Aims Understanding how gambling harm is distributed is essential to inform effective harm reduction measures. This first national Australian study of gambling harm-to-self examined the extent, distribution, risk factors, and health related quality of life (HRQoL) impacts of this harm. Methods A Random Digit Dialling sample of 15,000 Australian adults was weighted to key population variables. Key measures included the Gambling Harms Scale-10 (GHS-10), PGSI, SF-6D, gambling behaviours, and demographics. Analyses included ordinal logistic regression. Results Amongst gamblers, 14.7% reported harm on the GHS-10, including 1.9% reporting high-level harm. While high-level harm occurred mainly in the problem gambling group (77.3%), other PGSI groups accounted for most of the more prevalent low (98.5%) and moderate (87.2%) harms reported. Proximal predictors of greater harm were use of online gambling and more frequent gambling on electronic gaming machines (EGMs), race betting sports betting, poker, skin gambling, scratchies, and loot box purchasing. Distal predictors were being younger, male, single, Aboriginal or Torres Strait Islander, and speaking a non-English language at home. At the population level, the greatest aggregate HRQoL impacts were amongst lower-risk gamblers, confirming the results of other studies regarding the ‘prevention paradox’. Conclusions The distribution of harm across gambler risk groups indicates the need for preventive measures, not just interventions for problem gambling. Reducing harm requires modifying product features that amplify their risk, especially for EGMs, race betting and sports betting that are both inherently risky and widely used. Gambling harm exacerbates health disparities for disadvantaged and vulnerable groups, requiring targeted resources and support.

A broad quantitative literature has explored the extent and distribution of gambling-related harm. However, any quantitative measure involves a number of statistical decisions around item selection and weighting that may affect its ability to provide an accurate summary of a gambler's lived experience. This may especially be an issue with a condition as varied and multifaceted as gambling-related harm. The present research therefore used qualitative methods to validate the categorization of gamblers into four levels of harm via the Gambling Harms Scale (10-items) (GHS-10) through an analysis of 30 semi-structured interviews with gamblers. Results showed that unharmed gamblers saw gambling as just another leisure activity, which relieved stress and brought them closer to other people. Low harm gamblers were similar but could experience emotional stresses over their level of gambling expenditure. Just under half of all moderate harm gamblers experienced occasional severe financial impacts and emotional stresses from their gambling. Finally, all high harm gamblers experienced chronic financial impacts and emotional stresses, which spilled over into relationship problems for three quarters of this group, and negative impacts on health or work/study for around half of this group. These results showed that the severity of participants' lived experience of gambling increased with their GHS-10 score, providing a qualitative validation for this quantitative self-report measure. This qualitative validation for a quantitative scale is argued to be a promising avenue for future gambling research.

Background and aims:COVID-19 lockdowns limited access to gambling but simultaneously elevated psychosocial stressors. This study assessed the relative effects of these changes on gambling risk status during and after the Australian COVID-19 lockdown from late-March to late-May 2020.Methods:The study administered three surveys to people who had gambled within the past year at T1. Wave 1 asked about before (T1, N = 2,125) and during lockdown (T2, N = 2,125). Subsequent surveys focused on one year (T3; N = 649) and two years after lockdown (T4, N = 458). The dependent variable was changes in reporting any problem gambling symptoms (PGSI 0 vs 1+). Bivariate analyses and multinomial logistic regression tested for significant associations with: demographics, psychosocial stressors (perceived stress, psychological distress, loneliness, health anxiety about COVID, financial hardship, stressful life events), gambling participation and gambling frequency.Results:Gambling participation and at-risk gambling decreased between T1 and T2, increased at T3, with little further change at T4. When gambling availability was curtailed, decreased gambling frequency on EGMs, casino games, sports betting or race betting, and lower psychosocial stress, were associated with transitions from at-risk to non-problem gambling. When gambling availability resumed, increased EGM gambling frequency, decreased online gambling frequency, and higher psychosocial stress were associated with transitions from non-problem to at-risk gambling.Discussion and conclusions:Gambling availability appears a stronger influence on gambling problems, at the population level, than psychosocial risk factors. Reducing the supply of high-risk gambling products, particularly EGMs, is likely to reduce gambling harm.

