Preventing gambling related harm in adolescents: developing a peer-led, social network intervention
Lead Research Organisation:
University of Edinburgh
Department Name: College of Medicine & Vet Medicine
Abstract
In 2007 the UK government introduced the Gambling Act, which meant gambling could be advertised across a much broader range of media (e.g. television, social media, newspapers, door drops and billboards). This exposure creates a concern that young people are growing up in a culture where gambling is normalised, especially if you are a sports fan. Research has shown that young people (aged 12-17) are aware of, and attracted to, financial incentives to gamble (especially if the advertising comes from celebrities) and gambling odds, but do not understand how they work (Pitt et al, 2016, Pitt et al, 2017).
Research has also shown that an early age of the first gambling experience could result in gambling problems in later life (Rahman et al, 2012). In the UK a 2017 survey found that approximately one in ten 11-16 year olds had gambled in the past seven days. This means that more young people are gambling than smoking cigarettes (5%), (Gambling Commission, 2017). If young people start to experiment without understanding the potential harm caused by gambling they could experience gambling related harm (e.g. financial problems, relationship and emotional issues) in adulthood. This could not only affect them but other people around them.
This study will create a secondary school programme (intervention) to protect young people from gambling related harm by giving them the skills and confidence to understand the ways they could be influenced by gambling advertising, the actual odds of winning and the potential harm from gambling. In doing so, it will help young people resist future harmful gambling activity and, if they decide to gamble, have a greater awareness of how to gamble safely, within their own limits, and recognise when gambling could be becoming a problem.
We will do this by adapting an existing secondary school, peer led programme called ASSIST that has been successful in protecting young people from smoking harm (Campbell et al, 2008). The adapted ASSIST will use social network analysis to identify opinion leaders ('peer supporters') who are trained in gambling related harm and then tasked with spreading the new information they have learned to people they know. The proposed intervention will be based on the four stage model used in ASSIST: 1) identifying peer supporters via 'peer nomination'; 2) peer supporters attend a two-day training course (away from school delivered by external trainers); 3) peer supporters have informal conversations with other students and record conversations in a paper diary; 4) follow-up sessions (n=4) delivered in school by external trainers.
There are currently no evidence based secondary school, peer led, social network programmes to protect young people from gambling related harm so this early phase study is very important to develop the intervention in collaboration with schools, young people, researchers and youth workers. The study has two parts. The first is about developing the intervention and evaluation tools. This means we need to spend time talking to lots of people and asking for their help to make sure that the training is fun and the messages we want peer supporters to spread are clear and easy to discuss. We will do this by talking to school staff, students, parents and experts who either: work with young people; have experience of delivering ASSIST; or understand gambling and young people. Once we have done this we will spend time drafting a training manual and all the resources required to deliver the intervention. We will then go back to the people we spoke to and ask for their feedback and make further changes. Then, in part two, we will test and evaluate the intervention in one school to see how it works in real life and make further changes. By the end of the study we will have a complete intervention manual, training materials and evaluation tools that can be tested in more schools.
Research has also shown that an early age of the first gambling experience could result in gambling problems in later life (Rahman et al, 2012). In the UK a 2017 survey found that approximately one in ten 11-16 year olds had gambled in the past seven days. This means that more young people are gambling than smoking cigarettes (5%), (Gambling Commission, 2017). If young people start to experiment without understanding the potential harm caused by gambling they could experience gambling related harm (e.g. financial problems, relationship and emotional issues) in adulthood. This could not only affect them but other people around them.
This study will create a secondary school programme (intervention) to protect young people from gambling related harm by giving them the skills and confidence to understand the ways they could be influenced by gambling advertising, the actual odds of winning and the potential harm from gambling. In doing so, it will help young people resist future harmful gambling activity and, if they decide to gamble, have a greater awareness of how to gamble safely, within their own limits, and recognise when gambling could be becoming a problem.
We will do this by adapting an existing secondary school, peer led programme called ASSIST that has been successful in protecting young people from smoking harm (Campbell et al, 2008). The adapted ASSIST will use social network analysis to identify opinion leaders ('peer supporters') who are trained in gambling related harm and then tasked with spreading the new information they have learned to people they know. The proposed intervention will be based on the four stage model used in ASSIST: 1) identifying peer supporters via 'peer nomination'; 2) peer supporters attend a two-day training course (away from school delivered by external trainers); 3) peer supporters have informal conversations with other students and record conversations in a paper diary; 4) follow-up sessions (n=4) delivered in school by external trainers.
