Gambling patterns among young people are diverse, yet factors that affect changes in their gambling behaviour as they mature remain poorly understood. This study explores gambling trajectories and related sources of influence during childhood, early adolescence and later adolescence, and amongst adolescents at different levels of gambling risk. Qualitative interviews and online communities with 89 Australians aged 12-17 years explored their gambling experiences, from childhood to the present. Reflexive thematic narrative analysis revealed that children often learn how to gamble through their parents. Parents, peers, sports interests, advertising and simulated gambling continue to transfer gambling knowledge and skills throughout adolescence. Gambling is further reinforced through social rewards and is highly normalised through advertising. At-risk/problem gambling adolescents tended to report positive early memories of gambling, but also harmful parental gambling. They reported having friendship groups where betting is highly normalised. They purposefully honed their betting knowledge to demonstrate skill, and also gambled with in-game items (skins). Conversely, non-gamblers reported very little exposure to parental gambling, mirrored their parents' negative attitudes to gambling, were unlikely to have friends who gambled, and reported less interest in professional sport. Reducing youth gambling and gambling harm requires measures to tackle multiple layers of influence.

Background Gambling abstinence when underage lowers the risk of harmful gambling in later life. However, little research has examined why many young people refrain from gambling, even though this knowledge can inform protective strategies and lower risk factors to reduce underage gambling and subsequent harm. This study draws on the lived experience of adolescent non-gamblers to explore how social determinants while growing up have shaped their reasons and choices to not gamble.Methods Fourteen Australian non-gamblers, aged 12-17 years, participated in an in-depth individual interview (4 girls, 3 boys) or online community (4 girls, 3 boys). Questions in each condition differed, but both explored participants' gambling-related experiences while growing up, including exposure, attitudes and behaviours of parents and peers, advertising, simulated gambling and motivations for not gambling. The analysis used adaptive grounded theory methods.Results The grounded theory model identifies several reasons for not gambling, including not being interested, being below the legal gambling age, discouragement from parent and peers, concern about gambling addiction and harm, not wanting to risk money on a low chance of winning, and moral objections. These reasons were underpinned by several social determinants, including individual, parental, peer and environmental factors that can interact to deter young people from underage gambling. Key protective factors were parental role modelling and guidance, friendship groups who avoided gambling, critical thinking, rational gambling beliefs, financial literacy and having other hobbies and interests.Conclusions Choices to not gamble emanated from multiple layers of influence, implying that multi-layered interventions, aligned with a public health response, are needed to deter underage gambling. At the environmental level, better age-gating for monetary and simulated gambling, countering cultural pressures, and less exposure to promotional gambling messages, may assist young people to resist these influences. Interventions that support parents to provide appropriate role modelling and guidance for their children are also important. Youth education could include cautionary tales from people with lived experience of gambling harm, and education to increase young people's financial literacy, ability to recognise marketing tactics, awareness of the risks and harms of gambling, and how to resist peer and other normalising gambling influences.

Wagering affiliate marketing is a performance-based system where online wagering operators pay third parties (affiliates) to recruit and engage customers for them. Despite widespread use, it has attracted limited research attention in Australia and elsewhere. This exploratory Australian study aimed to capture key informant perspectives on (1) the key features of wagering affiliate marketing and (2) how it may increase the risk of gambling harm. Interviews were conducted with 44 individuals from 28 organisations representing wagering operators, wagering affiliates, gambling regulators and legal advisors, and gambling support providers. Based on thematic analysis, the findings identified numerous features in business and payment models used in wagering affiliate marketing that can increase the risk of gambling harm. Affiliate marketers are paid generous commissions by wagering operators to purposefully encourage new customers to bet and existing customers to bet more. In direct conflict with harm minimisation objectives, affiliate marketers are incentivised to target bettors with high-loss potential and people at-risk of gambling harm and engage in deceptive and predatory practices likely to attract vulnerable people. The current regulatory environment has limited capacity to monitor and prevent harmful and illegal practices and is further hampered by both the scale of the industry and its dynamic and hidden marketing practices. The findings can inform future research to test relationships between gambling affiliate marketing and gambling harm. They can also prompt consideration of more effective regulation and ways to increase consumer awareness about misleading affiliate practices.

