The Dependence of Online Gambling Businesses on High-Spending Customers: Quantification and Implications.

Online gambling has grown to be a significant industry but it faces regulatory threats because of perception that it is heavily dependent on a small segment of its customers who gamble heavily and at a level carrying elevated risk of harm. Employing a large multi-operator data set from Britain, which records individual transactions by some 140,000 individuals observed over one year, we are enabled to provide more precise estimates of the degree of concentration of revenue, compared with previous studies. High dependence on a relatively small number of customers is shown though there is variation from product to product in how small the group of account-holders of potential concern is. We conclude with a discussion of prospects for the industry in light of heightened awareness of gambling harm and resulting restrictions on online gambling spending introduced or proposed by governments or regulators in several jurisdictions.

Gambling Harm Experienced by Children Exposed to Parental Gambling: An Online Survey of Australians.

Although child wellbeing is known to be negatively affected by gambling, relatively little is known about the specific harms experienced by children exposed to parental gambling problems. The current study aimed to better understand gambling harm directly attributed to regular parental gambling in key areas of child wellbeing: financial, psychological, interpersonal wellbeing and intergenerational transmission of problem gambling. Using data from a national survey of Australian adults exposed to parental gambling under the age of 18 (n = 211), the results show that parental gambling was related significant levels of financial harm, abuse, neglect as well as relational and psychological problems as a direct result of parental gambling. The likelihood of experiencing gambling harms was positively associated with parental problem gambling severity. Harmful impacts of parental gambling as a child were also associated with a range of psychological problems in adulthood including depression, anxiety, Post-Traumatic Stress Disorder and intimate partner violence victimisation. Parental problem gambling severity was negatively associated with own lifetime gambling problems, suggesting a specific pattern of intergenerational transmission of problem gambling in children of regular, or heavy, gamblers. This research highlights the need for more supports for families with children in which at least one parent gambles regularly.

Gambling in Victoria: Changes in Participation, Problem Gambling and Gambling Environment Between 2008 and 2018.

Gambling and its impacts are an important public health issue. The relationship between gambling, problem gambling and gambling harm is complex and dynamic. Replicate prevalence studies are useful for surveillance and monitoring gambling impacts within jurisdictions. The purpose of this study was to compare changes in gambling and problem gambling in the Victorian adult population between 2008 and 2018 by investigating individual gambling activities and exploring their relationship with the Victorian gambling ecosystem. Gambling participation has decreased; problem gambling prevalence has not. Investigation beyond these summary measures reveals important details: (a) Electronic Gaming Machines (EGMs), casino table games, race and sports betting ('high-risk activities'), informal private betting, and Keno, and their associations with problem gambling endure. Further, the strength of this association is unaffected by changes in product technology, delivery, or the Victorian environment in which they reside, (b) participation in high-risk activities, excluding EGMs, increased while for other activities they decreased, (c) EGMs continue to pose the greatest risk for Victorians, (d) males and young adults continue having a higher problem gambling prevalence rate and preferring both online gambling and high-risk activities (excluding racing favoured by an ageing, older cohort, and Keno, by all ages), and (e) gambling access and exposure proliferated enabling single site multiple gambling opportunities on high-risk activities. Young adults represented a new vulnerable group as they reach the legal gambling age. The most effective interventions (based on major falls in real expenditure (losses) on EGMs, the highest risk activity) were the smoking bans, removal of ATMs from venues and decreases in bet size. There is great potential for prevention, intervention, and minimising harm in the gambling environment.

Skin Gambling Contributes to Gambling Problems and Harm After Controlling for Other Forms of Traditional Gambling.