There are currently no evidence based secondary school, peer led, social network programmes to protect young people from gambling related harm so this early phase study is very important to develop the intervention in collaboration with schools, young people, researchers and youth workers. The study has two parts. The first is about developing the intervention and evaluation tools. This means we need to spend time talking to lots of people and asking for their help to make sure that the training is fun and the messages we want peer supporters to spread are clear and easy to discuss. We will do this by talking to school staff, students, parents and experts who either: work with young people; have experience of delivering ASSIST; or understand gambling and young people. Once we have done this we will spend time drafting a training manual and all the resources required to deliver the intervention. We will then go back to the people we spoke to and ask for their feedback and make further changes. Then, in part two, we will test and evaluate the intervention in one school to see how it works in real life and make further changes. By the end of the study we will have a complete intervention manual, training materials and evaluation tools that can be tested in more schools.
Technical Summary
The Gambling Act 2005 expanded availability of gambling in the UK, meaning that young people have more exposure to gambling advertising and greater opportunity to gamble. Research has shown that an early age of the first gambling experience predicts the onset of gambling problems in later life (Rahman et al, 2012). A school based, peer lead, social network intervention will be the focus of the main study. In this early phase study, development of the intervention will be modelled on an existing intervention called ASSIST.
The research design has two packages:
Work package 1 - Intervention development (months 1-11). A three tier approach will be used:
Tier one will include in-depth interviews with academics, youth practitioners, Gamblers Anonymous, GamCare, RCA Trust (n=12-15). Two case study schools will be recruited for tier two. Teaching staff will be invited to take part in a face to face interview (n=4). Two mixed gender mini group discussions in each school will also be conducted (n=4, 16-24 students). Once these elements are complete two expert full day workshops will be convened (tier three), with academic, education, public and third sector colleagues (n=12-15). The first workshop will identify key learning outcomes for the intervention. The user manual and teaching materials will then be created. Case study schools will then be revisited to share the materials and seek detailed feedback. Parental consultation will also be added at this stage (4 focus groups - 2 per school n=24-32 parents in total). We will use these data to inform further refinement of the user manual and training materials. A second expert workshop (with the same delegates as the first) will be convened for final review and refinement. WP2 - feasibility study. One school in a deprived area, separate to those involved in WP1 will be recruited to test and refine the products from WP1 (months 12-18). All stages of programme delivery and process evaluation measures will be tested.
The research design has two packages:
Work package 1 - Intervention development (months 1-11). A three tier approach will be used:
Tier one will include in-depth interviews with academics, youth practitioners, Gamblers Anonymous, GamCare, RCA Trust (n=12-15). Two case study schools will be recruited for tier two. Teaching staff will be invited to take part in a face to face interview (n=4). Two mixed gender mini group discussions in each school will also be conducted (n=4, 16-24 students). Once these elements are complete two expert full day workshops will be convened (tier three), with academic, education, public and third sector colleagues (n=12-15). The first workshop will identify key learning outcomes for the intervention. The user manual and teaching materials will then be created. Case study schools will then be revisited to share the materials and seek detailed feedback. Parental consultation will also be added at this stage (4 focus groups - 2 per school n=24-32 parents in total). We will use these data to inform further refinement of the user manual and training materials. A second expert workshop (with the same delegates as the first) will be convened for final review and refinement. WP2 - feasibility study. One school in a deprived area, separate to those involved in WP1 will be recruited to test and refine the products from WP1 (months 12-18). All stages of programme delivery and process evaluation measures will be tested.
Planned Impact
The project will engage a wide range of non-academic beneficiaries which will further knowledge exchange between stakeholders and facilitate joint working for a future definitive trial.
Policy makers and commissioners
Engagement with policy makers (the Scottish Government) and local commissioners (Local Authority Education departments and NHS Boards) at this intervention development stage will be a priority for two reasons. First, it will raise awareness of gambling related harm in adolescents as a public health concern which could inform future policy. Second, it will facilitate joint working and initiate discussion around funding for future roll out should a definitive trial show a positive effect.
Schools, students and their social networks
We know from previous evaluations of ASSIST that there are wider benefits than just the behaviour change of interest, these will be transferable to schools who take part in this early phase development study. For example schools can benefit in three ways: 1) they will have access to a health promotion resource at no cost to them, with minimal staff time required; 2) once the intervention is delivered they have a cohort of students who are trained peer supporters and can be utilised for other activities (e.g. leading projects in the school, presenting to other students); 3) due to the selection of peer supporters, there will be a mix of students who take part - not just the high achievers - which means less visible or less academic students will be given the opportunity to get involved in school activities which extend beyond delivery of ASSIST. It also means that students who do not normally mix together will be given the opportunity to work together, which schools have reported as a benefit.
