{"paper_id":"01bbdb4e-e29b-4aae-ae99-a55dcc95da28","body_text":"Affected others’ perspectives on the burden, drivers, and prevention of gambling- related harms: a qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Affected others’ perspectives on the burden, drivers, and prevention of gambling- related harms: a qualitative study Devashish Ray, Laura J. McGowan, Aikaterini Grimani, Philip Newall, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9131253/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Gambling is increasingly recognised as a public health concern, with harms extending beyond individuals who gamble to their families, peers, and communities. However, young people and adults affected by others’ gambling remain under-represented in research on harm prevention messaging. Methods A critical qualitative inquiry approach was employed, involving four focus groups: two with adults affected by another person’s gambling (n = 10, aged 18–75 years) and two with young people living in households where an adult gambled (n = 10, aged 13–18 years). Participants were recruited through community networks and online platforms. Data were analysed thematically using the Framework Method. Results Three themes were identified. The first theme, Gambling-related harms are multifaceted and often hidden , highlights how harms extend beyond financial loss to include impacts on mental health, relationships, and family security, often reinforced by stigma and secrecy. Adults highlighted delayed recognition and minimisation of harm, while young people described diminished trust in adults who gambled. The second theme, Predatory tactics of the gambling industry , captures participants’ perceptions of aggressive marketing, celebrity endorsements, and the normalisation of gambling through sports and digital platforms. Adults expressed moral outrage and distrust, viewing the industry as exploitative and unethical, whereas young people emphasised the influence of celebrity and gaming-related promotions. The third theme, Harm prevention requires multi-level, targeted strategies , reflects participants’ views that industry slogans are ineffective and that prevention should instead emphasise credible, audience-specific messaging, lived-experience narratives, and systemic reforms. Adults underscored the invisibility of affected others and called for recognition and early support, while young people advocated for peer-led education integrated into schools and digital environments. Conclusions The findings underscore the need for targeted approaches to messaging that reflect the experiences of different groups affected by gambling and associated harms. Prevention strategies should combine tailored communication with upstream interventions—such as stricter regulation of advertising and affordability checks—to address the structural drivers of gambling-related harm. Acknowledging the moral and emotional dimensions of gambling-related harm is essential for rebuilding trust and ensuring that prevention messages are credible, compassionate, and effective. Gambling-related harm Affected others Gambling harm prevention Gambling marketing Qualitative research Introduction Gambling has emerged as a global public health issue, with harms extending beyond the relatively small proportion of people meeting diagnostic criteria for gambling disorder ( 1 , 2 ). Gambling-related harms include financial loss and profound effects on mental health, relationships, and communities, often with intergenerational consequences ( 3 , 4 ). Harms extend beyond gamblers to partners, children, peers, and the broader community, creating hidden secondary and tertiary harms ( 5 , 6 ). Scholars and policymakers increasingly advocate for a public health approach to gambling harm that focuses less on individual responsibility and more on population-level approaches that acknowledge the structural, social, and commercial determinants of harm ( 7 , 8 ). Messaging in a Public Health Approach to Gambling Within such a framework, public health messaging is considered one potential harm-prevention strategy. As seen in tobacco control, population-level messaging can shape risk perceptions, shift attitudes, and promote protective behaviours ( 9 ). In theory, gambling harm-prevention messages aim to increase awareness and understanding of gambling-related harms, promote harm-reduction strategies, and influence attitudes and beliefs about gambling, ultimately encouraging safer behaviours and reducing harm ( 10 ). Research indicates that gambling-urges and risk-related cognitions are key predictors of gambling-related harm and may therefore represent useful targets for prevention messaging ( 11 ). Though arguments can be made that messaging might only be one part of a required broader approach, even modest changes in individual behaviour, when achieved across large populations, can contribute to meaningful public health benefits ( 11 ). Limitations of Industry-led Messaging Despite the potential of messaging to contribute to harm reduction for gambling, the current model of industry-led gambling messaging in the UK does not readily align with public health objectives, as it focuses on individual-level behaviours. Industry-led messages such as “When the fun stops, stop” or “Take time to think” emphasise personal responsibility and have been found to be ineffective in reducing harmful gambling practices ( 12 , 13 ). Personal responsibility framing can reinforce guilt and stress, exacerbate health inequities, and distract from addressing structural drivers of harm ( 14 ). In Australia, independent, government-led messaging campaigns have been developed as part of a broader public health approach to gambling ( 15 ). Similar approaches have recently been identified as a policy priority in the UK reflecting a growing recognition of the need for independent, harm-reduction messaging ( 16 ). Targeted Approaches and Evidence Gaps The gambling industry’s own marketing demonstrates the importance of demographically targeted messaging, which shapes public perceptions of gambling-related risks and harms and drives engagement among vulnerable or high-risk groups ( 17 ). This highlights the need to adopt equally targeted harm-reduction strategies. A Finnish study ( 18 ) found that lower-risk gambling guidelines (LRGG) were generally accepted but required cultural and personal adjustments. Participants often perceived the guidelines as directed at “others” rather than themselves, showing that generic or externally imposed messages may lack personal relevance and therefore have limited impact. Scholars thus recommend that gambling harm-prevention messaging should distinguish between interventions for at-risk individuals and those for the general population ( 19 ). Qualitative research indicates that message responses vary primarily by age and gambling habits, rather than gender, sex, or ethnicity ( 10 ). For example, fear-based campaigns are rarely effective with younger people ( 20 ), whereas real-life stories, emotional appeals, and depictions of negative consequences tend to be more effective ( 21 , 22 ). Infrequent gamblers and older adults tend to respond better to messages emphasizing practical self-regulation strategies—such as managing finances and maintaining family responsibilities—while younger adults prefer messages that foreground their own play and perceived expertise ( 23 ). Yet, the evidence for the effectiveness of gambling messaging remains limited. A recent evidence review ( 24 ) identified both a general lack of evaluated messaging interventions and, importantly, that several demographic groups were underrepresented in intervention development and testing. This latter omission provided the primary rationale for the present study. Three demographic groups were notably under-represented in the gambling messaging literature: (i) young people, increasingly exposed to gambling through digital media, sports sponsorship, and game-like mechanics such as loot boxes, yet rarely included in prevention research ( 25 ); (ii) affected others, including partners, parents, and peers, who experience financial, emotional, and relational harms from another’s gambling but remain largely excluded from policy and message design ( 26 ); and (iii) ethnic and religious minority groups, who tend to gamble less frequently overall, yet those who do may face a higher risk of gambling-related harm ( 27 ). While the evidence base remains limited, existing studies nonetheless highlight the value of centring these groups in the design and evaluation of gambling harm prevention messaging. Studies with young people ( 28 , 29 ) and affected others ( 30 ) show that prevention is more effective when it reflects lived realities and provides actionable support. Scholars have also called for co-produced, independent messaging that is free from industry influence and grounded in audience perspectives ( 31 , 32 ). Young people in particular highlight the mismatch between adult-designed campaigns and their lived digital environments, calling for direct involvement in campaign and policy development ( 33 ). Applying Theory to Gambling Harm-Prevention Messaging Several theoretical perspectives help explain how gambling harm-prevention messages may or may not resonate with intended audiences. For instance, the health belief model suggests that individuals are more likely to respond when they perceive themselves to be at risk, believe the consequences of gambling harms are serious, and have confidence in their ability to act on the message ( 34 ). The social ecological model, applied to gambling by Oksanen et al. ( 35 ), emphasises that such responses are also shaped by wider social and cultural contexts, underscoring the need for messages that move beyond individual responsibility to acknowledge structural influences. Lastly, psychological reactance theory further shows that when messages are experienced as controlling or misaligned with audience realities, they can provoke resistance rather than engagement ( 36 ). Evidence also suggests that psychological constructs such as gambling urges, cognitions, and risk perceptions are consistently associated with gambling harms ( 11 ). Although their predictive power is modest at the individual level, they demonstrate clear theoretical and empirical links to behavioural outcomes. Their salience at the population level, together with their integration into these established behaviour-change models, provides a rationale for targeting them in messaging interventions. Taken together, these perspectives suggest that effective gambling harm-prevention messaging must balance individual-level relevance with sensitivity to broader contexts, while avoiding framings that risk generating resistance or stigma. While the primary purpose of this work was not to test or develop theory, we highlight the importance of using theoretical principles to predict and understand differential effects of intervention messaging in and between diverse populations ( 11 ). Study Aims As outlined above, there are evidence gaps and ongoing debate in gambling harm prevention regarding the relative effectiveness of universal versus targeted messaging strategies ( 37 ). This study therefore sought to explore the perspectives of two under-represented groups—1) young people residing in households with adult gambling exposure and 2) adults affected by someone else’s gambling—concerning their beliefs and views about gambling-related harms and public health gambling messaging. Our aim was not to assume that these groups necessarily hold fundamentally different perspectives, nor that findings could be directly generalised to the wider population. Rather, both groups have historically been excluded from research on prevention messaging, despite evidence that they experience distinct forms of gambling-related harm and exposure. We anticipated that some findings would be shared across both groups—for example, recognition of gambling’s emotional and relational impacts—while other insights might be unique to their lived contexts. Adults, as affected others, might emphasise the hidden burdens of supporting a loved one who gambles, whereas young people might highlight early exposures to gambling in digital and family environments. Exploring both commonalities and divergences was considered important for developing more inclusive, audience-appropriate public health messaging. Specifically, the study addressed two research questions (RQs): RQ 1. How do young people residing in households with adult gambling exposure and adults affected by someone else’s gambling conceptualise and understand the risks and harms associated with gambling? RQ 2. What strategies for public health messaging do young people residing