Esports betting and skin gambling involve betting on the outcomes of video game competitions and/or using virtual currencies for betting. The present study evaluated a conceptual model linking video game involvement, video-game related gambling, traditional gambling, and gambling problems and harm. Data were collected via a cross-sectional online survey with 737 participants aged 18 + who engaged in esports cash betting (n = 576), esports skin betting (n = 184), or skin gambling on games of chance (n = 330). The findings highlighted the distinctly different relationships esports cash betting versus skin gambling had with traditional gambling involvement and harmful gambling. Gambling with skins on games of chance was predictive of gambling problems and gambling harm after controlling for participation in traditional gambling (OR = 1.32 and 1.17 respectively). Whereas betting on esports with cash was associated with betting on a variety of other forms of gambling, and there was no unique contribution to problems and harm over and above participation on these other forms (e.g., EGMs, sports betting). Skin gambling is directly implicated in gambling problems and harm, whereas cash betting on esports is only indicative of interest in many forms of potentially harmful gambling. Greater research attention to skin gambling is warranted, and particularly with respect to its role as a virtual currency more easily accessible for gambling.

Seeking Solace in Gambling: The Cycle of Gambling and Intimate Partner Violence Against Women Who Gamble.

This study explored women's gambling in response to male intimate partner violence (IPV). Twenty-four women were recruited through service providers and online advertising. All women had been victimised by IPV and all experienced problems relating to the gambling on electronic gaming machines (EGMs). Thematic analysis of their in-depth interviews identified three major themes. The main pattern of gambling and IPV (Theme 1) was where ongoing coercive control preceded the woman's gambling. Situational violence in response to gambling was also observed. Regardless of temporal sequence, a self-perpetuating cycle of gambling and IPV victimisation was typically apparent, with both issues escalating over time. Reflecting severe traumatic violence, push factors from IPV that motivated the women's gambling (Theme 2) included physical escape, psychological escape, hope of regaining control over their lives, and gambling to cope with the legacy of abuse. Pull factors attracting these women to gambling venues (Theme 3) appeared to have heightened appeal to these victims of IPV. These included venues' social, geographic and temporal accessibility, allowance for uninterrupted play on EGMs, and the addictive nature of EGMs. These push and pull factors led to these women's prolonged and harmful gambling while exacerbating their partner's violence. Concerted efforts are needed to assist women in this cycle of IPV and gambling, prevent violence against women, and reduce harmful gambling products and environments.

"They loved gambling more than me." Women's experiences of gambling-related harm as an affected other.

BACKGROUND: Gambling poses a global threat to public health due to its far-reaching impacts. Research has demonstrated a ripple effect of harmful gambling on social network members and broader communities. While researchers have documented extreme harms associated with an affected other, limited research has qualitatively investigated how women describe their concerns about the gambling of a social network member, and any subsequent negative impacts on their own lives. METHODS: An online panel survey was conducted with women aged 18 years and older, who gambled at least once in the last 12 months, and resided in the Australian states of Victoria and New South Wales. This paper focused on the open text responses of a subsection of the sample (n = 136) who reported being negatively impacted by someone else's gambling. The study utilised reflexive thematic analysis to interpret the data. RESULTS: Results indicated that women were concerned about the gambling behaviours of a broad range of social network members. Open text responses regarding the nature of these concerns mostly related to individualised paradigms of gambling behaviour - including whether the participant perceived their network member could afford to gamble, was being responsible with their gambling, or were gambling too frequently. Participants experienced a range of negative impacts including significant financial issues, relationship difficulties, poorer emotional wellbeing as a result of worrying about the gambler, and loss of trust. Some described the negative experiences associated with growing up with a parent who gambled. CONCLUSION: The research demonstrates the broad impacts of gambling on affected others. This study enhances our understanding of how women are harmed by gambling and considers the complexities of their experiences and relationships with the gambler. This extends knowledge beyond quantitative descriptors of harm among affected others and provides a critical reflection on the nuances of women's experiences with gambling and gambling harm.

Young people in Australia discuss strategies for preventing the normalisation of gambling and reducing gambling harm.

