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Background Gambling behaviors among adolescents and young adults have been experiencing an upward trend in the last years, possibly because of new habits developed during the COVID-19 lockdown restrictions. Different preventive strategies have been proposed: universal classroom-based interventions have shown promising evidence as preventive tools, but challenges exist in engaging the target audience effectively. Serious games, i.e., those designed with the specific intent to educate, broaden knowledge, and change behaviors, have been tested with positive outcomes. Digital escape rooms constitute a modality of serious game that has shown potential for a variety of educational purposes, but their efficacy for preventing addictive behaviors, as well as their long-term impact, has not been widely studied. Methods The present protocol includes two studies: Study 1 aims to examine changes in gambling habits among a large sample ( N  = 420) of adolescents and young adults (aged 16–25) in Aragon, Spain, comparing pre-COVID-19 data to current trends. It will assess various gambling types, including online betting, and estimate the prevalence of problem gambling. Study 2 will be a cluster-randomized controlled trial focused on testing the effectiveness of the GAMBL-OUT digital escape-room in preventing gambling among a sample of 240 youngsters. It will evaluate knowledge, intentions, and attitudes pre- and post-intervention, as well as in a 3-month follow-up assessment. Implementation outcomes will also be assessed using qualitative methods, considering acceptability, adoption, appropriateness, feasibility, fidelity, penetration, and sustainability. Discussion The present project aims at assessing the gambling habits of a sample of 16–25-year-olds in the region of Aragon, Spain, that could be compared to the data gathered before the pandemic started, so not only the prevalence rates can be updated but also potential differences in habits (e.g., preferred gambling alternatives) can be detected. This will undoubtedly help the design of effective preventive measures, such as the GAMBL-OUT digital escape room, a serious game to be implemented in high schools with the aim of increasing knowledge, reducing intentions to gamble, and changing attitudes towards gambling. Trial registration This study was registered in ClinicalTrials.gov on 25/03/2025; registration number: NCT06904794.

Background Our knowledge on the prevalence of high-risk behaviors among women of Alborz is not reliable due to the sensitivity of the issue. This study aimed to estimate the prevalence of seven risk behaviors among the reproductive age women in Alborz Province, Iran. Method In this cross-sectional study, 2000 women were randomly selected from a registered healthcare system in 2019. A researcher-made questionnaire was used to collect the required data. The prevalence of the risk behaviors including drug abuse, hookah, alcohol drinking, tobacco smoking, extramarital intercourse, and gambling was estimated using the unmatched count technique, and the prevalence rate was reported at a 95% confidence interval. Results The response rate for this study was 95%. The estimated prevalence for drug abuse, hookah, alcohol drinking, tobacco smoking, extramarital intercourse, and gambling were 3% (95%CI: 2.78 to 3.22), 10.5% (95%CI: 10.29 to 10.71), 7% (95%CI: 6.78 to 7.22), 10% (95%CI: 9.78 to 10.22), 8.7% (95%CI, 8.29 to 8.71), and 7.5% (95%CI, 4.71 to 7.28), respectively. Conclusion High risk behaviors are highly prevalent among Iranian women. Enforcing laws, prohibition, marketing restrictions, increasing taxation, expanding treatment, promoting condom distribution and providing community-based service are recommended to reduce the effects of high risk behaviors among women.

Gambling Disorder is a prevalent psychiatric condition often linked to dysfunction of cognitive domains regulating impulsive behavior. Despite the centrality of impulsivity to neurobiological models of Gambling Disorder, a comprehensive meta-analysis of all impulsive cognitive domains has yet to be conducted. It is also not clear whether cognitive deficits in Gambling Disorder extend to those with problem (at-risk) gambling. A systematic review was undertaken of case–control studies examining the following cognitive domains in Gambling Disorder or in at-risk (problem) gambling: attentional inhibition, motor inhibition, discounting, decision-making, and reflection impulsivity. Case–control differences in cognition were identified using meta-analysis (random-effects modeling). Moderation analysis explored potential influences of age, gender, presence/absence of comorbidities in cases, geographical region, and study quality on cognitive performance. Gambling Disorder was associated with significant impairments in motor (g = 0.39–0.48) and attentional (g = 0.55) inhibition, discounting (g = 0.66), and decision-making (g = 0.63) tasks. For problem gambling, only decision-making had sufficient data for meta-analysis, yielding significant impairment versus controls (g = 0.66); however, study quality was relatively low. Insufficient data were available for meta-analysis of reflection impulsivity. There was evidence for significant publication bias only for the discounting domain, after an outlier study was excluded. Study quality overall was reasonable (mean score 71.9% of maximum), but most studies (~85%) did not screen for comorbid impulse control and related disorders. This meta-analysis indicates heightened impulsivity across a range of cognitive domains in Gambling Disorder. Decision-making impulsivity may extend to problem (at-risk) gambling, but further studies are needed to confirm such candidate cognitive vulnerability markers.