For students who are selected to become peer supporters this has been shown to increase their self-confidence (pride at being selected by their peers) and is also something they can add to job, college or university applications (Dobbie et al, 2017).
Findings from the PI's work (Dobbie, 2018) have shown that message diffusion extends beyond the school year and transfers to peer supporter social networks (e.g. family, friends, and neighbours). This means that they could potentially benefit by learning more about gambling related harm and the factors (e.g. advertising, complex gambling odds) that shape attitudes, perceptions and gambling behaviour.
Non-government organisations
The Gambling Commission, the Responsible Gambling Strategy Board and Gamble Aware are important NGOs that fund and set research priorities for gambling research in the UK. Sharing findings from this early phase development study could help shape future research priorities from a public health perspective (i.e. policy/regulation and behaviour change interventions)
Third sector
We have secured participation from our third sector colleagues working for DECIPHer IMPACT, Fast Forward and West Lothian Drug and Alcohol Services (WLDAS). All organisations will benefit from being part of a multi-disciplinary team with opportunity for future collaboration. In addition WLDAS will deliver the intervention in the feasibility study with potential for further delivery if funding is secured for a definitive trial.
Policy makers and commissioners
Engagement with policy makers (the Scottish Government) and local commissioners (Local Authority Education departments and NHS Boards) at this intervention development stage will be a priority for two reasons. First, it will raise awareness of gambling related harm in adolescents as a public health concern which could inform future policy. Second, it will facilitate joint working and initiate discussion around funding for future roll out should a definitive trial show a positive effect.
Schools, students and their social networks
We know from previous evaluations of ASSIST that there are wider benefits than just the behaviour change of interest, these will be transferable to schools who take part in this early phase development study. For example schools can benefit in three ways: 1) they will have access to a health promotion resource at no cost to them, with minimal staff time required; 2) once the intervention is delivered they have a cohort of students who are trained peer supporters and can be utilised for other activities (e.g. leading projects in the school, presenting to other students); 3) due to the selection of peer supporters, there will be a mix of students who take part - not just the high achievers - which means less visible or less academic students will be given the opportunity to get involved in school activities which extend beyond delivery of ASSIST. It also means that students who do not normally mix together will be given the opportunity to work together, which schools have reported as a benefit.
For students who are selected to become peer supporters this has been shown to increase their self-confidence (pride at being selected by their peers) and is also something they can add to job, college or university applications (Dobbie et al, 2017).
Findings from the PI's work (Dobbie, 2018) have shown that message diffusion extends beyond the school year and transfers to peer supporter social networks (e.g. family, friends, and neighbours). This means that they could potentially benefit by learning more about gambling related harm and the factors (e.g. advertising, complex gambling odds) that shape attitudes, perceptions and gambling behaviour.
Non-government organisations
The Gambling Commission, the Responsible Gambling Strategy Board and Gamble Aware are important NGOs that fund and set research priorities for gambling research in the UK. Sharing findings from this early phase development study could help shape future research priorities from a public health perspective (i.e. policy/regulation and behaviour change interventions)
Third sector
We have secured participation from our third sector colleagues working for DECIPHer IMPACT, Fast Forward and West Lothian Drug and Alcohol Services (WLDAS). All organisations will benefit from being part of a multi-disciplinary team with opportunity for future collaboration. In addition WLDAS will deliver the intervention in the feasibility study with potential for further delivery if funding is secured for a definitive trial.
Organisations
- University of Edinburgh (Lead Research Organisation)
- University of Glasgow (Collaboration)
- Cardiff University (Collaboration)
- Gambling Research Exchange Ontario (Collaboration)
- Decipher Impact Ltd (Collaboration)
- West Lothian Drug and Alcohol Service (Collaboration)
- University of Barcelona (Collaboration)
- UNIVERSITY OF DUNDEE (Collaboration)
- University of Stirling (Collaboration)
Publications


Dobbie F
(2024)
Protocol for a pilot cluster randomised controlled trial of PRoGRAM-A (preventing gambling-related harm in adolescents): a secondary school-based social network intervention.