BACKGROUND: The normalisation of gambling for young people has received considerable recent attention in the public health literature, particularly given the proliferation of gambling marketing aligned with sport. A range of studies and reports into the health and wellbeing of young people have recommended that they should be consulted and engaged in developing public health policy and prevention strategies. There are, however, very few opportunities for young people to have a say about gambling issues, with little consideration of their voices in public health recommendations related to gambling. This study aimed to address this gap by documenting young people's perceptions about strategies that could be used to counter the normalisation of gambling and prevent gambling related harm. METHODS: This study took a critical qualitative inquiry approach, which acknowledges the role of power and social injustice in health issues. Qualitative interviews, using a constructivist approach, were conducted with 54 young people (11-17 years) in Australia. Reflexive thematic analysis was used to interpret the data. RESULTS: Five overall strategies were constructed from the data. 1) Reducing the accessibility and availability of gambling products; 2) Changing gambling infrastructure to help reduce the risks associated with gambling engagement; 3) Untangling the relationship between gambling and sport; 4) Restrictions on advertising; and 5) Counter-framing in commercial messages about gambling. CONCLUSIONS: This study demonstrates that young people have important insights and provide recommendations for addressing factors that may contribute to the normalisation of gambling, including strategies to prevent gambling related harm. Young people hold similar views to public health experts about strategies aimed at de-normalising gambling in their local communities and have strong opinions about the need for gambling to be removed from sport.

How structural changes in online gambling are shaping the contemporary experiences and behaviours of online gamblers: an interview study.

BACKGROUND: Over the last decade, the provision of online gambling has intensified with increased access, enhanced betting markets, a broader product range, and prolific marketing. However, little research has explored how this intensification is influencing contemporary gambling experiences. This study focused on two research questions: 1) What changes in online gambling have online gamblers observed over the past decade? 2) How have these changes influenced the online gambling experiences and behaviours reported by treatment-seeking and non-treatment-seeking gamblers? METHODS: Two samples of Australian adults were interviewed: 1) 19 people who had been gambling online for at least a decade and with no history of treatment-seeking for online gambling, and 2) 10 people who had recently sought professional help for an online gambling problem. Telephone interviews were semi-structured, with questions that encouraged participants to consider how their online gambling, including any harmful gambling, had been influenced by changes in operator practices and online gambling environments. Data were analysed using thematic analysis. RESULTS: Both treatment- and non-treatment-seekers noted the increased speed and ease of online gambling, which now enables instant access from anywhere at any time and increased their gambling opportunities. Both groups highlighted the continued proliferation of advertising and inducements for online gambling, particularly during televised sports and racing events, in social media, and through targeted push marketing. Many treatment- and non-treatment-seekers were aware of the vast range of recently introduced bet types, particularly multi-bets. Treatment-seekers disproportionately reported negative effects from these changes, and described how and why they fostered their increased gambling, impulsive gambling, persistence and loss-chasing. They reported limited uptake and effectiveness of current harm minimisation tools. CONCLUSIONS: Counter to stated policy and practice objectives to minimise gambling harm, industry changes that have made online gambling easier, faster, and more heavily incentivised, and increased the array of complex bets with poorer odds, unduly affect addicted and harmed individuals - who are also the most profitable customers. Further consideration is needed to ensure gambling policy, industry practices and public health measures more effectively reduce gambling harm in contemporary settings. Inducements and the poor pricing of complex bets such as multi-bets, and their outsized attraction to players with problems, should be a key focus.

Gamblers' perceptions of responsibility for gambling harm: a critical qualitative inquiry.

BACKGROUND: Gambling has traditionally been conceptualised as an issue of addiction and personal responsibility. While there are now clear public health models that recognise that gambling harm is caused by a range of socio-cultural, environmental, commercial and political determinants, government and industry messages about gambling are still largely personal responsibility focused. Given the well-recognised issues associated with personal responsibility paradigms, this study sought to understand how gamblers themselves conceptualised responsibility for gambling harm. METHODS: A qualitatively led online panel survey was conducted with 363 adult gamblers in New South Wales and Victoria, Australia. Participants were asked to respond to what they thought were the causes of gambling harm, and what could be done to prevent harm. A reflexive thematic analysis was conducted. RESULTS: Six common tropes were constructed from gamblers' responses: (1) Gambling in moderation; (2) Personal responsibility for rational behaviour; (3) Character flaws; (4) Personal responsibility to seek help; (5) More education is needed; and (6) Governments are responsible for action - but motivation and efficacy are questioned. Gamblers primarily understood gambling harm as being a matter of personal responsibility, and government responsibility was generally seen as limited to providing information to facilitate informed gambling choices. CONCLUSIONS: This study demonstrates that gamblers' perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from 'responsible gambling' messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.