in households with adult gambling experience and adults affected by someone else’s gambling perceive as most useful in raising awareness of and reducing harms (including stigma), and why? Methods Study Design This study was guided by a critical qualitative inquiry approach (38), which recognises that gambling practices and harms are shaped by interacting individual, social, structural, and commercial determinants (39). This perspective emphasises health and social inequities and recognises the power of industry and government regulation in influencing gambling behaviours. We conducted four focus groups: two with adults affected by someone else’s gambling and two with young people residing in households with adult gambling exposure. Focus groups were used to explore participants’ views because they are socially oriented, allowing individuals to listen to others’ opinions and understandings while forming their own responses. This method was particularly suited to the study’s research questions, which sought to explore how beliefs and interpretations of gambling harms are constructed through social interaction. Among adults affected by another’s gambling, the group format encouraged validation and shared reflection, while for young people it provided a familiar, conversational environment conducive to open discussion of peer and family influences (40). Participants and recruitment A total of 20 participants took part (10 adults and 10 young people), a sample size appropriate for in-depth qualitative exploration through focus groups. Sample characteristics are shown in Table 1. All participants were residents of Tyne and Wear, a metropolitan county in north-east England. This geographic area was selected due to its well-documented challenges associated with gambling-related harms (41), which hold particular significance for policymakers seeking to develop targeted interventions. Adults (n = 10; aged 19–75 years; 8 females, 2 males) self-identified as ‘affected others’, meaning they experienced harms linked to the gambling of a close family member, partner, or friend. Young people (n = 10; aged 13–18 years; 4 females, 5 males, 1 non-binary) lived at home with a parent or guardian. For those under 16, parental consent was obtained alongside participant assent. Table 1 Sample characteristics (n = 20) Focus Group n Age (years) Gender Ethnicity Adults – Session 1 7 47–75 (m* = ~67) 6F, 1M 6 White, 1 Asian British Adults – Session 2 3 18–57 (m* = ~38) 2F, 1M 2 White, 1 Asian British Young people – Session 1 3 13–18 All F 1 White, 2 Asian British Young people – Session 2 7 15–16 5M, 1F, 1NB All White (*m= median; F=female, M= male, NB = non-binary) Participants were purposively sampled to ensure eligibility: adults who self-identified as affected others, and young people aged 13–18 years who lived at home with a parent or guardian who engaged in gambling. Eligibility was assessed after participants expressed interest in taking part. The inclusion criteria were clearly stated in the recruitment materials (posters and flyers), and the researcher (DR) verified eligibility via follow-up email correspondence to confirm that prospective participants met the required criteria. Young people identified as vulnerable in government guidance — for example, those receiving support from child social care services or holding education, health, and care plans—were excluded from the study. This exclusion reflected the substantial ethical complexity associated with research involving high-risk minors, the need for multi-level consent processes involving institutional gatekeepers, and constraints in research team capacity regarding safeguarding expertise. We acknowledge that this exclusion may have limited the diversity of perspectives captured. Recruitment materials, including flyers and participant information sheets, were produced by the research team. Input was sought through consultation with two members of the research unit’s strategic Patient and Public Involvement and Engagement (PPIE) team and with young people from Youth Focus Northeast . Their comments and suggestions were incorporated with the intention of making the materials clearer, more appropriate, and more engaging for prospective participants. The same individuals were later consulted on the development of focus group topic guides (see data collection). Eligible participants were identified and recruited using a combination of community outreach and online platforms. Flyers were distributed through local community centres and voluntary sector organisations, including the Voluntary Organisations’ Network Northeast (www.vonne.org.uk). Recruitment was further supported through online platforms that facilitate involvement in research, such as People in Research (www.peopleinresearch.org) and Voice ( www.voice-global.org). This multi-channel strategy was intended to maximise reach and support inclusion of participants from diverse backgrounds where possible. Data Collection Each focus group lasted approximately 70–85 minutes and was conducted in-person, except for one youth group which adopted a hybrid format to accommodate participants joining remotely. Data collection for the adult focus groups took place in February 2024, and the youth focus groups were conducted in March and May 2024. Separate topic guides were developed by the research team for adults and young people. As noted earlier, input was sought from two members of the unit’s strategic PPIE team. Additionally, for the topic guide for the young people, input was obtained from a young people’s advisory group (https://generationr.org.uk). Two researchers (DR and LM) with experience of conducting focus groups facilitated the group discussions. The sessions were digitally audio-recorded by DR and transcribed by UK Transcription (www.uktranscription.com). Analysis A thematic analysis was conducted, structured within the Framework Method (42). Both deductive and inductive approaches were integrated throughout the analysis. Coding and framework development were supported by NVivo 15 (43), which was used to manage transcripts, apply the coding hierarchy, and chart data within the Framework Method matrix. The deductive framework was developed prior to detailed coding, informed by the study’s research questions, topic guide, and relevant theoretical and empirical literature on gambling harms and prevention messaging. These sources provided the initial high-level categories (e.g., perceived harms, message credibility, structural determinants ), which guided early coding. During analysis, inductive coding was conducted concurrently to capture concepts that did not fit within the preliminary framework—such as moral framing of gambling behaviour, intergenerational impacts, and peer-led prevention preferences emerging from participants’ accounts. Through iterative team discussions, these inductive codes were reviewed and, where relevant, integrated into or used to modify the original framework. Analytical stages included: Familiarisation and open coding by each researcher. Development and refinement of a shared coding framework through team discussion, including comparison of deductive and inductive codes. Application of the evolving framework across all transcripts using NVivo. Synthesis of themes and subthemes through cross-group comparison. Further details of the analytic process, including the initial deductive framework, examples of inductive codes that emerged during analysis, and the final integrated framework of themes and subthemes, are provided in Additional file 1. This documentation illustrates how the Framework Method was applied iteratively to ensure that both the theoretically derived and data-driven elements of the analysis were transparently and systematically integrated. Results The thematic analysis produced three overarching themes. Themes 1 and 2 address how participants conceptualise and interpret gambling-related harms (RQ1), while Theme 3 addresses participants’ perspectives on effective public health messaging and prevention strategies (RQ2). Within each theme, several subthemes were found to be common to both adults and young people, revealing shared perspectives on the nature of gambling-related harms and prevention. Additionally, there were subthemes that were specific to one population group, capturing distinctive experiences of adults affected by another person’s gambling and of young people exposed to gambling within their households. In the sections that follow, shared subthemes are presented first, followed by adult-specific and young people-specific subthemes where relevant. A summary of themes and subthemes, including whether they were shared or group-specific, is provided in Table 2 . Quotations from participants are labelled with a code to protect anonymity. The code denotes the focus group and participant number, where ‘F’ refers to ‘focus group participant’ and serves as a unique identifier (e.g., FG1_F02 = Adult Focus Group 1, Participant 2; YP2_F01 = Young People’s Group 2, Participant 1). Table 2 Summary of themes and subthemes. Theme Subtheme Participant group Summary of findings 1. Gambling-related harms are multifaceted and often hidden 1.1 Compulsive and addictive nature Shared* Gambling described as compulsive and addictive; adults stressed loss of control; young people (YP) emphasised chasing losses (RQ1). 1.2 Mental health and emotional harms Shared Harms included stress, anxiety, depression, and sometimes suicide; YP noted loss of trust (RQ1). 1.3 Financial harms Shared Money loss linked to insecurity; adults stressed household strain; YP noted lack of funds for family needs (RQ1). 1.4 Harms to relationships Shared Adults described family breakdown and conflict; YP reported neglect and disappointment (RQ1). 1.5 Stigma, secrecy, and denial Shared Shame reinforced harms; adults described silence, YP mentioned embarrassment (RQ1). 1.6 Delayed recognition/minimisation Adult-specific Adults described harms unnoticed or minimised until severe, highlighting prevention gaps (RQ1 & RQ2). 1.7 Erosion of trust in gambling adults Youth-specific YP described mistrust of gambling parents/carers, shaping perceptions of harm (RQ1). 2. The predatory tactics of the gambling industry 2.1 Normalisation of gambling Shared Gambling seen as routine; linked to sport and daily life (RQ1). 2.2 Aggressive marketing Shared Relentless advertising; YP highlighted celebrity/influencer appeal (RQ1). 2.3 Technology and accessibility Shared Online gambling seen as driving harm; YP noted gambling-like gaming features (RQ1). 2.4 Framing of responsibility Shared Industry slogans seen as tokenistic and deflecting responsibility (RQ1). 2.5 Perceptions of exploitation and betrayal by the gambling industry Shared Expressions of moral outrage and distrust, industry viewed as exploitative and profit-driven, and framing harms as ethical and social issues rather than individual failings (RQ1 & RQ2) 2.6 Perceived government inaction Adult-specific Adults critiqued lack of regulation and political will, linking to prevention gaps (RQ1 & RQ2) 2.7 Celebrity endorsement Youth-specific YP stressed influence of sports figures and celebrities, framing gambling as appealing (RQ1 & RQ2) 3. Harm prevention requires multi-level, targeted strategies 3.1 Tailored messaging Shared Adults stressed family/financial framing; YP stressed digital platforms and relevance (RQ2). 3.2 Lived-experience stories Shared Real-life accounts seen as more credible than abstract messages (RQ2). 3.3 Negative emotional appeals Shared Fear-based messaging seen as stigmatising or ineffective (RQ2). 3.4 Structural interventions Shared Adults called for regulation and affordability checks; YP called for decoupling sport from gambling (RQ2). 3.5 Support for affected others Adult-specific Adults emphasised recognition and early support for families (RQ1 & RQ2). 