Preventing gambling related harm in adolescents: developing a peer-led, social network intervention

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.

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 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.