Culture, church, and collective: a qualitative study about gambling harm prevention and reduction in Aotearoa/New Zealand-a Tongan male perspective.

BACKGROUND: In New Zealand, Pacific people continue to be more at risk of gambling harm than the general population, despite increasing public health efforts and treatment service provisions introduced to address this social and health issue. In looking at why this is so, our first concern was to ask why the delivery of the prevailing gambling-focussed programmes was not influencing Pacific gambling behaviours. In seeking to answer this question, it was important to explore ethnic-Pacific-specific factors of gambling harm prevention and reduction. METHODS: The research design was interpretivist/constructivist and phenomenological, applied through the lens of a Tongan worldview. Participants comprised Tongan male elders and youth. Recruitment of participants was through snowball sampling from churches and kava-drinking circles. A total of 28 elders and 18 youth participated through focus group talanoa and individual talanoa. This study employed descriptive thematic analysis. RESULTS: Participants were not aware of any policy document or problem-gambling preventative programmes. Four key themes were raised, which include raising the awareness of existing gambling harm treatment providers, the church influence in addressing gambling harm, community-based strategies, and cultural-based approaches. CONCLUSIONS: This study proposes several recommendations such as more awareness of gambling harm providers in community, increasing cultural spaces and church engagements, and calls for further research in addressing the prevention and reduction of gambling harm amongst the Tongan community in New Zealand.

How survey mode affects estimates of the prevalence of gambling harm: a multisurvey study.

Recent general population surveys have produced highly variable estimates of the extent of problem gambling in Great Britain, ranging from as low as 0.4% to as high as 2.7% of adults. This level of uncertainty over the true level of problem gambling creates difficulties for policy makers and those planning treatment and support services for individuals and families affected by problem gambling. In this article, we assess the extent to which differences in approaches to sampling and measurement between surveys contribute to variability in estimates of problem gambling. We compare estimates of problem gambling using the Problem Gambling Severity Index across eight different surveys conducted at approximately the same time but which use different sampling and measurement strategies. Our findings show that surveys conducted online produce substantially higher estimates of problem gambling compared with in-person interview surveys. This is because online surveys, whether using probability or non-probability sampling, overrepresent people who are more likely to gamble online and to gamble frequently, relative to the proportions of these groups in the general population.

The Gambling Behaviour and Attitudes to Sports Betting of Sports Fans.

Survey responses from a sample of nearly 15,000 Australian sports fans were used to study the determinants of: (i) gambling behaviour, including if a person does gamble and the type of gambling engaged with; (ii) the number of sports and non-sports bets made over a 12-month period; and (iii) attitudes towards betting on sports. The probability of betting on sports decreased with increasing age and was lower for women and people with a university education. This gender difference varied with age, with the greatest difference found among the young. Similar effects were observed for the number of sports bets made, which declined with age. The gender difference in the number of sports bets also varied with age with the greatest difference found among the young arising from the high propensity of young men to bet on sports. Attitudes to sports betting were also analysed, with a key finding that, within friendship circles, the views that sports betting is perceived as harmless, common and very much a part of enjoying sports were stronger among young men. These permissive attitudes were stronger among people who bet on sports and those who bet on sports more frequently. The analysis of sports fans provides insights into the characteristics of the target market most likely to bet on sports, which can be used to inform public health initiatives and harm reduction campaigns.

Measuring Gambling Harm: The Influence of Response Scaling on Estimates and the Distribution of Harm Across PGSI Categories.

Recent research has shown that harm is not just a feature of problem gambling, but can also be observed in other lower risk categories. Some debates exist, however, as to the distribution of harm across these categories and how harm should be best measured. This study was designed to examine how estimates of self-reported harm are affected by the methodology used. A particular focus was on how harm estimates for low and higher risk gambling (as classified by the PGSI) varied when respondents were able to make more graded attributions of their harm to gambling. An online panel sample of 554 gamblers responded to a brief survey that included the PGSI, measures of gambling harm drawn from Browne et al. (Assessing gambling-related harm in Victoria: a public health perspective, Victorian Responsible Gambling Foundation, Melbourne, 2016) as well as questions about demographics and gambling habits. The recruitment was designed to obtain good representation of each PGSI group, with 23% found to be problem gamblers; 36% moderate risk and 21% low risk gamblers. In support of Browne et al. (2016), the findings showed that higher proportions of harm in low risk gamblers is likely to be identified when one uses binary or 'any harm' scoring, but that this effect mostly disappears when more graded scoring or attribution of harm measures are used. Higher risk PGSI groups consistently reported more harms and more serious harms than lower risk groups. It was concluded that the measurement of gambling harm and its estimated distribution over PGSI categories is quite sensitive to how it is measured.