3.6 Early, peer-led education Youth-specific YP advocated for participatory, relatable school-based education (RQ2). “Shared” indicates subthemes reported across both adult and young people’s focus groups. Theme 1: Gambling-related harms are multifaceted and often hidden Both young people and adults with lived experience of gambling-related harms as an ‘affected other’ described these harms as broad, cumulative, and frequently hidden from public view. Harms were seen to extend beyond financial loss to encompass psychological, emotional, relational, and social impacts. The perceived invisibility of gambling-related harms, particularly when compared with other public health issues such as alcohol or drug use, was a recurring concern across groups. Shared subthemes Subtheme 1.1: Compulsive and addictive nature of gambling Participants often framed gambling as inherently compulsive and difficult to control. Adults, in particular, emphasised its addictive qualities, with one noting, “Once he started, he couldn’t stop. It was like a switch had gone off” (FG2_F04). Young people similarly highlighted the cycle of chasing losses as central to gambling’s addictive pull. As one reflected, “At first, it is just trying to get more money, but then you just start losing more and more money and it’s hard to get out of it” (YP1_F02). Subtheme 1.2: Mental health and emotional harms Participants frequently linked gambling to a range of psychological and emotional difficulties. Adults described the toll on family life, explaining, “You’re living with constant stress. It’s not just the money, it’s the lies, the worry, the not knowing” (FG1_F03). Several accounts also highlighted severe consequences, with gambling associated with depression and, in extreme cases, suicide. As one participant recalled, “One of my son’s close friends committed suicide… He was only 24” (FG1_F01). Young people emphasised the erosion of trust and emotional distance created by a parent’s gambling, with one stating, “You stop seeing them the same way. It’s like you don’t trust them anymore” (YP2_F01). Subtheme 1.3: Financial harms While financial loss was a recurring theme, participants stressed that this was rarely experienced in isolation but intertwined with emotional and relational consequences. One adult explained, “It wasn’t just the bills not getting paid. It was the arguments, the shame, the feeling of not being secure at home” (FG1_F02). Young people similarly recognised how gambling redirected household finances away from family needs, with one noting, “You notice there’s no money for things at home, like food or going out, because it’s all gone on betting” (YP1_F03). Subtheme 1.4: Harms to relationships Adults frequently described the breakdown of trust and communication within families, explaining that, “It changes everything. You stop talking properly, you hide things, you don’t feel like a family anymore” (FG2_F05). For young people, relational harms were closely tied to feeling let down by adults, as one said, “When your dad’s gambling, it feels like he cares more about that than about you” (YP1_F02). Subtheme 1.5: Stigma, secrecy, and denial Participants noted that stigma and shame reinforced the hidden nature of harms, making them harder to address. As one adult put it, “Nobody talks about it. You hide it because you don’t want people to know. That just makes it worse” (FG1_F01). Young people echoed this, explaining that embarrassment and fear of judgement prevented them from disclosing a parent’s gambling: “You don’t tell your friends about it, ‘cause it’s embarrassing. You just keep it to yourself” (YP2_F02). Adult-specific subtheme Subtheme 1.6: Delayed recognition and minimisation of harm Adults often reflected on how harms went unrecognised or were minimised until they had become severe. Some described normalising problematic gambling behaviour within the family or explaining away its impacts. As one participant explained, “You don’t see it as harm at first; you just think it’s a phase, or that it’s not that bad, until it really blows up” (FG2_F02). Adults viewed this delayed recognition as reinforcing the hidden and cumulative nature of gambling-related harms. Young people-specific subtheme Subtheme 1.7: Erosion of trust in gambling adults While both groups described relational harms, young people uniquely emphasised the erosion of trust in parents and carers who gambled. Beyond disappointment, this often translated into long-term shifts in how they viewed adult authority. One participant explained, “It makes you not want to listen to them, ‘cause if they can’t even stop gambling, why should you take their advice?” (YP1_F01). Young people described this mistrust as affecting how they viewed the reliability and dependability of adults in their families. Theme summary Taken as a whole, participants described gambling-related harms as complex, layered, and frequently concealed. Both adults and young people described harms that extended far beyond finances to affect mental health, relationships, and family life, with stigma and secrecy compounding their impact. Adults additionally spoke of delayed recognition and minimisation of harms, while young people uniquely emphasised mistrust in gambling adults. Broadly, participants described gambling not as an isolated behaviour but as a pervasive source of distress that affected multiple aspects of everyday life. Theme 2: The predatory tactics of the gambling industry Young people and adults alike consistently characterised the gambling industry as exploitative, describing its strategies as designed to maximise revenue while minimising awareness of risk. Across accounts, participants felt that industry tactics normalised gambling, manipulated vulnerability, and deflected responsibility. Shared subthemes Subtheme 2.1: Normalisation of gambling Participants described how gambling had become embedded in everyday life, particularly through sport and advertising. Young people pointed to the integration of betting into football culture, with one stating, “It’s become part of watching footy. Betting odds are just part of the commentary now” (YP1_F01). Adults similarly reflected on the ubiquity of gambling, noting, “It’s just normal now, you see it all the time on telly, even if you’re not into betting” (FG1_F03). Subtheme 2.2: Aggressive marketing strategies Participants in both groups described gambling marketing as omnipresent and deliberately persuasive, noting its presence across sports broadcasts, television, and social media. Adults expressed frustration that such marketing persists despite growing evidence of gambling-related harm, viewing it as exploitative and irresponsible. One participant remarked, “ You can’t watch a match without seeing betting ads—it’s everywhere” (FG1_F03). Young people similarly recognised the intensity of exposure, commenting that it normalises gambling as part of everyday entertainment. As one explained, “They make it look like everyone’s doing it, like it’s just another game” (YP1_F01). Participants agreed that the volume and style of advertising contributed to a sense of saturation, reinforcing gambling as a normal low-risk leisure activity. Subtheme 2.3: Technology and accessibility The accessibility of online gambling was viewed as a major driver of harm. Adults described how constant access increased risk, with one noting, “It’s 24/7 now. You don’t have to walk into a bookie, it’s in your pocket” (FG1_F04). Young people expressed concern about gambling-like features in games and apps, explaining that, “Loot boxes are basically gambling, but no one calls it that” (YP1_F03). Subtheme 2.4: Framing of personal responsibility Participants criticised the industry’s emphasis on slogans such as “When the fun stops, stop”, viewing these as tokenistic and harmful. One adult reflected, “They put the blame back on you, like it’s your fault if you get addicted” (FG2_F01). Young people also recognised this framing, with one explaining, “They make it sound like it’s just your problem if you get hooked, not theirs” (YP2_F01). Participants viewed this deflection of responsibility as shifting attention away from wider drivers of harm. Subtheme 2.5: Perceptions of exploitation and betrayal by the gambling industry Participants, particularly in the first adult group, spoke with strong emotion and moral conviction about the gambling industry’s role in causing harm. The industry was described as exploitative, deceptive, and driven by profit at the expense of people’s wellbeing. Several participants expressed a sense of betrayal, arguing that companies knowingly design products and marketing strategies to “hook” people while presenting gambling as harmless entertainment. For many, this perceived hypocrisy — promoting “fun” while profiting from addiction and loss — evoked anger and distrust. As one participant said, “They call it gaming to make it sound harmless, but it’s gambling—and it destroys lives” (FG1_F04). Among young people, similar frustrations surfaced, with one stating, “They know people are being harmed; they just don’t care. They’re loving that people get harmed because it makes them more money” (YP2_F03). These remarks reflected deep moral disapproval and a sense that both the gambling industry and policymakers had failed in their duty to protect the public. This strong feeling of exploitation and betrayal extended beyond the companies themselves to the wider systems that enable them. For some participants, anger was directed not only at the industry’s tactics but also at the perceived failure of government and regulators to intervene, setting the stage for wider discussions about policy inaction and accountability. Adult-specific subtheme Subtheme 2.6: Perceived government inaction This adult-specific subtheme illustrates how affected others conceptualise harm and highlight perceived prevention gaps. Adults uniquely highlighted the role of government, expressing frustration at what they saw as insufficient regulation and political will to address gambling harms. As one participant put it, “The government doesn’t really want to stop it—they get too much money from the industry” (FG2_F03). Adults described what they saw as a lack of government action or regulation, suggesting that this perceived inaction deepened their distrust toward industry-led initiatives. Young people-specific subtheme Subtheme 2.7: Celebrity endorsement and youth appeal While both groups criticised the pervasiveness of gambling marketing, young people highlighted the distinct influence of celebrity and influencer promotion, describing how admiration for sports figures and online personalities makes gambling appear aspirational and low-risk. One participant explained, “If your favourite footballer is in an advert, people my age are going to take notice” (YP2_F02). Participants noted that such campaigns increase the visibility and social acceptability of gambling among young audiences, blurring the boundaries between entertainment, sport, and commercial promotion. Theme summary Participants collectively described the gambling industry as deliberately exploitative, embedding its products in everyday spaces, marketing aggressively, leveraging technology, and shifting responsibility onto individuals. Many expressed anger and moral disapproval toward what they saw as an industry that profits from harm and conceals risk, reinforcing feelings of betrayal and distrust. Adults additionally pointed to government inaction, while young people emphasised the role of celebrity endorsements and youth-oriented marketing. Participants reported that these strategies normalised gambling and exacerbated vulnerability, leaving them sceptical of industry motives and distrustful of its messaging. Against this backdrop, participants emphasised the need for prevention efforts beyond industry-led slogans. These ideas about prevention are explored in detail in the next theme. Theme 3: Harm prevention requires multi-level, targeted strategies Across both populations, participants emphasised that effective prevention requires a combination of tailored messaging for distinct audiences and structural interventions to reduce exposure, accessibility, and affordability of gambling. Young people and adults alike dismissed current industry-led slogans as ineffective, stigmatising, and disconnected from their lived realities. Shared subthemes Subtheme 3.1: Messaging must be tailored for different groups Participants stressed that prevention messages cannot be generic but need to address specific audiences. Adults described the importance of recognising different life stages and responsibilities, explaining that, “For parents, it might be about family, paying bills, keeping a roof over your head. For young people, it’s got to be different” (FG1_F02). Young people reinforced this point by emphasising relevance and delivery platforms, with one suggesting, “Talk to us where we are—on TikTok, on Instagram. Not just posters no one looks at” (YP2_F02). Subtheme 3.2: Lived-experience stories enhance credibility Authentic narratives were seen as more powerful than abstract warnings or statistics. As one adult noted, “If someone’s been through it and tells their story, that hits harder than any numbers” (FG2_F03). Young people also emphasised the importance of hearing relatable voices, with one suggesting, “Hearing someone your age talk about it would make more sense than just stats” (YP1_F02). Subtheme 3.3: Negative emotional appeals risk backfiring Participants cautioned against fear-based campaigns, suggesting they could reinforce secrecy and guilt. One adult explained, “Scaring people just makes them