Quantitative self-report measures for gambling-related harm experienced by gamblers themselves are established in the literature, whereas similar measures of gambling-related harm to affected others (AOs, a.k.a. concerned significant others) are given less attention. The impact of gambling-related harm varies significantly among different relationship types, such as partners, family members, and friends. Moreover, while many studies concentrate primarily of AOs of individuals meeting the threshold criteria for “problem gambling”, AOs of gamblers with less severe issues can also experience harm. The present work takes a qualitative approach to understanding gambling-related harm as experienced by AOs, by exploring the lived experience of 30 AOs across these three relationship types, and the full spectrum of AO harm according to the Short Gambling Harm Screen for Concerned Significant Others (SGHS-CSO) self-report measure. The results showed that the level of AO harm varied both across and within each relationship type depending on how heavily the gambler gambled, whether the two people gambled together, how close the relationship was, the AO’s level of social support, and also how interdependent the two people’s life situations were. AOs enacted multiple strategies to help reduce harm for the gambler and themselves, or alternatively distanced themselves from the gambler. The findings indicate that SGHS-CSO comparisons may work reasonably well within a given relationship type, but also suggest ways to improve the comparability of measured harm across different AO relationship types.

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.

Background: Electronic gaming machines (EGMs) are recognised as one of the most harmful forms of gambling at an individual level. However, it is unclear whether restriction of EGM functions and accessibility results in meaningful reductions in population-level gambling harm. Methods: This study employed a natural policy experiment to compare gambling problems between Australian residents in Western Australia (WA), where EGMs are restricted to a single venue and have different structural features, and residents in other Australian jurisdictions where EGMs are widely accessible in casinos, hotels and clubs. The accessibility of non-EGM forms of gambling is generally similar across all Australian jurisdictions. The study draws on a large (N = 15,000) nationally-representative dataset.Findings: Although gambling participation was slightly higher in WA, EGM participation was approximately half that found in the rest of Australia. Aggregate gambling problems and harm were about one-third lower in WA, and self-reported attribution of harm to EGMs by gamblers and affected others was 2·7x and 4x lower, respectively. Analyses using mediation and moderation determined that the attributable impact of EGMs in WA was 70% lower than elsewhere, and was responsible for the vast majority of the discrepancy in gambling problems (indirect path = -0·055, 95% CI -0·071; -0·038). Attributable problems to casino table games were slightly higher in WA, potentially due to redirection of demand, but this effect size was small relative to the reduction of problems due to EGMs. On an individual level, for a given level of participation in EGMs and other forms, the risk of problems were similar in WA and the rest of Australia. Interpretation: Reduced harm from gambling in WA is due to restricted accessibility of EGMs, and there is little transfer of problems to other gambling forms. These results suggest that restricting the accessibility of EGMs substantially reduces gambling harm.Funding: Gambling Research Australia (GRA) funded this research. GRA is a partnership between the Commonwealth, State and Territory Governments to initiate and manage a national program of gambling research.

This study compared land-based-only gamblers (LBOGs), online-only gamblers (OOGs), and mixed-mode gamblers (MMGs), based on a 2019 Australian national telephone survey (N = 15,000). It examined 1) prevalence, demographics and gambling behaviours, 2) problematic gambling, 3) most harmful gambling forms, 4) gambling-related harms-to-self, and 5) risk factors for higher problem gambling severity. Results estimated that 43.1% of Australians were non-gamblers, 39.5% LBOGs, 12.8% MMGs and 4.6% OOGs. MMGs were more likely than LBOGs to be male, younger, unmarried, Australian-born, and indigenous. OOGs were more likely than MMGs to be married, university educated, born outside of Australia, speak a non-English language, and less likely to be indigenous. As hypothesised, MMGs had the highest gambling involvement, gambling problems and gambling-related harm. Relative risk of gambling problems for MMGs (5.1% problem gambling; 11.0% moderate risk gambling), exceeded that of both LBOGs (1.4%; 3.8%) and OOGs (0.7%; 4.7%). Risk factors for problematic gambling included engaging in more gambling forms, being male, single, less educated, indigenous, and speaking a non-English language. Crucially, gambling on the internet (OOGs and MMGs combined) was associated with higher problem gambling severity than land-based-only gambling (LBOGs), even after controlling for these risk factors. The findings can inform targeted public health measures.

The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., “skilled companion animal” and “service animal”) due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed.