The Relationship Between Family Gambling Problems, Other Family Stressors, and Health Indicators in a Large Population-Representative Sample of Australian Adults.

PURPOSE: Harms due to excessive gambling can be experienced by gamblers and those close to them. Family gambling problems (FGPs) are currently under-researched, particularly in population-representative samples. This study aimed to identify prevalence, risk factors, and the complex of stressors and health-related consequences associated with FGPs, as well as isolating the impact of FGPs on physical and psychological health problems. METHODS: We analysed data from the National Health Survey 2011-13, a large (N = 15,475) nationally representative sample of Australian adults. Participants reported on the presence of 14 family stressors (including FGPs), self-assessed health status, and risky health behaviours. Psychological impact was measured by the Kessler Psychological Distress Scale-10, as well as several indicators of the presence of mental health problems. RESULTS: Overall, 1.7% of households reported a FGP. Interviewees in these households reported three times the number of other stressors than those without a FGP. In addition, they were around eight times more likely to be experiencing other addictions (drug and alcohol related problems) and stressors associated with socially deviant behaviours (trouble with police, abuse or violent crime, and witness to violence). Once age, gender, socioeconomic disadvantage, and other stressors were controlled for, FGPs significantly predicted lower self-assessed health and higher psychological distress. CONCLUSIONS: FGPs occur within a complex of other addictions and stressors, impacting the quality of life of people close to problem gambling. The findings are discussed in relation to their support for General Strain Theory (Agnew, Criminology 30:47-87, 1992).

A framework for indirect elicitation of the public health impact of gambling problems.

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.

Baby boomers as gamblers: recognizing and preventing gambling harm with intersectional approach.

OBJECTIVES: This study aims to discuss and analyse the gambling habits and perceptions towards gambling cultures and problems among the large 'baby boomer' generation in Finland from an intersectional approach. These people born between 1945 and 1955 in their retirement or approaching retirement may face new risks regarding gambling. The results of this study support the designing of harm prevention among this ageing generation. STUDY DESIGN: Twenty-five people were interviewed in six focus groups. Participants' gambling experience varied from non-gambling to having experienced some problems. Three of the focus groups had participants with second degree education the highest, and three of the groups had participants with second degree education the lowest. Four interviews were conducted in the capital area and two in rural environments. METHODS: The group interview data were analysed with thematic content analysis. After initial coding in accordance with the research questions, subthemes and final themes were formed. Results are discussed through the final themes. RESULTS: The main results concern the gambling habits on the participants' life course: from shared, cultural experiences in their childhood to mostly minor gambling on the edge of retirement; the mutual understanding of the enormous growth in gambling supply during their lifetime, but emphasizing the importance of gambling monopoly for the society; and framing gambling problems as an individual tendency. CONCLUSIONS: The prevention of gambling harm within this generation needs to take into account the historical changes they have lived: from few, harmless gambling products framed as an instrument to support 'good causes' to the current world of commercial gambling. The deterministic understanding of gambling problems as an individual flaw may prevent recognizing problem gambling and seeking help to tackle the problems. Risks for gambling harm relate more to the gambling structures and cultures this ageing generation lives in, and the deterministic, individual understanding of gambling harm they share, than to marginalized positions they may have through gender or education.

Building momentum for local action on problem gambling in Leeds and Yorkshire.