hide it more. They won’t talk about it if they feel judged” (FG2_F01). Young people likewise argued that such approaches fail to engage their peers, with one noting, “If it’s just scary stuff, people my age just switch off” (YP2_F03). Participants suggested that such approaches could reinforce stigma or disengagement. Subtheme 3.4: Structural interventions are essential alongside messaging Both groups insisted that messaging alone was insufficient without broader reforms. Adults called for stronger regulation of advertising and affordability checks, with one stating, “If you don’t change the rules, nothing changes. The ads, the easy money—it just keeps people hooked” (FG1_F05). Young people highlighted the need to disrupt the association between gambling and sport, arguing, “Stop putting betting on football shirts. It makes it look like part of the game” (YP2_F01). Adult-specific subtheme Subtheme 3.5: Recognition and support for affected others This adult-specific subtheme demonstrates how affected others understand their position within the broader landscape of gambling harms (RQ1) and what they believe prevention and support strategies should address (RQ2). Adults uniquely stressed the importance of recognising and supporting those harmed by someone else’s gambling. As one participant explained, “It’s not just the gambler who needs help. Families need support too, but they’re forgotten about” (FG2_F02). Adults expressed concern that prevention and intervention strategies often overlook affected others. Young people-specific subtheme Subtheme 3.6: Early, peer-led education This youth-specific subtheme sheds light on how young people view the relevance of prevention strategies (RQ2). Young people emphasised the value of education delivered early and through relatable messengers. One participant suggested, “It would help if people our age talked about it in schools, so it feels real and not just teachers telling you” (YP1_F03). Young people called for prevention approaches that use peer-led, participatory formats. Theme summary In summary, participants agreed that prevention cannot rely on generic, industry-led slogans. Instead, they called for messaging that is tailored, credible, and emotionally resonant, supported by broader structural reforms to address exposure and access. Adults additionally emphasised the importance of recognition and support for affected others, while young people called for early, peer-led education. Participants across groups emphasised prevention strategies that combine individual-level communication with upstream interventions and that respond to the realities of different groups. Discussion This study explored the perspectives of two groups often overlooked in gambling research: adults affected by someone else’s gambling and young people living in households where gambling occurs. It highlights how adults affected by others’ gambling and young people living in households where gambling occurs conceptualise gambling-related harms and prevention. Three overarching themes were identified: gambling-related harms are multifaceted and often hidden; the gambling industry is perceived as predatory by those affected by harms; and there is support among these groups for multi-level, targeted strategies for harm prevention. Our analysis showed that some understandings of harm and prevention were shared across both adults and young people, while others reflected the distinctive contexts of each group. Shared subthemes included the breadth of harms, their concealment through stigma and denial, and scepticism toward industry-led responsibility messaging. Group-specific subthemes added depth. Adults emphasised delayed recognition of harm, the invisibility of affected others, and perceived government inaction, while young people described mistrust of gambling adults, the appeal of celebrity endorsements, and the value of peer-led education. This pattern suggests that while some concerns resonate across groups, others are shaped by lived realities that are rarely represented in gambling harm research. The accounts of both adults and young people are consistent with prior work demonstrating that gambling harms are wide-ranging, cumulative, and relational, extending beyond the individual gambler ( 5 , 44 ). Stigma and secrecy emerged strongly, echoing research showing how shame inhibits both gamblers and families from seeking support ( 4 ). Adults’ reflections on minimisation and delayed recognition align with earlier evidence on the hidden nature of gambling harms within families ( 45 ). Young people’s accounts of mistrust and disappointment in gambling adults add further weight to findings that harms are intergenerational and can undermine perceptions of family security ( 46 ). Both groups portrayed the gambling industry as predatory, highlighting aggressive marketing, sports sponsorship, and the integration of gambling into digital environments. These perceptions reinforce critiques that industry practices normalise gambling and shift responsibility onto individuals ( 8 , 17 ). Discussions in the adult groups also conveyed a strong moral dimension, reflecting anger, distrust, and a sense of betrayal toward the gambling industry. Taken together, these accounts position gambling harm not only as a public health issue but also as a matter of social justice and corporate accountability. Young people focused particularly on the appeal of celebrity endorsements and the “gamblification” of gaming, consistent with evidence of children’s and adolescents’ susceptibility to gambling promotion in sport and digital media ( 25 , 47 ). Adults, meanwhile, expressed frustration at weak regulation and political reliance on gambling revenue, echoing critiques that structural and policy-level factors perpetuate harm across the population ( 1 ). The third theme highlighted the need for prevention strategies that move beyond generic responsibility slogans to approaches that are targeted, credible, and multi-level. Both groups emphasised the value of lived-experience narratives over abstract warnings. While qualitative studies consistently suggest such narratives are perceived as relatable and meaningful, evidence on their effectiveness remains limited, despite one study showing that narrative-based harm prevention adverts led to stronger reductions than other prevention adverts on gambling urges ( 48 ). Participants also cautioned against fear-based appeals, which they felt could reinforce stigma rather than promoting behaviour change. This aligns with evidence from gambling research showing that fear or guilt-provoking messages can provoke defensiveness and stigma, limiting their effectiveness ( 49 ). Adults uniquely stressed the lack of recognition and support for affected others, while young people emphasised the importance of early, peer-led education integrated into schools and digital platforms. The study findings resonate with debates about the limitations of universal prevention strategies. A recent Finnish study examining the feasibility and acceptability of “lower risk” gambling guidelines found that although the guidelines were generally regarded as useful, participants often perceived them as directed at “others” and emphasising the need for contextual adaptation ( 18 ). Such evidence contributes to ongoing discussions about whether gambling harm prevention should prioritise broad awareness-raising or approaches tailored to the needs of specific groups ( 50 ). In our study, some insights were shared across adults and young people, while others reflected group-specific experiences, underscoring the importance of inclusive and differentiated approaches—consistent with earlier work on the distinct needs of affected others ( 45 ) and young people ( 28 ). Taken together, this suggests that effective prevention will require both universal messaging that raises awareness of gambling as a public health issue and targeted strategies that address the lived realities of affected others and young people. Limitations The study was based on a small and geographically localised sample, and the findings are not intended to, nor do we claim they can be taken to, reflect the experiences of participants in other regions or demographic groups. Instead, we argue that they highlight the importance of more representative and stratified sampling approaches in studies seeking to develop and test messaging that is effective at a population level, alongside the inclusion of diverse communities in targeted work to build a broader understanding of perspectives. Demographic groups are rarely homogenous, and we highlight that young people identified as particularly vulnerable (e.g., those supported by social care) were excluded from the present work due to ethical and resource constraints. This exclusion likely led to an underrepresentation of experiences associated with the most acute manifestations of gambling-related harm, emphasising the need for future research that explicitly incorporates these voices. While we anticipate that some of the specific learning is likely to be transferable to comparable samples with shared experiences, we invite researchers to continue to explore perspectives with these, and other, under- or unrepresented groups. Of particular note, a recent systematic review ( 24 ) highlighted the underrepresentation of ethnically minoritised communities, and we echo their call for more work with these communities. Implications for policy and public health messaging The findings suggest that effective gambling harm prevention strategies must extend beyond individuals who gamble to include affected others, whose needs remain largely overlooked. Participants stressed that public health messaging can be effective when it is credible, non-stigmatising, and grounded in the lived realities of its audiences. In addition, participants’ strong feelings of anger and distrust toward the gambling industry point to the importance of rebuilding public confidence. Credible, transparent communication and visible accountability from government and industry are essential to ensure prevention messages are not perceived as hollow or insincere. Messaging strategies may therefore need to focus less on individual responsibility and more on validation, hope, and systemic support. Tailored approaches are essential: young people called for participatory, peer-led education embedded in schools and digital environments, while adults highlighted the invisibility of affected others and the need for early recognition tools. For young people, the embedding of gambling within sport, digital platforms, and youth-oriented spaces highlights the need for stricter regulation of advertising and sponsorship. Importantly, both groups emphasised that messaging must be accompanied by upstream measures such as affordability checks and advertising restrictions, ensuring that communication strategies are supported by structural reforms. Overall, the findings suggest that public health messaging must be embedded within a broader policy framework that tackles the structural drivers of gambling-related harm. Conclusion This study provides an in-depth, multi-perspective analysis of gambling-related harm, illustrating the complex interplay between personal vulnerability, industry influence, and the policy environment. Adults affected by others’ gambling and young people in our study described harms as cumulative, relational, and often concealed. The gambling industry’s normalisation of risk through advertising, gamification, and digital access was perceived as a key driver of harm, particularly among youth. Significantly, participants identified substantial gaps in support, especially for affected others who remain largely invisible in many policy and service responses. The study also highlights the moral and emotional dimensions shaping public perceptions of gambling harm. Participants expressed anger, distrust, and a sense of betrayal toward the gambling industry, viewing its practices as exploitative and unethical. Acknowledging these sentiments is important for designing credible prevention efforts and restoring public confidence in the institutions responsible for regulating gambling. Our findings underscore the need for prevention strategies that are targeted, developmentally appropriate, and systemically grounded. Such strategies should combine public messaging that validates lived experience with structural policies that reduce risk exposure, alongside early recognition tools that empower affected individuals and communities. Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Newcastle University Faculty of Medical Sciences Ethics Review Committee (reference number 2623/35307). During recruitment, all participants completed an informed consent form. All participants received shopping vouchers worth £30 at the end of the session. Consent for publication Not applicable. Competing interests The authors declare that they have no competing financial or non-financial interests. Funding This project is funded by the National Institute for Health and Care Research (NIHR) [Policy Research Unit Behavioural and Social Sciences (project reference NIHR206124)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Author Contribution DR (first and corresponding author) contributed to the protocol, study design, data collection, data analyses, first manuscript draft, and manuscript review. LM contributed to the study design, data collection, data analysis, and manuscript review. PN contributed to the first manuscript draft and manuscript review. AG contributed to manuscript review. MK contributed to the protocol, study design, manuscript review, and funding acquisition. EO contributed to the protocol, study design, data analyses, first manuscript draft, manuscript review, and funding acquisition. MK and EO are joint last authors. Acknowledgement The research team thanks Dr Lesley Hall, manager of the NIHR Policy Research Unit in Behavioural Science, for project oversight and support. We are grateful to two members of the Unit’s Patient and Public Involvement and Engagement Strategy Group and to members of the young people’s advisory group at GenerationR (https://generationr.org.uk) for their valuable input on the development of the focus group topic guides. We also thank Neha Jain, NIHR School for Public Health Research Pre-doctoral Fellow, Newcastle University, who co-facilitated one of the young people’s focus groups alongside the lead researcher. Finally, we thank all focus group participants for generously sharing their time and perspectives. 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Prevention of problem gambling: A comprehensive review of the evidence and identified best practices. 2012. Available from: https://hdl.handle.net/10133/3121 Oksanen A, Sirola A, Savolainen I, Koivula A, Kaakinen M, Vuorinen I, et al. Social ecological model of problem gambling: A cross-national survey study of young people in the United States, South Korea, Spain, and Finland. Int J Environ Res Public Health. 2021;18(6):3220. McCullock SP, Louderback ER, LaPlante DA. Examining factors that hinder the efficacy of responsible gambling messages: Modeling predictors and effects of responsible gambling message fatigue. Int Gambl Stud. 2025;25(1):46–64. Ukhova D, Marionneau V, Nikkinen J, Wardle H. Public health approaches to gambling: a global review of legislative trends. Lancet Public Health. 2023. Denzin NK. Critical qualitative inquiry. Qualitative Inq. 2017;23(1):8–16. Johnson RH, Pitt H, Randle M, Thomas SL. 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Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 15 May, 2026 Reviewers agreed at journal 12 May, 2026 Reviewers invited by journal 29 Apr, 2026 Editor assigned by journal 16 Mar, 2026 Submission checks completed at journal 16 Mar, 2026 First submitted to journal 15 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9131253\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":631769565,\"identity\":\"836b6e47-14e7-427b-83d6-2f95bfe7f134\",\"order_by\":0,\"name\":\"Devashish Ray\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"Newcastle University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Devashish\",\"middleName\":\"\",\"lastName\":\"Ray\",\"suffix\":\"\"},{\"id\":631769566,\"identity\":\"8b9b28af-9c9b-4bea-8483-8d398477c247\",\"order_by\":1,\"name\":\"Laura J. 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Gambling-related harms include financial loss and profound effects on mental health, relationships, and communities, often with intergenerational consequences (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Harms extend beyond gamblers to partners, children, peers, and the broader community, creating hidden secondary and tertiary harms (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). Scholars and policymakers increasingly advocate for a public health approach to gambling harm that focuses less on individual responsibility and more on population-level approaches that acknowledge the structural, social, and commercial determinants of harm (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003ch3\\u003eMessaging in a Public Health Approach to Gambling\\u003c/h3\\u003e\\n\\u003cp\\u003eWithin such a framework, public health messaging is considered one potential harm-prevention strategy. As seen in tobacco control, population-level messaging can shape risk perceptions, shift attitudes, and promote protective behaviours (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). In theory, gambling harm-prevention messages aim to increase awareness and understanding of gambling-related harms, promote harm-reduction strategies, and influence attitudes and beliefs about gambling, ultimately encouraging safer behaviours and reducing harm (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). Research indicates that gambling-urges and risk-related cognitions are key predictors of gambling-related harm and may therefore represent useful targets for prevention messaging (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). Though arguments can be made that messaging might only be one part of a required broader approach, even modest changes in individual behaviour, when achieved across large populations, can contribute to meaningful public health benefits (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations of Industry-led Messaging\\u003c/h2\\u003e \\u003cp\\u003eDespite the potential of messaging to contribute to harm reduction for gambling, the current model of industry-led gambling messaging in the UK does not readily align with public health objectives, as it focuses on individual-level behaviours. Industry-led messages such as \\u003cem\\u003e\\u0026ldquo;When the fun stops, stop\\u0026rdquo;\\u003c/em\\u003e or \\u003cem\\u003e\\u0026ldquo;Take time to think\\u0026rdquo;\\u003c/em\\u003e emphasise personal responsibility and have been found to be ineffective in reducing harmful gambling practices (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). Personal responsibility framing can reinforce guilt and stress, exacerbate health inequities, and distract from addressing structural drivers of harm (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). In Australia, independent, government-led messaging campaigns have been developed as part of a broader public health approach to gambling (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). Similar approaches have recently been identified as a policy priority in the UK reflecting a growing recognition of the need for independent, harm-reduction messaging (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eTargeted Approaches and Evidence Gaps\\u003c/h3\\u003e\\n\\u003cp\\u003eThe gambling industry\\u0026rsquo;s own marketing demonstrates the importance of demographically targeted messaging, which shapes public perceptions of gambling-related risks and harms and drives engagement among vulnerable or high-risk groups (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). This highlights the need to adopt equally targeted harm-reduction strategies. A Finnish study (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e) found that lower-risk gambling guidelines (LRGG) were generally accepted but required cultural and personal adjustments. Participants often perceived the guidelines as directed at \\u0026ldquo;others\\u0026rdquo; rather than themselves, showing that generic or externally imposed messages may lack personal relevance and therefore have limited impact. Scholars thus recommend that gambling harm-prevention messaging should distinguish between interventions for at-risk individuals and those for the general population (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Qualitative research indicates that message responses vary primarily by age and gambling habits, rather than gender, sex, or ethnicity (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). For example, fear-based campaigns are rarely effective with younger people (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e), whereas real-life stories, emotional appeals, and depictions of negative consequences tend to be more effective (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). Infrequent gamblers and older adults tend to respond better to messages emphasizing practical self-regulation strategies\\u0026mdash;such as managing finances and maintaining family responsibilities\\u0026mdash;while younger adults prefer messages that foreground their own play and perceived expertise (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eYet, the evidence for the effectiveness of gambling messaging remains limited. A recent evidence review (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e) identified both a general lack of evaluated messaging interventions and, importantly, that several demographic groups were underrepresented in intervention development and testing. This latter omission provided the primary rationale for the present study. Three demographic groups were notably under-represented in the gambling messaging literature: (i) young people, increasingly exposed to gambling through digital media, sports sponsorship, and game-like mechanics such as loot boxes, yet rarely included in prevention research (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e); (ii) affected others, including partners, parents, and peers, who experience financial, emotional, and relational harms from another\\u0026rsquo;s gambling but remain largely excluded from policy and message design (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e); and (iii) ethnic and religious minority groups, who tend to gamble less frequently overall, yet those who do may face a higher risk of gambling-related harm (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eWhile the evidence base remains limited, existing studies nonetheless highlight the value of centring these groups in the design and evaluation of gambling harm prevention messaging. Studies with young people (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e) and affected others (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e) show that prevention is more effective when it reflects lived realities and provides actionable support. Scholars have also called for co-produced, independent messaging that is free from industry influence and grounded in audience perspectives (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Young people in particular highlight the mismatch between adult-designed campaigns and their lived digital environments, calling for direct involvement in campaign and policy development (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003ch3\\u003eApplying Theory to Gambling Harm-Prevention Messaging\\u003c/h3\\u003e\\n\\u003cp\\u003eSeveral theoretical perspectives help explain how gambling harm-prevention messages may or may not resonate with intended audiences. For instance, the health belief model suggests that individuals are more likely to respond when they perceive themselves to be at risk, believe the consequences of gambling harms are serious, and have confidence in their ability to act on the message (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e). The social ecological model, applied to gambling by Oksanen et al. (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e), emphasises that such responses are also shaped by wider social and cultural contexts, underscoring the need for messages that move beyond individual responsibility to acknowledge structural influences. Lastly, psychological reactance theory further shows that when messages are experienced as controlling or misaligned with audience realities, they can provoke resistance rather than engagement (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). Evidence also suggests that psychological constructs such as gambling urges, cognitions, and risk perceptions are consistently associated with gambling harms (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). Although their predictive power is modest at the individual level, they demonstrate clear theoretical and empirical links to behavioural outcomes. Their salience at the population level, together with their integration into these established behaviour-change models, provides a rationale for targeting them in messaging interventions.