BACKGROUND:Both the Problem Gambling Severity Index (PGSI) and the Short Gambling Harms Screen (SGHS) purport to identify individuals harmed by gambling. However, there is dispute as to how much individuals are harmed, conditional on their scores from these instruments. We used an experienced utility framework to estimate the magnitude of implied impacts on health and wellbeing. METHODS:We measured health utility using the Short Form Six-Dimension (SF-6D), and used this as a benchmark. All 2603 cases were propensity score weighted, to balance the affected group (i.e., SGHS 1+ or PGSI 1+ vs 0) with a reference group of gamblers with respect to risk factors for gambling harm. Weighted regression models estimated decrements to health utility scores attributable to gambling, whilst controlling for key comorbidities. RESULTS:We found significant attributable decrements to health utility for all non-zero SGHS scores, as well as moderate-risk and problem gamblers, but not for PGSI low-risk gamblers. Applying these coefficients to population data, we find a similar total burden for both instruments, although the SGHS more specifically identified the subpopulation of harmed individuals. For both screens, outcomes on the SF-6D implies that about two-thirds of the 'burden of harm' is attributable to gamblers outside of the most severe categories. CONCLUSIONS:Gambling screens have hitherto provided nominal category membership, it has been unclear whether moderate or 'at-risk' scores imply meaningful impact, and accordingly, population surveys have typically focused on problem gambling prevalence. These results quantify the health utility decrement for each category, allowing for tracking of the aggregate population impact based on all affected gamblers.

Background and aims:Gambling-related harm to concerned significant others (CSOs) is an important public health issue since it reduces CSOs' health and wellbeing in numerous life domains. This study aimed to 1) estimate the first national prevalence of CSOs harmed by gambling in Australia; 2) identify the characteristics of CSOs most at risk of harm from another person's gambling; 3) compare the types and number of harms experienced by CSOs based on their relationship to the person who gambles; and 4) compare the number of harms experienced by CSOs by self-identified gender.Methods:Based on a national CATI survey weighted to population norms, 11,560 respondents reported whether they had been personally and negatively affected by another person's gambling in the past 12 months; and if so, answered detailed questions about the harms experienced from the person's gambling who had harmed them the most.Results:Past-year prevalence of gambling-related harm to adult Australian CSOs was (6.0%; 95% CI 5.6%-6.5%). CSOs most commonly reported emotional harms, followed by relationship, financial, health and vocational harms, respectively. Former partners reported the most harm, followed by current partners, other family members and non-family members, respectively. Female CSOs were more likely to report more harm and being harmed by a partner or other family member, and male CSOs from a non-family member.Discussion and conclusions:The findings provide new insights into the wider societal burden of gambling and inform measures aimed at reducing harm to CSOs from gambling and supporting them to seek help.

Do stressful life events cause gambling problems, or do gambling problems cause stressful life events? This study used a retrospective design to examine the temporal order of these associations. Specifically, the study employed a life course calendar in a self-directed online survey to minimise memory biases common in retrospective designs. A total of 1564 US respondents who had gambled at any point in their life (51.0% female, median age 46) were asked whether, for each year of their adult life, they had experienced each of eight stressful life events, and whether they had engaged in casual or heavy gambling, drinking or drug use, with heavy gambling defined in line with a problem gambling definition. We found that five stressful life events were associated with the onset of heavy gambling: work issues, financial issues, legal issues, relationship issues and the death of a loved one. The same five stressful life events predict the cessation of an episode of heavy gambling, indicating a possible tendency for gambling problems to self-resolve in the presence of stress. Insights are also gained into comorbidities with alcohol and drug use, and the course of stressful life events and gambling and substance use throughout the life course, albeit with a non-representative sample. The methodology allows tentative conclusions in terms of possible causation pathways, indicating that stressful life events may play a role both in the onset and the maintenance (or cessation) of gambling problems.

Jurisdictions around the world have a self-declared mandate to reduce gambling-related harm. However, historically, this concept has suffered from poor conceptualisation and operationalisation. However, recent years have seen swift advances in measuring gambling harm, based on the principle of it being a quantifiable decrement to the health and wellbeing of the gambler and those connected to them. This review takes stock of the background and recent developments in harm assessment and summarises recent research that has validated and applied the Short Gambling Harms Screen and related instruments. We recommend that future work builds upon the considerable psychometric evidence accumulated for the feasibility of direct elicitation of harmful consequences. We also advocate for grounding harms measures with respect to scalar changes to public health utility metrics. Such an approach will avoid misleading pseudo-clinical categorisations, provide accurate population-level summaries of where the burden of harm is carried, and serve to integrate gambling research with the broader field of public health.

Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.