The COVID-19 pandemic has dramatically changed everyday life, and policy makers have raised concerns about possible changes in gambling patterns during the pandemic. This study aimed to examine whether self-reported gambling has increased during the pandemic, and to examine potential correlates of such a change. This general population survey study in Sweden collected self-report data from 2016 web survey members (51 percent men, nine percent moderate-risk/problem gamblers). Correlates of increased gambling and increased gambling specifically due to COVID-19-related cancellation of sports were calculated. Four percent reported an overall gambling increase during the pandemic. The proportion of individuals reporting an increase, compared to individuals reporting a decrease, was markedly higher for online casinos (0.62), online horse betting (0.76) and online lotteries (0.73), and lower for sports betting (0.11). Overall, gambling increases were independently associated with gambling problems and increased alcohol consumption. In the sub-group, where there was an increase in specific gambling types in response to cancelled sports betting events, rates of gambling problems were high. In conclusion, only a minority report increased gambling in response to the pandemic, but this group has markedly higher gambling problems and changes in alcohol consumption, and may represent a sub-group with a particularly high vulnerability. This calls for preventive action in people with higher gambling risks in response to the pandemic.

Background Harm from gambling is known to impact individuals, families, and communities; and these harms are not restricted to people with a gambling disorder. Currently, there is no robust and inclusive internationally agreed upon definition of gambling harm. In addition, the current landscape of gambling policy and research uses inadequate proxy measures of harm, such as problem gambling symptomology, that contribute to a limited understanding of gambling harms. These issues impede efforts to address gambling from a public health perspective. Methods Data regarding harms from gambling was gathered using four separate methodologies, a literature review, focus groups and interviews with professionals involved in the support and treatment of gambling problems, interviews with people who gamble and their affected others, and an analysis of public forum posts for people experiencing problems with gambling and their affected others. The experience of harm related to gambling was examined to generate a conceptual framework. The catalogue of harms experienced were organised as a taxonomy. Results The current paper proposes a definition and conceptual framework of gambling related harm that captures the full breadth of harms that gambling can contribute to; as well as a taxonomy of harms to facilitate the development of more appropriate measures of harm. Conclusions Our aim is to create a dialogue that will lead to a more coherent interpretation of gambling harm across treatment providers, policy makers and researchers.

Background Gambling disorder is related to high overall gambling engagement; however specific activities and modalities are thought to have stronger relationships with gambling problems. This study aimed to isolate the relationship between specific gambling activities and modalities (Internet and venue/land-based) to gambling disorder and general psychological distress. Past-month Internet gamblers were the focus of this investigation because this modality may be associated with gambling disorders in a unique way that needs to be separated from overall gambling intensity. Methods Australians who had gambled online in the prior 30 days ( N  = 998, 57% male) were recruited through a market research company to complete an online survey measuring self-reported gambling participation, problem gambling severity, and psychological distress. Results When controlling for overall gambling frequency, problem gambling was significantly positively associated with the frequency of online and venue-based gambling using electronic gaming machines (EGMs) and venue-based sports betting. Psychological distress was uniquely associated with higher frequency of venue gambling using EGMs, sports betting, and casino card/table games. Conclusions This study advances our understanding of how specific gambling activities are associated with disordered gambling and psychological distress in users of Internet gambling services. Our results suggest that among Internet gamblers, online and land-based EGMs are strongly associated with gambling disorder severity. High overall gambling engagement is an important predictor of gambling-related harms, nonetheless, venue-based EGMs, sports betting and casinos warrant specific attention to address gambling-related harms and psychological distress among gamblers.

COVID-19 and lockdown strategies may affect mental health and addictive behavior differently in the population, and elite athletes are among the professions clearly affected by the pandemic. This study in top elite athletes aimed to study current perceived psychological influence from COVID-19 and symptoms of depression, anxiety and changes in alcohol drinking, gambling behavior and problem gambling in the midst of the COVID-19 lockdown. This web survey included athletes in top leagues of soccer, ice hockey and handball in Sweden (N = 327, 62% men). A total of 66% and 51% were worried about the future of their sport or about their own future in sports, respectively. Feeling worse psychologically during the pandemic was common (72% of women, 40% of men, p < 0.001); depression criteria were endorsed by 19% of women and three percent of men (p < 0.001); anxiety criteria by 20% of women and five percent of men (p < 0.001). Reporting increased gambling during the pandemic was associated with gambling problem severity. Moderate-risk or problem gambling was seen in 10% of men and none of the women (p < 0.001). Depression and anxiety were associated with feeling worse during the COVID-19 pandemic and with concern over one’s own sports future. In conclusion, COVID-19-related distress is common in elite athletes and associated with mental health symptoms. Gambling increase during the pandemic was rare, but related to gambling problems, which were common in male athletes. The calls for increased focus on COVID-19-related concerns in athletes and on problem gambling in male athletes.

