Framing a public health approach to gambling harms in Wales: Challenges and opportunities

Available online – Report commissioned by Public Health Wales takes a broader perspective on the impact of gambling than previous traditional medical perspectives.

Introduction: Recent years have seen substantial increases in the availability of gambling. In Great Britain, the gambling industry’s annual Gross Gambling Yield (GGY; that is, the difference between bets paid in and bets paid out) has increased to £14.4bn in 2017/18. This suggests that either more people are gambling or that those who do gamble are spending more money gambling than previously. These observations, along with rapid technological changes that now provide gambling products and services through online and mobile platforms to more sectors of the population, have heightened concerns about the numbers of people at-risk of experiencing gambling harms and associated social costs Access full report

Reference: Rogers, R.D., Wardle, H., Sharp, C.A., Dymond, S., Davies, T.J., Hughes, K. & Astbury, G. (2019). Framing a public health approach to gambling harms in Wales: Challenges and opportunities. Cardiff: Public Health Wales.


A mapping review of research on gambling harm in three regulatory environments [open access article]

Background: Harmful gambling is a complex issue with diverse antecedents and resulting harms that have been studied from multiple disciplinary perspectives. Although previous bibliometric reviews of gambling studies have found a dominance of judgement and decision-making research, no bibliometric review has examined the concept of “harm” in the gambling literature, and little work has quantitatively assessed how gambling research priorities differ between countries.

Methods: Guided by the Conceptual Framework of Harmful Gambling (CFHG), an internationally relevant framework of antecedents to harmful gambling, we conducted a bibliometric analysis focusing on research outputs from three countries with different gambling regulatory environments: Canada, Australia, and New Zealand. Using a Web of Science database search, 1424 articles published from 2008 to 2017 were retrieved that could be mapped to the eight CFHG factors. A subsample of articles (n = 171) containing the word “harm” in the title, abstract, or keywords was then drawn. Descriptive statistics were used to examine differences between countries and trends over time with regard to CFHG factor and harm focus

Results: Psychological and biological factors dominate gambling research in Canada whereas resources and treatment have received more attention in New Zealand. A greater percentage of Australia and New Zealand publications address the gambling environment and exposure to gambling than in Canada. The subset of articles focused on harm showed a stronger harms focus among New Zealand and Australian researchers compared to Canadian-authored publications.

Conclusions: The findings provide preliminary bibliometric evidence that gambling research foci may be shaped by jurisdictional regulation of gambling. Countries with privately operated gambling focused on harm factors that are the operators’ responsibility, whereas jurisdictions with a public health model focused on treatment and harm reduction resources. In the absence of a legislated requirement for public health or harm minimisation focus, researchers in jurisdictions with government-operated gambling tend to focus research on factors that are the individual’s responsibility and less on the harms they experience. Given increased international attention to gambling-related harm, regulatory and research environments could promote and support more diverse research in this area. Access full article

Reference: Baxter, D.G., Hilbrecht, M., Wheaton, C.T.J. (2019). A mapping review of research on gambling harm in three regulatory environments. Harm Reduction Journal, 16(12).

Effects of prevention and harm reduction interventions on gambling behaviours and gambling related harm: An umbrella review [open access article]

Harms related to gambling have been found not only to affect problem gamblers, but also to occur amongst low- and moderate-risk gamblers. This has resulted in calls for a public health approach to address a possible ‘prevention paradox’ in gambling related harm. The aim of this study was to evaluate the systematic review evidence base on the effects of prevention and harm reduction interventions on gambling behaviours, and gambling related harm. We also aimed to examine differential effects of interventions across socio-demographic groups. Access full article


  • First umbrella review evaluating the effectives of prevention and harm reduction interventions on gambling behaviour.
  • Found evidence of 10 reviews reporting 55 unique primary studies.
  • Evidence relates mostly to pre-commitment/limit setting, self-exclusion, youth prevention programmes and messages/feedback.
  • Review-level evidence is poor, and no review reported differential effects of interventions across sociodemographic groups.

Naoimh McMahon, Katie Thomson, Eileen Kaner, & Clare Bambra. (2019). Addictive Behaviors, 90.

Online gambling: Addicted to addiction / Tim Cowen and Phillip Blond [open access e-publication]

[From the executive summary] In May 2018, the Government announced the introduction of a £2 limit on Fixed Odds Betting Terminals (FOBTs). ResPublica campaigned for this in the 2017 Paper, ‘Wheel of Misfortune’, which demonstrates the impact these machines have upon gamblers at risk of developing a problem, and indicates the more general problem for society at large. Following on from this, ResPublica published the report ‘Watershed’, which has argued for government to close the legislative loopholes that exist in gambling advertising. This report builds on the recommendations in the previous ResPublica reports, developing a growing package of reforms to make the gambling industry more sustainable and responsible. Access e-publication online

About the Campaign for Fairer Gambling
The Campaign for Fairer Gambling is a not-for-profit organisation that aims to ensure delivery and enforcement of the licensing objectives of the 2005 Gambling Act, including preventing gambling from being a source of disorder or crime, ensuring that gambling is conducted in a fair and open way, and protecting children and other vulnerable persons from being harmed or exploited by gambling.