The importance of safeguarding young people from harmful gambling is widely acknowledged, but limited research has sought adolescents’ perspectives on strategies to provide this protection. The current study addresses this gap in understanding. Eighty-nine Australians aged 12–17 years, classed as either at-risk/problem gamblers, non-problem gamblers or non-gamblers, participated in qualitative interview and/or online community conditions. Themes extracted from the data on the things participants believe should be implemented to achieve this aim include open and honest advice from parents; schools-based education that is meaningful, authentic and based on lived experience; truth and transparency in advertising; social marketing that reaches and informs youth; and governments to regulate the gambling and gaming industries into acting ethically and not exploiting young people. At-risk/problem gambler adolescents were able to offer more detailed suggestions on strategies that would protect young people from gambling harm, frequently drawing on their own personal experiences or the stories they heard from others. Multifaceted strategies are required to help adolescents make informed decisions about gambling. Developing and implementing such strategies to protect minors from gambling harm requires a cohesive effort and commitment to addressing this public health issue. Recommendations on how regulators, industry, parents and other stakeholders may contribute to this effort are discussed.

This study explores the lived experience of simulated gambling as young people grow up. Qualitative research with 89 Australians aged 12–17 years explored their chronological experiences of simulated gambling and monetary gambling. Reflexive thematic narrative analysis identified common and contrasting themes amongst at-risk/problem gambling, non-problem gambling, and non-gambling participants. As young people grow up, they engage in simulated gambling more frequently, in more diverse settings, and on activities more akin to monetary gambling. Their motivations expand from valuing virtual prizes, to also valuing social benefits and opportunities to learn new gambling games, compete against other players and demonstrate skill. Simulated gambling becomes highly normalised from childhood and before young people realise its potential for gaming and gambling harm. Behavioural associations between simulated gambling and harmful gaming were evident, but those between simulated gambling and harmful monetary gambling were less clear. Restricting youth access to simulated gambling would help protect them from harm.

Numerous responsible gambling (RG) strategies are promoted to assist consumers to “gamble responsibly”. However, consumer adoption of RG strategies, how this varies by gambler risk group, and whether usage is associated with non-problematic gambling are largely unknown. This study aimed to (1) determine how use of RG-related strategies differs amongst regular gamblers by gambler risk group; and (2) identify RG-related strategies whose usage predicts non-problem/low risk gambling. Regular Australian gamblers on high-risk products (N = 860), recruited through gambling venues and an online wagering operator, were surveyed about their use of RG strategies promoted on the website of their jurisdiction’s main RG agency. Knowledge of RG strategies was reasonably high amongst all gambler risk groups, but lower-risk groups were more likely to use RG strategies. A logistic regression correctly predicted 82.1 % of lower-risk gamblers and 77.2 % of higher-risk gamblers. Predictors of lower-risk gambling included: greater confidence in their understanding of RG; endorsement of lower gambling expenditure and frequency limits; fewer erroneous gambling beliefs; being less likely to gamble to win money, challenge their skills/beat the odds, or forget about worries and stresses; and being more likely to gamble for pleasure/entertainment. Lower-risk gamblers were more likely to set a money limit in advance of gambling and to balance their gambling with other activities. These findings contribute to understanding which strategies are favoured by different risk groups, and which are associated with safer levels of gambling. They can guide consumer information aimed at enhancing RG consumption and future research on RG consumption.