A part of online gambling consumption takes place in offshore markets. Lack of regulatory control over offshore offers erodes many public policy and public health objectives. Channelling consumption from offshore markets to regulated markets is therefore used as justification in many gambling policy decisions. Yet, it is currently unknown how reliable existing estimates of the size of offshore markets are. This scoping review investigates how offshore gambling markets are measured in the Nordic context and what kinds of uncertainties are involved in existing measures. We searched available estimates of offshore gambling markets from academic and grey literature in four Nordic countries (Denmark, Finland, Norway, Sweden). The final sample consists of 32 reports. To supplement the results, we conducted key informant interviews and our own analysis of available data. 24 estimates concerned the monetary value of offshore gambling as a percentage of the full market. Nine estimates concerned the population prevalence of offshore gambling. In terms of methodologies, most studies reported figures from a private gambling intelligence company H2 gambling capital, either directly or combined with other data sources. Different methodological choices yielded different estimates. An important part of reports was funded by the gambling industry. Industry reports tended to have higher overall estimates of offshore gambling due to methodological choices. The measurement of offshore gambling is a politically sensitive topic wrought with uncertainties. More reliable methods and figures are needed to better inform harm prevention and consumer protection in the online environment. Inaccurate offshore measures can be used as a tool for regulatory resistance. A transparent and scientifically validated measurement tool is needed to improve the evidence-base.

Esports betting (i.e., betting on the outcome of professional competitive videogaming matches) has become a regular feature of most online gambling websites in recent years. The present study compared differences between esports bettors and traditional sports bettors, in addition to exploring factors that predict participation in esports betting. Data regarding demographics, impulsivity, psychopathological symptoms, gaming, and gambling among 359 esports bettors (mean age = 37.98 years [SD = 13.64]; 86.9% male) and 326 sports bettors (mean age = 43.79 years [SD = 13.75]; 91.7% male) from the United Kingdom, Hungary, and Canada were collected through surveys via two gambling service providers (Betway and Midnite) and a gaming magazine. Compared to sports bettors, esports bettors were significantly younger, scored higher on gambling risk severity, and had more gaming disorder symptoms. Esports bettors were also more likely than sports bettors to report higher levels of stress, anxiety, and depression symptoms, and impulsivity, as well as be driven by coping, social, and financial motives to engage in betting. In an unadjusted binary regression model, being younger, being driven by coping, social, and financial motives, and reporting elevated levels of impulsivity, depression, anxiety, and stress symptoms were predictors of esports betting. Higher rates of problem gambling severity and gaming disorder symptoms were also predictors of esports betting. The findings suggest that esports bettors are a distinct betting group, and vulnerable to multiple gaming/gambling-related harms and psychopathological harms. •Esports bettors are likely to be younger, employed, and belong to ethnic minorities.•Esports bettors have more problem gambling and gaming disorder symptoms.•Esports bettors are driven by financial, social and coping gambling motives.•Sports bettors overestimate impact of sporting knowledge in making successful bets.

Background Gambling products differ in terms of their harm potential. Products are also constantly developing and changing. However, little research has addressed changes and trends in the types of gambling that are associated with harms. The current study explores trends in the gambling product categories identified as harmful in longitudinal helpline data from three Nordic countries. Methods We use data collected by national helplines in Denmark (StopSpillet), Finland (Peluuri) and Sweden (Stödlinjen) in their daily operations (N = 46 646). The data consist of information collected on gamblers and concerned significant others who have contacted these helplines between January 2019 and December 2022. We analyse which gambling products are mentioned as harmful by clients. The analysis uses linear regression with the interaction term (country) times time regressed over the outcome variable (proportion per month). Results The results show that an increased share of contacts concern online gambling. Online casino products have become the most harmful category across contexts. The share of reported harms from online betting and new emerging online forms is also increasing. The share of land-based products as a reported source of harms has decreased across 2019–22. Conclusions The results suggest that online gamlbing environments, and particularly online casino products, are associated with increasing harms to help-seekers. The harmfulness of different gambling products may not be stable, but change over time. Further harm prevention efforts are needed to address the online gambling field, including emerging formats.