In New South Wales (NSW), the Gaming Machines Act 2001 and the Gaming Machines Regulation 2010 require venues to implement a minimum set of practices in the responsible conduct of gambling (RCG); and all managers of venues with gaming machines and all employees and club directors with gaming machine duties, must complete an accredited RCG training course. There has not been a recent comprehensive examination undertaken in NSW into the effectiveness of RCG programs and training in facilitating RCG in clubs and hotels. This research was conducted to assist in building an evidence-base with which to consider future options for enhancements to RCG requirements, practices and training. Its overarching objective was to contribute to the review and potential improvement of RCG practices in NSW venues. This study aims to contribute to the review and potential improvement of Responsible Conduct of Gambling (RCG) practices in NSW venues. Conducted by Central Queensland University, the research was commissioned by the NSW Office of Responsible Gambling and funded through the Responsible Gambling Fund.

Prior studies have identified self-regulatory strategies that are infrequently used by problem-gamblers, but which might be protective if used. However, guidelines with evidence-based safe gambling practices (SGPs) that prevent gambling-related harm are lacking. This study aimed to: 1) identify a parsimonious set of evidence-based SGPs that best predict non-harmful gambling amongst gamblers who are otherwise most susceptible to experiencing gambling harm; 2) examine how widely are they used; and 3) assess whether their use differs by gambler characteristics. A sample of 1,174 regular gamblers in Alberta Canada completed an online survey measuring uptake of 43 potential SGPs, gambling harms and numerous risk factors for harmful gambling. Elastic net regression identified a sub-sample of 577 gamblers most susceptible to gambling harm and therefore most likely to benefit from the uptake of SGPs. A second elastic net predicted gambling harm scores in the sub-sample, using the SGPs as candidate predictors. Nine SGPs best predicted non-harmful gambling amongst this sub-sample. The behaviour most strongly associated with increased harm was using credit to gamble. The behaviour most strongly associated with reduced harm was 'If I'm not having fun gambling, I stop'. These SGPs form the basis of evidence-based safe gambling guidelines which can be: 1) promoted to consumers, 2) form the basis of self-assessment tests, 3) used to measure safe gambling at a population level, and 4) inform supportive changes to policy and practice. The guidelines advise gamblers to: stop if they are not having fun, keep a household budget, keep a dedicated gambling budget, have a fixed amount they can spend, engage in other leisure activities, avoid gambling when upset or depressed, not use credit for gambling, avoid gambling to make money, and not think that strategies can help you win. These guidelines are a promising initiative to help reduce gambling-related harm.

Previous research has established direct messages (such as emails and text messages) are a widely seen form of advertising and are highly influential on sports betting and race betting behaviour. Nevertheless, few studies have examined the specific content of these messages, and whether their content is related to account-holders’ betting behaviour. The current study used an ecological momentary assessment design to examine direct messages received from wagering operators during the week around major Australian sports and racing events. Respondents completed a baseline survey followed by short daily surveys over a period of 1 week during peak betting periods, and provided the research team with the emails and text messages they received from wagering operators during this time. A sample of 102 sports and 110 race bettors provided a total of 931 messages. These messages subsequently underwent a content analysis to extract key features that were promoted, including inducements, incentives, and bet type. The analysis found the messages were saturated with inducements to bet, however no relationships were identified between the content of messages and the gambling risk status or betting frequency of participants. The most common types of incentives offered included bonus bets, rewards points, better odds/winnings, and reduced risk. Frequently promoted inducements included bonus or better winnings, refund/stake back offers, and match your stake/deposit. Given the influences of inducements on increasing betting expenditure and impulsive betting identified through previous research, taken together with the findings of the current study, direct messages may contribute to experiencing gambling-related harm. These findings have important implications for consumer education and the regulation of direct messages.

This study compared the experience of gambling related harms between gamblers and spouses, whilst taking into account gender and problem gambling severity. Participants (N = 5036, 2603 females) from Australia and New Zealand completed a retrospective survey that probed the prevalence of specific harms from gambling within six harm domains (financial, work/study, health, emotional/psychological, relationship, and social deviance). Overall there was a similar count of total harms reported across all domains experienced by spouses (vs gamblers), however the types and patterns of harms reported were markedly different. Spouses reported the highest number of harms within the emotional/psychological and relationship domains, whereas gamblers experienced a higher number of harms in all other domains. Spouses were five to six times more likely to report increased conflict in their relationship due to gambling, greater relationship tension, and ending a relationship. In comparison, gamblers reported more severe health-related harms, such as suicide attempts and increased alcohol consumption. The findings highlight the unique ways in which gamblers and their spouses each respond to the presence of gambling problems.

.................................................................................................................... 3 Table of contents ...................................................................................................... 5 List of tables ............................................................................................................. 9 List of figures ......................................................................................................... 11 Key terms and acronyms ....................................................................................... 12 Executive summary ................................................................................................ 13 1. Background .................................................................................................... 25 1.