LAUSR

OBJECTIVES Gambling availability, participation and expenditure have increased markedly in many parts of the world. This is expected to continue and have significant public health impacts. The purpose of this study is to examine the changing epidemiology of gambling and gambling-related harm and its implications for public health policy and practice. STUDY DESIGN This is a narrative review. METHODS Relevant literature, with an emphasis on recent studies and reviews, was examined to identify major epidemiological findings and trends. RESULTS Greater gambling availability was associated with an increase in participation and expenditure and a rise in at-risk and problem gambling prevalence rates. While problem gamblers experience considerable harm, most harm arises from non-problem gamblers. These harms are substantial and impact disproportionately marginalised populations. The burden of harm is mainly due to financial problems, damage to relationships and health, psychological distress and adverse effects on work and education. Although at-risk and problem gambling rates initially increased in many jurisdictions, they subsequently declined. More recently, in some jurisdictions, while gambling participation has declined, at-risk and problem gambling rates have plateaued. This at least partly is due to an accumulating 'pool' of past problem gamblers who are highly prone to relapse and other vulnerable groups continuing to experience heavy gambling exposure. CONCLUSION Public health policies need to focus strongly on reducing exposure to more 'toxic' gambling forms as well as increasing the availability of interventions to assist at-risk and problem gamblers and prevent relapse. Policies and programmes are likely to be more effective if population heterogeneity is considered, and they also address the wide range of modifiable risk and protective factors at individual, community and societal levels. Many of these are shared with other health and social morbidities.