\\u003c/p\\u003e \\u003cp\\u003eTaken together, these perspectives suggest that effective gambling harm-prevention messaging must balance individual-level relevance with sensitivity to broader contexts, while avoiding framings that risk generating resistance or stigma. While the primary purpose of this work was not to test or develop theory, we highlight the importance of using theoretical principles to predict and understand differential effects of intervention messaging in and between diverse populations (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy Aims\\u003c/h3\\u003e\\n\\u003cp\\u003eAs outlined above, there are evidence gaps and ongoing debate in gambling harm prevention regarding the relative effectiveness of universal versus targeted messaging strategies (\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). This study therefore sought to explore the perspectives of two under-represented groups\\u0026mdash;1) young people residing in households with adult gambling exposure and 2) adults affected by someone else\\u0026rsquo;s gambling\\u0026mdash;concerning their beliefs and views about gambling-related harms and public health gambling messaging.\\u003c/p\\u003e \\u003cp\\u003eOur aim was not to assume that these groups necessarily hold fundamentally different perspectives, nor that findings could be directly generalised to the wider population. Rather, both groups have historically been excluded from research on prevention messaging, despite evidence that they experience distinct forms of gambling-related harm and exposure. We anticipated that some findings would be shared across both groups\\u0026mdash;for example, recognition of gambling\\u0026rsquo;s emotional and relational impacts\\u0026mdash;while other insights might be unique to their lived contexts. Adults, as affected others, might emphasise the hidden burdens of supporting a loved one who gambles, whereas young people might highlight early exposures to gambling in digital and family environments. Exploring both commonalities and divergences was considered important for developing more inclusive, audience-appropriate public health messaging.\\u003c/p\\u003e \\u003cp\\u003eSpecifically, the study addressed two research questions (RQs):\\u003c/p\\u003e \\u003cp\\u003eRQ 1. How do young people residing in households with adult gambling exposure and adults affected by someone else\\u0026rsquo;s gambling conceptualise and understand the risks and harms associated with gambling?\\u003c/p\\u003e \\u003cp\\u003eRQ 2. What strategies for public health messaging do young people residing in households with adult gambling experience and adults affected by someone else\\u0026rsquo;s gambling perceive as most useful in raising awareness of and reducing harms (including stigma), and why?\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\"\\u003e\\n \\u003ch2\\u003eStudy Design\\u003c/h2\\u003e\\n \\u003cp\\u003eThis study was guided by a critical qualitative inquiry approach (38), which recognises that gambling practices and harms are shaped by interacting individual, social, structural, and commercial determinants (39). This perspective emphasises health and social inequities and recognises the power of industry and government regulation in influencing gambling behaviours. We conducted four focus groups: two with adults affected by someone else\\u0026rsquo;s gambling and two with young people residing in households with adult gambling exposure.\\u003c/p\\u003e\\n \\u003cp\\u003eFocus groups were used to explore participants\\u0026rsquo; views because they are socially oriented, allowing individuals to listen to others\\u0026rsquo; opinions and understandings while forming their own responses. This method was particularly suited to the study\\u0026rsquo;s research questions, which sought to explore how beliefs and interpretations of gambling harms are constructed through social interaction. Among adults affected by another\\u0026rsquo;s gambling, the group format encouraged validation and shared reflection, while for young people it provided a familiar, conversational environment conducive to open discussion of peer and family influences (40).\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003ch3\\u003eParticipants and recruitment\\u003c/h3\\u003e\\n\\u003cp\\u003eA total of 20 participants took part (10 adults and 10 young people), a sample size appropriate for in-depth qualitative exploration through focus groups. Sample characteristics are shown in Table\\u0026nbsp;1. All participants were residents of Tyne and Wear, a metropolitan county in north-east England. This geographic area was selected due to its well-documented challenges associated with gambling-related harms (41), which hold particular significance for policymakers seeking to develop targeted interventions.\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eAdults (n\\u0026thinsp;=\\u0026thinsp;10; aged 19\\u0026ndash;75 years; 8 females, 2 males) self-identified as \\u0026lsquo;affected others\\u0026rsquo;, meaning they experienced harms linked to the gambling of a close family member, partner, or friend.\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eYoung people (n\\u0026thinsp;=\\u0026thinsp;10; aged 13\\u0026ndash;18 years; 4 females, 5 males, 1 non-binary) lived at home with a parent or guardian. For those under 16, parental consent was obtained alongside participant assent.\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eSample characteristics (n\\u0026thinsp;=\\u0026thinsp;20)\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\n \\u003cp\\u003eFocus Group\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\n \\u003cp\\u003en\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\n \\u003cp\\u003eAge (years)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\n \\u003cp\\u003eEthnicity\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\n \\u003cp\\u003eAdults \\u0026ndash; Session 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\n \\u003cp\\u003e47\\u0026ndash;75 (m* = ~67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\n \\u003cp\\u003e6F, 1M\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\n \\u003cp\\u003e6 White, 1 Asian British\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\n \\u003cp\\u003eAdults \\u0026ndash; Session 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\n \\u003cp\\u003e18\\u0026ndash;57 (m* = ~38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\n \\u003cp\\u003e2F, 1M\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\n \\u003cp\\u003e2 White, 1 Asian British\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\n \\u003cp\\u003eYoung people \\u0026ndash; Session 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\n \\u003cp\\u003e13\\u0026ndash;18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\n \\u003cp\\u003eAll F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\n \\u003cp\\u003e1 White, 2 Asian British\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\n \\u003cp\\u003eYoung people \\u0026ndash; Session 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\n \\u003cp\\u003e15\\u0026ndash;16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\n \\u003cp\\u003e5M, 1F, 1NB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\n \\u003cp\\u003eAll White\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"5\\\"\\u003e(*m= median; F=female, M= male, NB\\u0026thinsp;=\\u0026thinsp;non-binary)\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eParticipants were purposively sampled to ensure eligibility: adults who self-identified as affected others, and young people aged 13\\u0026ndash;18 years who lived at home with a parent or guardian who engaged in gambling. Eligibility was assessed after participants expressed interest in taking part. The inclusion criteria were clearly stated in the recruitment materials (posters and flyers), and the researcher (DR) verified eligibility via follow-up email correspondence to confirm that prospective participants met the required criteria.\\u003c/p\\u003e\\n\\u003cp\\u003eYoung people identified as vulnerable in government guidance \\u0026mdash; for example, those receiving support from child social care services or holding education, health, and care plans\\u0026mdash;were excluded from the study. This exclusion reflected the substantial ethical complexity associated with research involving high-risk minors, the need for multi-level consent processes involving institutional gatekeepers, and constraints in research team capacity regarding safeguarding expertise. We acknowledge that this exclusion may have limited the diversity of perspectives captured.\\u003c/p\\u003e\\n\\u003cp\\u003eRecruitment materials, including flyers and participant information sheets, were produced by the research team. Input was sought through consultation with two members of the research unit\\u0026rsquo;s strategic Patient and Public Involvement and Engagement (PPIE) team and with young people from \\u003cem\\u003eYouth Focus Northeast\\u003c/em\\u003e. Their comments and suggestions were incorporated with the intention of making the materials clearer, more appropriate, and more engaging for prospective participants. The same individuals were later consulted on the development of focus group topic guides (see data collection).\\u003c/p\\u003e\\n\\u003cp\\u003eEligible participants were identified and recruited using a combination of community outreach and online platforms. Flyers were distributed through local community centres and voluntary sector organisations, including the Voluntary Organisations\\u0026rsquo; Network Northeast (www.vonne.org.uk). Recruitment was further supported through online platforms that facilitate involvement in research, such as \\u003cem\\u003ePeople in Research\\u003c/em\\u003e (www.peopleinresearch.org) and \\u003cem\\u003eVoice (\\u003c/em\\u003ewww.voice-global.org). This multi-channel strategy was intended to maximise reach and support inclusion of participants from diverse backgrounds where possible.\\u003c/p\\u003e\\n\\u003ch3\\u003eData Collection\\u003c/h3\\u003e\\n\\u003cp\\u003eEach focus group lasted approximately 70\\u0026ndash;85 minutes and was conducted in-person, except for one youth group which adopted a hybrid format to accommodate participants joining remotely. Data collection for the adult focus groups took place in February 2024, and the youth focus groups were conducted in March and May 2024. Separate topic guides were developed by the research team for adults and young people. As noted earlier, input was sought from two members of the unit\\u0026rsquo;s strategic PPIE team. Additionally, for the topic guide for the young people, input was obtained from a young people\\u0026rsquo;s advisory group (https://generationr.org.uk). Two researchers (DR and LM) with experience of conducting focus groups facilitated the group discussions. The sessions were digitally audio-recorded by DR and transcribed by UK Transcription (www.uktranscription.com).\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec11\\\"\\u003e\\n \\u003ch2\\u003eAnalysis\\u003c/h2\\u003e\\n \\u003cp\\u003eA thematic analysis was conducted, structured within the Framework Method (42). Both deductive and inductive approaches were integrated throughout the analysis. Coding and framework development were supported by NVivo 15 (43), which was used to manage transcripts, apply the coding hierarchy, and chart data within the Framework Method matrix. The deductive framework was developed prior to detailed coding, informed by the study\\u0026rsquo;s research questions, topic guide, and relevant theoretical and empirical literature on gambling harms and prevention messaging. These sources provided the initial high-level categories (e.g., \\u003cem\\u003eperceived harms, message credibility, structural determinants\\u003c/em\\u003e), which guided early coding.\\u003c/p\\u003e\\n \\u003cp\\u003eDuring analysis, inductive coding was conducted concurrently to capture concepts that did not fit within the preliminary framework\\u0026mdash;such as moral framing of gambling behaviour, intergenerational impacts, and peer-led prevention preferences emerging from participants\\u0026rsquo; accounts. Through iterative team discussions, these inductive codes were reviewed and, where relevant, integrated into or used to modify the original framework.\\u003c/p\\u003e\\n \\u003cp\\u003eAnalytical stages included:\\u003c/p\\u003e\\n \\u003col\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eFamiliarisation and open coding by each researcher.\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eDevelopment and refinement of a shared coding framework through team discussion, including comparison of deductive and inductive codes.\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eApplication of the evolving framework across all transcripts using NVivo.