Problem gambling has not been a priority within either Leeds City Council or partnership plans. However, financial inclusion, licencing and public health teams have been able to develop a cross-Council approach to problem gambling. This has been aided by an upfront payment plus annual payments to the Council that have been part of the licencing agreement for a new casino. As a result, research has been commissioned on local prevalence. This showed a higher rate of problem gamblers (1.8%) than national estimates with a similar level to nationally of those 'at risk'. The research also showed that local services had difficulties identifying problem gamblers and signposting for support. This had led to a high profile communications campaign to coincide with 'Responsible Gambling Week' complemented by training for frontline workers. The interviews undertaken for the research, plus the findings themselves, have been a powerful help in securing interest and commitment beyond the Council and to the health and third sectors. The use of local stories has helped build momentum for partnership working. For example, focus groups to explore how gambling affected migrants and medical student interviews with university students. The article will describe how increasing understanding across partners has helped build confidence to provide cross city responses to national consultations and contribute to national publications and conferences. Of even greater significance, the local National Health Service has secured funding from GambleAware for a Northern Gambling Service to be based in Leeds with satellites in the North East and Greater Manchester. This will provide treatment for those with severe gambling addiction. Additional support will come from a significant increased provision of GamCare services working to identify, screen and support problem gamblers. The use of Council premises for both of these services is testament to joint working. Recognising that this is a new emerging agenda has led to the creation of a Yorkshire and Humber Problem Gambling Working Group, endorsed by the Association of Directors of Public Health. This has resulted in shared learning and determining a consistent approach to harm. Even during a short time, the degree of interest has risen substantially. A regional gambling harm reduction framework has been produced that sets out a menu of actions. This intends to help local areas determine their own priorities. There is increasing recognition that problem gambling is a public health issue. Leadership requires a systems led, and Health in All Policies, approach to ensure problem gambling is not seen as a narrow niche issue led by public health staff. There is a need to recognise that engagement takes time. However, this is a new and emerging issue. The solutions to problem gambling are not clear and this allows for more creative, pragmatic and coproduced approaches.

Proximal and Distal Risk Factors for Gambling Problems Specifically Associated with Electronic Gaming Machines.

Electronic gaming machines (EGMs) are widely used and the gambling product most commonly associated with harmful gambling. Understanding factors that increase the risk of problematic EGM play is therefore important. Previous studies into risk factors for EGM gambling have used measures of problem gambling based on an individual's total gambling activity, which therefore do not distinguish harmful gambling specifically associated with EGMs. This study used an EGM-specific measure (PGSI-EGM) to achieve its aim of identifying risk factors specifically associated with problematic EGM play. By removing nuisance effects from other gambling forms that higher-risk gamblers typically engage in, this approach provides a more accurate assessment of the determinants of EGM-related problems. An online survey was completed by 1932 at-least monthly EGM players in Australia. It measured demographics, EGM gambling behaviour, motivations, gambling urges, gambling fallacies, trait self-control, alcohol misuse, and the PGSI-EGM. A penalised regression model identified the most important proximal predictors of higher-risk EGM gambling as: higher gambling urges, higher levels of erroneous cognitions, playing EGMs more frequently, higher session expenditure, longer sessions, usually playing EGMs alone, and playing EGMs in more venues. Lower trait self control was the strongest distal determinant. Higher-risk EGM players tended to be younger, male, more educated, never married, to have higher (although still modest) incomes, and be more likely to have alcohol problems. These findings can inform interventions such as treatment, consumer education and venue interventions.

A mapping review of research on gambling harm in three regulatory environments.

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.

Challenges in the Conceptualisation and Measurement of Gambling-Related Harm.

This paper examines the significance of recent developments in research relating to gambling-related harm. Previous research, it is argued, has failed to capture gambling-harm in a way that is useful to inform public policy and regulation. This is because most standardised psychometric measures and the DSM classifications have conflated gambling behaviour and harm and mostly focused on serious harms. As a result, little has generally been known about the prevalence of harm in lower risk gambling groups. Here we summarise the findings from recent harm research, the methodologies used and their conceptual implications. It is argued that strong progress has been made in the categorization and measurement of gambling harm, but that caution must be applied when applying these measures to estimate the 'burden of disease' associated with gambling in the community. Particular issues discussed include: the differentiation of opportunity cost and harm; the validity of additive methods involving different severities of measured harm; using comparisons with unfamiliar disorders; and the validity of prevention paradox arguments in this area of research.