon and Rivers continued and deflected

Gregory Bateson was one of the last and most distinguished products of the school of anthropology that Haddon and Rivers created in Cambridge after the Torres Strait Expedition. Beginning his career shortly after Rivers' death, Bateson used the interwar years to create a theoretical approach that continued and deflected that of Haddon and Rivers. His major ethnography from this period, Naven, evidenced his complex academic positioning between the legacy of Rivers and the new paradigm emerging around Malinowski and Radcliffe-Brown. After the Second World War, Bateson's intellectual project emerged as even closer to Rivers' in both psychological and evolutionary dimensions.