Gambling-related harm and the prevention paradox

Abstract (163 words) The prevention paradox (PP) describes a situation in which a greater number of adverse events arise from lower-risk population categories, because they are more prevalent than higher-risk groups. There has been limited and conflicting evidence as to whether the PP applies to gambling-related harm. We assessed the prevalence of 72 harmful consequences from gambling across four risk problem gambling risk categories. Respondents who had gambled on non-lottery forms in the past 6 months completed an online survey (N = 1,524, 49.4% male). The data were weighted to the known prevalence of these risk categories. The prevalence of gambling harms, including severe harms, was generally higher in the three combined lower risk categories compared to the high-risk, but low prevalence, problem-gambling category. The PP was supported not only for milder harms (e.g. increased credit-card debt), but in the case of many serious harms: experiencing separation or end of a relationship, loss of a job, needing to sell personal items, and experiencing domestic violence from gambling. Implications (49 words) The result concords with other sources of evidence that indicate that the bulk of population-level impact of gambling problems are experienced by non-problem gamblers; i.e. those who do not meet clinical criteria for disordered gambling or addiction. This supports the case for a public-health approach to ameliorating gambling-related harm