\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eSynthesis of themes and subthemes through cross-group comparison.\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003cp\\u003eFurther details of the analytic process, including the initial deductive framework, examples of inductive codes that emerged during analysis, and the final integrated framework of themes and subthemes, are provided in Additional file 1. This documentation illustrates how the Framework Method was applied iteratively to ensure that both the theoretically derived and data-driven elements of the analysis were transparently and systematically integrated.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe thematic analysis produced three overarching themes. Themes 1 and 2 address how participants conceptualise and interpret gambling-related harms (RQ1), while Theme 3 addresses participants\\u0026rsquo; perspectives on effective public health messaging and prevention strategies (RQ2). Within each theme, several subthemes were found to be common to both adults and young people, revealing shared perspectives on the nature of gambling-related harms and prevention. Additionally, there were subthemes that were specific to one population group, capturing distinctive experiences of adults affected by another person\\u0026rsquo;s gambling and of young people exposed to gambling within their households.\\u003c/p\\u003e \\u003cp\\u003eIn the sections that follow, shared subthemes are presented first, followed by adult-specific and young people-specific subthemes where relevant. A summary of themes and subthemes, including whether they were shared or group-specific, is provided in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. Quotations from participants are labelled with a code to protect anonymity. The code denotes the focus group and participant number, where \\u0026lsquo;F\\u0026rsquo; refers to \\u0026lsquo;focus group participant\\u0026rsquo; and serves as a unique identifier (e.g., FG1_F02\\u0026thinsp;=\\u0026thinsp;Adult Focus Group 1, Participant 2; YP2_F01\\u0026thinsp;=\\u0026thinsp;Young People\\u0026rsquo;s Group 2, Participant 1).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSummary of themes and subthemes.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTheme\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSubtheme\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eParticipant group\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eSummary of findings\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"6\\\" rowspan=\\\"7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1. Gambling-related harms are multifaceted and often hidden\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.1 Compulsive and addictive nature\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eGambling described as compulsive and addictive; adults stressed loss of control; young people (YP) emphasised chasing losses (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.2 Mental health and emotional harms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eHarms included stress, anxiety, depression, and sometimes suicide; YP noted loss of trust (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.3 Financial harms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMoney loss linked to insecurity; adults stressed household strain; YP noted lack of funds for family needs (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.4 Harms to relationships\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAdults described family breakdown and conflict; YP reported neglect and disappointment (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.5 Stigma, secrecy, and denial\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eShame reinforced harms; adults described silence, YP mentioned embarrassment (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.6 Delayed recognition/minimisation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAdult-specific\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAdults described harms unnoticed or minimised until severe, highlighting prevention gaps (RQ1 \\u0026amp; RQ2).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.7 Erosion of trust in gambling adults\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eYouth-specific\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eYP described mistrust of gambling parents/carers, shaping perceptions of harm (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"6\\\" rowspan=\\\"7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2. The predatory tactics of the gambling industry\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.1 Normalisation of gambling\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eGambling seen as routine; linked to sport and daily life (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.2 Aggressive marketing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eRelentless advertising; YP highlighted celebrity/influencer appeal (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.3 Technology and accessibility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eOnline gambling seen as driving harm; YP noted gambling-like gaming features (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.4 Framing of responsibility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eIndustry slogans seen as tokenistic and deflecting responsibility (RQ1).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.5 Perceptions of exploitation and betrayal by the gambling industry\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eExpressions of moral outrage and distrust, industry viewed as exploitative and profit-driven, and framing harms as ethical and social issues rather than individual failings (RQ1 \\u0026amp; RQ2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.6 Perceived government inaction\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAdult-specific\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAdults critiqued lack of regulation and political will, linking to prevention gaps (RQ1 \\u0026amp; RQ2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.7 Celebrity endorsement\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eYouth-specific\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eYP stressed influence of sports figures and celebrities, framing gambling as appealing (RQ1 \\u0026amp; RQ2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"5\\\" rowspan=\\\"6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3. Harm prevention requires multi-level, targeted strategies\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.1 Tailored messaging\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAdults stressed family/financial framing; YP stressed digital platforms and relevance (RQ2).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.2 Lived-experience stories\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eReal-life accounts seen as more credible than abstract messages (RQ2).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.3 Negative emotional appeals\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFear-based messaging seen as stigmatising or ineffective (RQ2).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.4 Structural interventions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eShared\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAdults called for regulation and affordability checks; YP called for decoupling sport from gambling (RQ2).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.5 Support for affected others\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAdult-specific\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAdults emphasised recognition and early support for families (RQ1 \\u0026amp; RQ2).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.6 Early, peer-led education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eYouth-specific\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eYP advocated for participatory, relatable school-based education (RQ2).\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003e\\u0026ldquo;Shared\\u0026rdquo; indicates subthemes reported across both adult and young people\\u0026rsquo;s focus groups.\\u003c/em\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme 1: Gambling-related harms are multifaceted and often hidden\\u003c/h2\\u003e \\u003cp\\u003eBoth young people and adults with lived experience of gambling-related harms as an \\u0026lsquo;affected other\\u0026rsquo; described these harms as broad, cumulative, and frequently hidden from public view. Harms were seen to extend beyond financial loss to encompass psychological, emotional, relational, and social impacts. The perceived invisibility of gambling-related harms, particularly when compared with other public health issues such as alcohol or drug use, was a recurring concern across groups.\\u003c/p\\u003e \\u003cp\\u003eShared subthemes\\u003c/p\\u003e \\u003cp\\u003eSubtheme 1.1: Compulsive and addictive nature of gambling\\u003c/p\\u003e \\u003cp\\u003eParticipants often framed gambling as inherently compulsive and difficult to control. Adults, in particular, emphasised its addictive qualities, with one noting, \\u003cem\\u003e\\u0026ldquo;Once he started, he couldn\\u0026rsquo;t stop. It was like a switch had gone off\\u0026rdquo;\\u003c/em\\u003e (FG2_F04). Young people similarly highlighted the cycle of \\u003cem\\u003echasing losses\\u003c/em\\u003e as central to gambling\\u0026rsquo;s addictive pull. As one reflected, \\u003cem\\u003e\\u0026ldquo;At first, it is just trying to get more money, but then you just start losing more and more money and it\\u0026rsquo;s hard to get out of it\\u0026rdquo;\\u003c/em\\u003e (YP1_F02).\\u003c/p\\u003e \\u003cp\\u003eSubtheme 1.2: Mental health and emotional harms\\u003c/p\\u003e \\u003cp\\u003eParticipants frequently linked gambling to a range of psychological and emotional difficulties. Adults described the toll on family life, explaining, \\u003cem\\u003e\\u0026ldquo;You\\u0026rsquo;re living with constant stress. It\\u0026rsquo;s not just the money, it\\u0026rsquo;s the lies, the worry, the not knowing\\u0026rdquo;\\u003c/em\\u003e (FG1_F03). Several accounts also highlighted severe consequences, with gambling associated with depression and, in extreme cases, suicide. As one participant recalled, \\u003cem\\u003e\\u0026ldquo;One of my son\\u0026rsquo;s close friends committed suicide\\u0026hellip; He was only 24\\u0026rdquo;\\u003c/em\\u003e (FG1_F01). Young people emphasised the erosion of trust and emotional distance created by a parent\\u0026rsquo;s gambling, with one stating, \\u003cem\\u003e\\u0026ldquo;You stop seeing them the same way. It\\u0026rsquo;s like you don\\u0026rsquo;t trust them anymore\\u0026rdquo;\\u003c/em\\u003e (YP2_F01).\\u003c/p\\u003e \\u003cp\\u003eSubtheme 1.3: Financial harms\\u003c/p\\u003e \\u003cp\\u003eWhile financial loss was a recurring theme, participants stressed that this was rarely experienced in isolation but intertwined with emotional and relational consequences. One adult explained, \\u003cem\\u003e\\u0026ldquo;It wasn\\u0026rsquo;t just the bills not getting paid. It was the arguments, the shame, the feeling of not being secure at home\\u0026rdquo; (FG1_F02).\\u003c/em\\u003e Young people similarly recognised how gambling redirected household finances away from family needs, with one noting, \\u003cem\\u003e\\u0026ldquo;You notice there\\u0026rsquo;s no money for things at home, like food or going out, because it\\u0026rsquo;s all gone on betting\\u0026rdquo; (YP1_F03).\\u003c/em\\u003e\\u003c/p\\u003e \\u003cp\\u003eSubtheme 1.4: Harms to relationships\\u003c/p\\u003e \\u003cp\\u003eAdults frequently described the breakdown of trust and communication within families, explaining that, \\u003cem\\u003e\\u0026ldquo;It changes everything. You stop talking properly, you hide things, you don\\u0026rsquo;t feel like a family anymore\\u0026rdquo;\\u003c/em\\u003e (FG2_F05). For young people, relational harms were closely tied to feeling let down by adults, as one said, \\u003cem\\u003e\\u0026ldquo;When your dad\\u0026rsquo;s gambling, it feels like he cares more about that than about you\\u0026rdquo;\\u003c/em\\u003e (YP1_F02).\\u003c/p\\u003e \\u003cp\\u003eSubtheme 1.5: Stigma, secrecy, and denial\\u003c/p\\u003e \\u003cp\\u003eParticipants noted that stigma and shame reinforced the hidden nature of harms, making them harder to address. As one adult put it, \\u003cem\\u003e\\u0026ldquo;Nobody talks about it. You hide it because you don\\u0026rsquo;t want people to know. That just makes it worse\\u0026rdquo;\\u003c/em\\u003e (FG1_F01). Young people echoed this, explaining that embarrassment and fear of judgement prevented them from disclosing a parent\\u0026rsquo;s gambling: \\u003cem\\u003e\\u0026ldquo;You don\\u0026rsquo;t tell your friends about it, \\u0026lsquo;cause it\\u0026rsquo;s embarrassing. You just keep it to yourself\\u0026rdquo;\\u003c/em\\u003e (YP2_F02).