in Pilot and feasibility studies

Hunt K
(2020)
Protocol for a Mixed-Method Investigation of the Impact of the COVID-19 Pandemic and Gambling Practices, Experiences and Marketing in the UK: The "Betting and Gaming COVID-19 Impact Study".
in International journal of environmental research and public health

Littlecott HJ
(2022)
Exploring the association between school-based peer networks and smoking according to socioeconomic status and tobacco control context: a systematic review.
in BMC public health

Purves RI
(2020)
Examining the frequency and nature of gambling marketing in televised broadcasts of professional sporting events in the United Kingdom.
in Public health


Wardle H
(2021)
Regulatory Resistance? Narratives and Uses of Evidence around "Black Market" Provision of Gambling during the British Gambling Act Review.
in International journal of environmental research and public health

Wardle H
(2021)
The impact of the initial Covid-19 lockdown upon regular sports bettors in Britain: Findings from a cross-sectional online study.
in Addictive behaviors
Description | Intersectional Perspectives For Community Inclusion: Understanding The Past, Shaping The Future With Older Marginalised IDD And LGBT+People |
Amount | £821,722 (GBP) |
Funding ID | (ES/W012771/1) |
Organisation | Economic and Social Research Council |
Sector | Public |
Country | United Kingdom |
Start | 08/2022 |
End | 07/2025 |
Description | PHR Project: NIHR150838 - PRoGRAM-A (Preventing Gambling Related Harm in Adolescents): a pilot cluster randomised control trial to prevent gambling harm in young people |
Amount | £475,570 (GBP) |
Funding ID | NIHR150838 |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 03/2023 |
End | 08/2024 |
Description | Co-applicant to an ESRC funding application |
Organisation | University of Dundee |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Based on the methodology I designed for PRoGRAM-A and my social network research experience (again developed through PRoGRAM-A), colleagues from the University of Dundee invited me to join their funding application to the ESRC to study ageing and loneliness using social network approches. |
Collaborator Contribution | Lead the funding applcation. |
Impact | Funding application to ESRC, decision expected din April 2022. |
Start Year | 2021 |
Description | Funding application to ESRC |
Organisation | University of Glasgow |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Based on my previous experience and the relevance of my UKRI funded study I was invited to serve as a Co-Investigator on a research study entitled: Transitions to more harmful forms of gambling during Covid-19 pandemic: behaviours and targeted marketing in young people and bettors on sport. My role is to give advice and support on all aspects of the study and support elements of the qualitative analysis. |
Collaborator Contribution | Professor Gerda Reith and Dr Richard Purves are Co-Investigators. |
Impact | Two peer reviewed articles: Wardle H, Donnachie C, Critchlow N, Brown A, Bunn C, Dobbie F, Gray C, Mitchell D, Purves R, Reith G, Stead M & Hunt K (2021) The impact of the initial Covid-19 lockdown upon regular sports bettors in Britain: findings from a cross-sectional online study. Addictive Behaviors. Hunt K, Critchlow N, Brown A, Bunn C, Dobbie F, Donnachie C, Gray C, Purves R, Reith G, Stead M, Mitchell D & Wardle H (2020) Protocol for a mixed-method investigation of the impact of the Covid-19 pandemic and gambling practices, experiences and marketing in the UK: the "Betting and gaming Covid-19 impact study". International Journal of Environmental Research and Public Health, 17 (22), Art. No.: 8449. https://doi.org/10.3390/ijerph17228449 |
Start Year | 2020 |
Description | Funding application to the NHIR PHR |
Organisation | Cardiff University |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Lead funding application |
Collaborator Contribution | Contributed to writing funding application |
Impact | Stage 1 application submitted November 2021. Invited to submit stage 2 application, due April 2022. Approved for funding July 2022. Project started 1st March 2023 |
Start Year | 2021 |
Description | Funding application to the NHIR PHR |
Organisation | Decipher Impact Ltd |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | Lead funding application |
Collaborator Contribution | Contributed to writing funding application |
Impact | Stage 1 application submitted November 2021. Invited to submit stage 2 application, due April 2022. Approved for funding July 2022. Project started 1st March 2023 |
Start Year | 2021 |
Description | Funding application to the NHIR PHR |
Organisation | University of Glasgow |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Lead funding application |
Collaborator Contribution | Contributed to writing funding application |
Impact | Stage 1 application submitted November 2021. Invited to submit stage 2 application, due April 2022. Approved for funding July 2022. Project started 1st March 2023 |
Start Year | 2021 |
Description | Funding application to the NHIR PHR |
Organisation | University of Stirling |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Lead funding application |
Collaborator Contribution | Contributed to writing funding application |