Minimal research has been published about inducements for sports and race betting, despite their ready availability and aggressive advertising. This paper aimed to document the range and structural features of these inducements, and analyse their alignment with the harm minimisation and consumer protection goals of responsible gambling. A scan of all inducements offered on the websites of 30 major race and sports betting brands located 223 separate inducements which we categorised into 15 generic types, all offering financial incentives to purchase. These comprised sign-up offers, refer-a-friend offers, happy hours, mobile betting bonuses, multi-bet offers, refund/stake-back offers, matching stakes/deposits, winnings paid for ‘close calls’, bonus or better odds, bonus or better winnings, competitions, reduced commission, free bets to selected punters, cash rebates and other free bets. All inducements were subject to numerous terms and conditions which were complex, difficult to find, and obscured by legalistic language. Play-through conditions of bonus bets were particularly difficult to interpret and failed basic requirements for informed choice. Website advertisements for inducements were prominently promoted but few contained a responsible gambling message. The results were analysed to generate 12 research propositions considered worthy of empirical research to inform much needed regulatory reform in this area.

This study provides analysis of a representative national sample of Internet gamblers. Using participant data from the 2007 British Gambling Prevalence Survey (n=9003 adults aged 16 years and over), all participants who had gambled online, bet online, and/or who had used a betting exchange in the last 12 months (6% of the total sample) were compared with all other gamblers who had not gambled via the Internet (62% of the sample). Results showed that Internet gambling and non-Internet gambling had a significant association with smoking (nicotine) and drinking (alcohol). Self-reported general health status was not significantly associated with Internet gambling but was significantly associated with offline gambling. Analysis of DSM-IV scores showed that problem gambling prevalence rate was significantly higher among Internet gamblers than non-Internet gamblers (5% versus 0.5%) and that Internet gamblers were significantly more likely to endorse individual DSM-IV items compared to non-Internet gamblers.

Using data from the 2007 British Gambling Prevalence Survey, relationships were explored between gambling variables and each of the three key indices of a person's social position, controlling for age and sex. Personal income was found to be positively and linearly related to gambling prevalence, to number of gambling activities engaged in, and to positive attitudes towards gambling; household occupational category was significantly associated with prevalence and frequency of gambling, with problem or moderate risk gambling, and with attitudes towards gambling (managerial and professional, and intermediate, categories obtained lower values than other categories on each of those variables); area deprivation was significantly positively and linearly related to frequency and volume of gambling and to reports of close relatives having gambling problems. The analyses presented here, whilst primarily exploratory, suggest that future surveys should go further towards examining gambling issues as ones of family and community significance.

Previous research has shown an association between gambling, alcohol and cigarette smoking. Co-occurrence of problem gambling with other behavioural and psychological disorders can exacerbate, or be exacerbated by, problem gambling. Using participant data from the 2007 British Gambling Prevalence Survey (n = 9003 adults aged 16 years and above), secondary analysis was carried out on the relationship between gambling and three particular areas of co-occurrence. These were general health status, cigarette smoking and alcohol consumption. All analysis was age standardised to allow comparisons between groups after adjusting for the effects of any difference in their age distributions. Results showed that: (i) cigarette smokers were significantly more likely to gamble in the past year compared to non-smokers, (ii) cigarette smokers were over three times more likely than non-smokers to be a problem gambler, (iii) alcohol consumption as measured by the number of units drunk on the person's heaviest drinking day was not significantly associated with having gambled in the past year, (iv) alcohol consumption as measured by the number of units drank on the person's heaviest drinking day in the past year was significantly associated with problem gambling, (v) health status was not significantly associated with past year gambling and (vi) the prevalence rate of problem gambling among those with poor health were over three times as likely to be a problem gambler compared to those with good health. Implications of these results are discussed.</.

Data from the 2007 British Gambling Prevalence Survey were used to examine the psychometric properties of the two problem gambling scales used in the survey: the Canadian Problem Gambling Severity Index (PGSI) and a DSM-IV-based scale. Analysis was based on those who reported any gambling in the past 12 months (between 5483 and 5528 participants for most analyses). The PGSI gave evidence of high internal reliability, uni-dimensionality, and good item-response characteristics. Several PGSI items showed extreme male to female endorsement ratios and a possible conclusion is that the PGSI is under-estimating the prevalence of problem gambling among women. The DSM-IV-based scale showed only satisfactory internal reliability, evidence suggesting bi-dimensionality, and poor performance of at least two items: those relating to gambling-related crime and ‘chasing losses’. The results also suggest that, for population survey purposes, problem gambling/non-problem gambling might best be viewed as lying on a continuum.