About ResPublica
The ResPublica Trust (ResPublica) is an independent non-partisan think tank. Through our research, policy innovation and programmes, we seek to establish a new economic, social and cultural settlement. In order to heal the long-term rifts in our country, we aim to combat the concentration of wealth and power by distributing ownership and agency to all, and by re-instilling culture and virtue across our economy and society.

Suicidality among gambling helpline callers: A consideration of the role of financial stress and conflict [subscription access article]

Carr, M. M., Ellis, J. D. & Ledgerwood, D. M. (2018). The American Journal on Addictions, 27(6), 531-537. doi:10.1111/ajad.12787

Abstract: Background and Objectives
High rates of suicidal ideation and attempts secondary to gambling are well established among those with gambling disorders. The present study explores potential risk factors for suicidal ideation and/attempt among a sample of help‐line callers.

Participants (N = 202) completed measures assessing demographics; gambling behavior; and financial, family/social, employment, substance use, and legal difficulties related to gambling. Bivariate analyses, logistic regression, and mediation analyses were used to explore relationship between predictors and risk of suicidal ideation and attempt.

Female gender, gambling severity (including engagement in illegal behaviors), a history of mental health problems, financial problems, and conflict related to gambling were associated with current suicidality in this sample. Mediation analyses revealed that financial problems were associated with increased familial conflict, which was in turn associated with increased suicidality.

Family and social conflict may be one important way in which financial problems confer risk for suicidality among problem gamblers. These results align with findings from the substance use disorder (SUD) literature and highlight one potential factor that may merit further assessment and/or intervention.

Scientific Significance
Researchers and clinicians may want to consider the overall level of conflict a patient is experiencing when assessing suicide risk among individuals with gambling problems. Professionals may also want to consider the suitability of interventions to address conflict within the context of gambling treatment. Article details and access conditions

The economics of gambling: A collection of essays (open access thesis)

Wheeler, Rhys (2018). (PhD Thesis, Lancaster University). Retrieved from:

Abstract: Chapter 2 examines the harm associated with being a problem gambler. Problem gambling is conventionally determined by having a score in a questionnaire screen that exceeds some critical value. The UK is fortunate in having large representative sample surveys that embed such questions, and our estimate from the 2010 survey is that several hundred thousand people in the UK could be afflicted by PG. However, existing literature has not evaluated the size of the harm associated with being a problem gambler and this chapter uses this individual level survey data to evaluate the effect of problem gambling on self-reported well-being. Together with a corresponding effect of income on well-being a money-metric of the harm associated with being a problem gambler is derived. An important methodological challenge is that well-being and the harm experienced may be simultaneously determined. Nonetheless, instrumental variable estimates suggest that problem gambling imposes an even larger reduction in well-being than least squares would suggest. The role of gambling expenditures in the transmission between problem gambling and well-being is considered, distinguishing between draw-based games, such as lotto, from scratchcards, and from other forms of gambling.

Chapter 3 investigates the price elasticity of demand for the UK National Lottery – astate-licensed, draw-based lotto game. Little is known about the price elasticity of demand for gambling products because the “price” is typically hard to define. The exception is “lotto” where an economics literature has focused on the response of sales to variations in the prize distribution. Existing literature has used these responses make inferences about the price elasticity of demand, where price is defined as the cost of entry minus the expected winnings. In particular, the variation in the value of the jackpot prize pool, due to rollovers that are a feature of lotto, has been used as an instrument for price. This chapter argues that rollovers do not make valid instruments, because of their correlation with lagged sales, and propose an alternative identification strategy which exploits two arcane features of lotto. Finally, this chapter evaluates whether changes to the design of the UK National Lottery in 2013 and 2015 had a positive effect on the sales figures.

Chapter 4 investigates the extent to which the large, flat-rate tax imposed on the UK National Lottery is regressive. This chapter evaluates a Working-Leser demand model for lotto tickets using both Heckman’s selection model and Cragg’s double hurdle estimator using v household-level data. A unique strategy is employed to identify these two-stage routines by exploiting exogenous differences in consumer preference arising from religious practice. The income elasticity of lottery tickets is found to be significantly lower than previous estimates, suggesting that lottery tickets are inferior goods and that the (high) flat-rate tax imposed on lotto tickets is more regressive than previously thought. Whilst the three chapters are stand-alone essays, they are linked by the use of modern statistical techniques and the use of the best possible data. Together, they address key issues on the economics of gambling and the results are new to their respective literatures and of interest to academics and policy makers alike. Access thesis online

A study into the themes and typologies of binge gambling episodes [presentation available online]

By Verity Harris. Supervisors: Dr. Amanda Roberts and Dr Stephen Sharman.

Motive & methods: Research suggests to look into the patterns and relationships of binge gambling with other gambling types. Themes and typologies of problem gamblers binge episodes, to gain potential insight into binge gamblers episodes. Gordon Moody Association: intensive residential treatment programme in the UK for the most severely addicted. Access to 10 years worth of data. 52 interviews used, aged 21– 63, all males. Thematic Analysis: Chosen for it’s flexibility, simple use and ability to analyse latent level of data. Ethics has been collected and approved by SOPREC; Research discussing binge gamblers is in reference to Nower and Blaszczynski (2003). View presentation online