Impact | Stage 1 application submitted November 2021. Invited to submit stage 2 application, due April 2022. Approved for funding July 2022. Project started 1st March 2023 |
Start Year | 2021 |
Description | Funding application to the NHIR PHR |
Organisation | West Lothian Drug and Alcohol Service |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | Lead funding application |
Collaborator Contribution | Contributed to writing funding application |
Impact | Stage 1 application submitted November 2021. Invited to submit stage 2 application, due April 2022. Approved for funding July 2022. Project started 1st March 2023 |
Start Year | 2021 |
Description | Invited to join gambling academics forum |
Organisation | Gambling Research Exchange Ontario |
Country | Canada |
Sector | Charity/Non Profit |
PI Contribution | To contribute expertise to the forum |
Collaborator Contribution | As above |
Impact | One peer review publication: https://www.bmj.com/content/bmj/370/bmj.m2613.full.pdf |
Start Year | 2020 |
Description | Oversees work experience |
Organisation | University of Barcelona |
Department | Psychiatry Barcelona |
Country | Spain |
Sector | Academic/University |
PI Contribution | The PI was approached by a Spanish post-graduate student who expressed an interest in the study after reading about it online. He advised that the Spanish Government had a bursary for Spanish post-graduate students to apply for work experience in a UK University. His funding was successful and he worked on the study for three months contributing to a literature review and mapping of existing gambling education resources |
Collaborator Contribution | See above |
Impact | See above. |
Start Year | 2019 |
Description | Part-time secondment to the University of Glasgow for 27 months |
Organisation | University of Glasgow |
Department | School of Social and Political Sciences Glasgow |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Based on my previous experience and the relevance of my UKRI funded study I was invited to join the Gambling Research Glasgow groups at the University of Glasgow. The focus of my secondment is to help build research capacity within the group and secure new research grants. This secondment has supported my stage 1 application to the NIHR PHR programme to conduct a pilot study of PRoGRAM-A as which will build on the UKRI MCR PHIND funding we were given to conduct the development and feasibility work. |
Collaborator Contribution | Supporting development of our stage 1 application to the NIHR PHR programme to conduct a pilot study of PRoGRAM-A as which will build on the UKRI MCR PHIND funding we were given to conduct the development and feasibility work. |
Impact | Supporting development of our stage 1 application to the NIHR PHR programme to conduct a pilot study of PRoGRAM-A as which will build on the UKRI MCR PHIND funding we were given to conduct the development and feasibility work. Plus a funding application to ESRC to conduct a longitudinal cohort study of gambling in the UK and Malawi Publications (see publication section) |
Start Year | 2020 |
Description | Third sector collaboration |
Organisation | Decipher Impact Ltd |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | See below |
Collaborator Contribution | Colleagues from Decipher Impact (now re-branded to Evidence to Impact) were already key partners on the study. However, when the study Research Fellow, commenced a period of maternity leave we were able to strengthen the collaboration by seconding one of their researchers into post. Their experience of the programme we were adapting for PRoGRAM-A was invaluable and it remains an incredibly productive and successful collaboration (we are currently preparing a funding application to the CSO, see funding section). |
Impact | Delivery output for the development study. Contribution to the NIHR PHR application for a pilot study. |
Start Year | 2020 |
Description | Conference presentation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | Presentation and networking. |
Year(s) Of Engagement Activity | 2022 |
Description | Established expert working group to offer gambling advise to Scottish Government |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | Quarterly meetings with Scottish Government to advise minsters on gambling |
Year(s) Of Engagement Activity | 2023 |
Description | Impact session Alva Academy Health Week |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Schools |
Results and Impact | Presentation delivered as part of health week to a secondary school (Alva Academy ) |
Year(s) Of Engagement Activity | 2022 |
Description | Media article |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | Media article |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.thenational.scot/news/19559432.new-initiative-teach-scottish-pupils-dangers-gambling/ |
Description | Presentation to SPECTRUM Academy |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | Invited speaker to academics who are part of the SPECTRUM consortium to introduce them to gambling as a growing public health issue. |
Year(s) Of Engagement Activity | 2022 |
Description | Stakeholder workshop |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Other audiences |
Results and Impact | Dissemination workshop to share findings from the study and identify key components and content for the delivery manual. |
Year(s) Of Engagement Activity | 2020 |