A new 14-item scale of general attitudes towards gambling (the Attitudes Towards Gambling Scale: ATGS) was developed for use in the 2007 British Gambling Prevalence Survey. The development of the scale is described. Based on the responses of a representative sample of 8880 people of 16 years of age or more, evidence is presented of good internal reliability and statistically significant associations with a range of socio-demographic, own and family gambling and lifestyle variables. Overall, and in all sub-groups except the heaviest gamblers, attitudes were found to be negative: more people believed that gambling is foolish and dangerous, and of greater harm than benefit to families, communities and society as a whole, than the reverse. The majority, however, were against prohibition of gambling. Public opinion appears to be out of line with the view of gambling in Britain that lay behind the 2005 Gambling Act. It will be of interest to see whether attitudes change in the forthcoming years. The ATGS is a suitable measure for use in future surveys in the UK and in other English speaking countries.

Economic evaluation requires monetary measures or a single outcome for use across all interventions to assist decisions about service provision. Monetary values can be estimated through willingness to pay methods but there are difficulties, with few analyses successfully using these methods to value all outcomes (Drummond et al., 2005). Instead, economic evaluation most often uses a single outcome. The quality-adjusted life-year (QALY), as recommended by the National Institute for Health and Clinical Excellence (NICE) in the UK (NICE, 2004), has become the dominant measure within economic evaluation. QALYs may be formed from a number of different measures, including the EQ-5D (Brooks, 1996), the SF-36 (Brazier et al., 2002) and the Health Utility Index (Horsman et al., 2003), but all focus entirely on health as the outcome of interest. The majority of analyses in the UK are currently conducted using EQ-5D, a measure with five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) each with three levels (Brooks, 1996).

This paper reports the first application of the capabilities approach to the development and valuation of an instrument for use in the economic evaluation of health and social care interventions. The ICECAP index of capability for older people focuses on quality of life rather than health or other influences on quality of life, and is intended to be used in decision making across health and social care in the UK. The measure draws on previous qualitative work in which five conceptual attributes were developed: attachment, security, role, enjoyment and control. This paper details the innovative use within health economics of further iterative qualitative work in the UK among 19 informants to refine lay terminology for each of the attributes and levels of attributes used in the eventual index. For the first time within quality of life measurement for economic evaluation, a best-worst scaling exercise has been used to estimate general population values (albeit for the population of those aged 65+ years) for the levels of attributes, with values anchored at one for full capability and zero for no capability. Death was assumed to be a state in which there is no capability. The values obtained indicate that attachment is the attribute with greatest impact but all attributes contribute to the total estimation of capability. Values that were estimated are feasible for use in practical applications of the index to measure the impact of health and social care interventions.

Background The index of capability (ICECAP) was developed using in-depth interviews with 40 older people and comprises five attributes: attachment, security, enjoyment, role and control. This paper explores the construct validity of these five capability attributes.Methods An interview survey was conducted with individuals aged 65 and over located across the UK. Data were analysed in six categories (socio-demographic variables and general well-being, contact with others, health, nature of the locality and environment, social support and participation) using chi-squared tests (for categorical variables) or one-way analysis of variance (for continuous variables).Results About 315 individuals were interviewed (response rate 66%). Relationships were generally as anticipated with, for example: strong relationships between age and capability and well-being and capability, but no relationships between capability and either sex or social class; strong relationships between physical measures of health and role, enjoyment and control, and between mental health measures and attachment and enjoyment.Conclusions This study provides some early evidence for the construct validity of the ICECAP measure. Where anticipated relationships were not observed this might in part be explained in that the ICECAP index asks about capability, but the factors with which associations were examined were largely and inevitably measures of function.