\\u003c/p\\u003e \\u003cp\\u003eAdult-specific subtheme\\u003c/p\\u003e \\u003cp\\u003eSubtheme 1.6: Delayed recognition and minimisation of harm\\u003c/p\\u003e \\u003cp\\u003eAdults often reflected on how harms went unrecognised or were minimised until they had become severe. Some described normalising problematic gambling behaviour within the family or explaining away its impacts. As one participant explained, \\u003cem\\u003e\\u0026ldquo;You don\\u0026rsquo;t see it as harm at first; you just think it\\u0026rsquo;s a phase, or that it\\u0026rsquo;s not that bad, until it really blows up\\u0026rdquo;\\u003c/em\\u003e (FG2_F02). Adults viewed this delayed recognition as reinforcing the hidden and cumulative nature of gambling-related harms.\\u003c/p\\u003e \\u003cp\\u003eYoung people-specific subtheme\\u003c/p\\u003e \\u003cp\\u003eSubtheme 1.7: Erosion of trust in gambling adults\\u003c/p\\u003e \\u003cp\\u003eWhile both groups described relational harms, young people uniquely emphasised the erosion of trust in parents and carers who gambled. Beyond disappointment, this often translated into long-term shifts in how they viewed adult authority. One participant explained, \\u003cem\\u003e\\u0026ldquo;It makes you not want to listen to them, \\u0026lsquo;cause if they can\\u0026rsquo;t even stop gambling, why should you take their advice?\\u0026rdquo;\\u003c/em\\u003e (YP1_F01). Young people described this mistrust as affecting how they viewed the reliability and dependability of adults in their families.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme summary\\u003c/h2\\u003e \\u003cp\\u003eTaken as a whole, participants described gambling-related harms as complex, layered, and frequently concealed. Both adults and young people described harms that extended far beyond finances to affect mental health, relationships, and family life, with stigma and secrecy compounding their impact. Adults additionally spoke of delayed recognition and minimisation of harms, while young people uniquely emphasised mistrust in gambling adults. Broadly, participants described gambling not as an isolated behaviour but as a pervasive source of distress that affected multiple aspects of everyday life.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme 2: The predatory tactics of the gambling industry\\u003c/h2\\u003e \\u003cp\\u003eYoung people and adults alike consistently characterised the gambling industry as exploitative, describing its strategies as designed to maximise revenue while minimising awareness of risk. Across accounts, participants felt that industry tactics normalised gambling, manipulated vulnerability, and deflected responsibility.\\u003c/p\\u003e \\u003cp\\u003eShared subthemes\\u003c/p\\u003e \\u003cp\\u003eSubtheme 2.1: Normalisation of gambling\\u003c/p\\u003e \\u003cp\\u003eParticipants described how gambling had become embedded in everyday life, particularly through sport and advertising. Young people pointed to the integration of betting into football culture, with one stating, \\u003cem\\u003e\\u0026ldquo;It\\u0026rsquo;s become part of watching footy. Betting odds are just part of the commentary now\\u0026rdquo;\\u003c/em\\u003e (YP1_F01). Adults similarly reflected on the ubiquity of gambling, noting, \\u003cem\\u003e\\u0026ldquo;It\\u0026rsquo;s just normal now, you see it all the time on telly, even if you\\u0026rsquo;re not into betting\\u0026rdquo;\\u003c/em\\u003e (FG1_F03).\\u003c/p\\u003e \\u003cp\\u003eSubtheme 2.2: Aggressive marketing strategies\\u003c/p\\u003e \\u003cp\\u003eParticipants in both groups described gambling marketing as omnipresent and deliberately persuasive, noting its presence across sports broadcasts, television, and social media. Adults expressed frustration that such marketing persists despite growing evidence of gambling-related harm, viewing it as exploitative and irresponsible. One participant remarked, \\u0026ldquo;\\u003cem\\u003eYou can\\u0026rsquo;t watch a match without seeing betting ads\\u0026mdash;it\\u0026rsquo;s everywhere\\u0026rdquo;\\u003c/em\\u003e (FG1_F03).\\u003c/p\\u003e \\u003cp\\u003eYoung people similarly recognised the intensity of exposure, commenting that it normalises gambling as part of everyday entertainment. As one explained, \\u003cem\\u003e\\u0026ldquo;They make it look like everyone\\u0026rsquo;s doing it, like it\\u0026rsquo;s just another game\\u0026rdquo;\\u003c/em\\u003e (YP1_F01). Participants agreed that the volume and style of advertising contributed to a sense of saturation, reinforcing gambling as a normal low-risk leisure activity.\\u003c/p\\u003e \\u003cp\\u003eSubtheme 2.3: Technology and accessibility\\u003c/p\\u003e \\u003cp\\u003eThe accessibility of online gambling was viewed as a major driver of harm. Adults described how constant access increased risk, with one noting, \\u003cem\\u003e\\u0026ldquo;It\\u0026rsquo;s 24/7 now. You don\\u0026rsquo;t have to walk into a bookie, it\\u0026rsquo;s in your pocket\\u0026rdquo;\\u003c/em\\u003e (FG1_F04). Young people expressed concern about gambling-like features in games and apps, explaining that, \\u003cem\\u003e\\u0026ldquo;Loot boxes are basically gambling, but no one calls it that\\u0026rdquo;\\u003c/em\\u003e (YP1_F03).\\u003c/p\\u003e \\u003cp\\u003eSubtheme 2.4: Framing of personal responsibility\\u003c/p\\u003e \\u003cp\\u003eParticipants criticised the industry\\u0026rsquo;s emphasis on slogans such as \\u0026ldquo;When the fun stops, stop\\u0026rdquo;, viewing these as tokenistic and harmful. One adult reflected, \\u003cem\\u003e\\u0026ldquo;They put the blame back on you, like it\\u0026rsquo;s your fault if you get addicted\\u0026rdquo;\\u003c/em\\u003e (FG2_F01). Young people also recognised this framing, with one explaining, \\u003cem\\u003e\\u0026ldquo;They make it sound like it\\u0026rsquo;s just your problem if you get hooked, not theirs\\u0026rdquo;\\u003c/em\\u003e (YP2_F01). Participants viewed this deflection of responsibility as shifting attention away from wider drivers of harm.\\u003c/p\\u003e \\u003cp\\u003eSubtheme 2.5: Perceptions of exploitation and betrayal by the gambling industry\\u003c/p\\u003e \\u003cp\\u003eParticipants, particularly in the first adult group, spoke with strong emotion and moral conviction about the gambling industry\\u0026rsquo;s role in causing harm. The industry was described as exploitative, deceptive, and driven by profit at the expense of people\\u0026rsquo;s wellbeing. Several participants expressed a sense of betrayal, arguing that companies knowingly design products and marketing strategies to \\u0026ldquo;hook\\u0026rdquo; people while presenting gambling as harmless entertainment. For many, this perceived hypocrisy \\u0026mdash; promoting \\u0026ldquo;fun\\u0026rdquo; while profiting from addiction and loss \\u0026mdash; evoked anger and distrust.\\u003c/p\\u003e \\u003cp\\u003eAs one participant said, \\u003cem\\u003e\\u0026ldquo;They call it gaming to make it sound harmless, but it\\u0026rsquo;s gambling\\u0026mdash;and it destroys lives\\u0026rdquo;\\u003c/em\\u003e (FG1_F04). Among young people, similar frustrations surfaced, with one stating, \\u003cem\\u003e\\u0026ldquo;They know people are being harmed; they\\u003c/em\\u003e just don\\u0026rsquo;t care. They\\u0026rsquo;re loving that people get harmed because it makes them more money\\u0026rdquo; (YP2_F03).\\u003c/p\\u003e \\u003cp\\u003eThese remarks reflected deep moral disapproval and a sense that both the gambling industry and policymakers had failed in their duty to protect the public. This strong feeling of exploitation and betrayal extended beyond the companies themselves to the wider systems that enable them. For some participants, anger was directed not only at the industry\\u0026rsquo;s tactics but also at the perceived failure of government and regulators to intervene, setting the stage for wider discussions about policy inaction and accountability.\\u003c/p\\u003e \\u003cp\\u003eAdult-specific subtheme\\u003c/p\\u003e \\u003cp\\u003eSubtheme 2.6: Perceived government inaction\\u003c/p\\u003e \\u003cp\\u003eThis adult-specific subtheme illustrates how affected others conceptualise harm and highlight perceived prevention gaps.\\u003c/p\\u003e \\u003cp\\u003eAdults uniquely highlighted the role of government, expressing frustration at what they saw as insufficient regulation and political will to address gambling harms. As one participant put it, \\u003cem\\u003e\\u0026ldquo;The government doesn\\u0026rsquo;t really want to stop it\\u0026mdash;they get too much money from the industry\\u0026rdquo;\\u003c/em\\u003e (FG2_F03). Adults described what they saw as a lack of government action or regulation, suggesting that this perceived inaction deepened their distrust toward industry-led initiatives.\\u003c/p\\u003e \\u003cp\\u003eYoung people-specific subtheme\\u003c/p\\u003e \\u003cp\\u003eSubtheme 2.7: Celebrity endorsement and youth appeal\\u003c/p\\u003e \\u003cp\\u003eWhile both groups criticised the pervasiveness of gambling marketing, young people highlighted the distinct influence of celebrity and influencer promotion, describing how admiration for sports figures and online personalities makes gambling appear aspirational and low-risk. One participant explained, \\u0026ldquo;If your favourite footballer is in an advert, people my age are going to take notice\\u0026rdquo; (YP2_F02).\\u003c/p\\u003e \\u003cp\\u003eParticipants noted that such campaigns increase the visibility and social acceptability of gambling among young audiences, blurring the boundaries between entertainment, sport, and commercial promotion.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme summary\\u003c/h2\\u003e \\u003cp\\u003eParticipants collectively described the gambling industry as deliberately exploitative, embedding its products in everyday spaces, marketing aggressively, leveraging technology, and shifting responsibility onto individuals. Many expressed anger and moral disapproval toward what they saw as an industry that profits from harm and conceals risk, reinforcing feelings of betrayal and distrust. Adults additionally pointed to government inaction, while young people emphasised the role of celebrity endorsements and youth-oriented marketing. Participants reported that these strategies normalised gambling and exacerbated vulnerability, leaving them sceptical of industry motives and distrustful of its messaging. Against this backdrop, participants emphasised the need for prevention efforts beyond industry-led slogans. These ideas about prevention are explored in detail in the next theme.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme 3: Harm prevention requires multi-level, targeted strategies\\u003c/h2\\u003e \\u003cp\\u003eAcross both populations, participants emphasised that effective prevention requires a combination of tailored messaging for distinct audiences and structural interventions to reduce exposure, accessibility, and affordability of gambling. Young people and adults alike dismissed current industry-led slogans as ineffective, stigmatising, and disconnected from their lived realities.\\u003c/p\\u003e \\u003cp\\u003eShared subthemes\\u003c/p\\u003e \\u003cp\\u003eSubtheme 3.1: Messaging must be tailored for different groups\\u003c/p\\u003e \\u003cp\\u003eParticipants stressed that prevention messages cannot be generic but need to address specific audiences. Adults described the importance of recognising different life stages and responsibilities, explaining that, \\u003cem\\u003e\\u0026ldquo;For parents, it might be about family, paying bills, keeping a roof over your head. For young people, it\\u0026rsquo;s got to be different\\u0026rdquo;\\u003c/em\\u003e (FG1_F02). Young people reinforced this point by emphasising relevance and delivery platforms, with one suggesting, \\u003cem\\u003e\\u0026ldquo;Talk to us where we are\\u0026mdash;on TikTok, on Instagram. Not just posters no one looks at\\u0026rdquo;\\u003c/em\\u003e (YP2_F02).\\u003c/p\\u003e \\u003cp\\u003eSubtheme 3.2: Lived-experience stories enhance credibility\\u003c/p\\u003e \\u003cp\\u003eAuthentic narratives were seen as more powerful than abstract warnings or statistics. As one adult noted, \\u003cem\\u003e\\u0026ldquo;If someone\\u0026rsquo;s been through it and tells their story, that hits harder than any numbers\\u0026rdquo;\\u003c/em\\u003e (FG2_F03). Young people also emphasised the importance of hearing relatable voices, with one suggesting, \\u003cem\\u003e\\u0026ldquo;Hearing someone your age talk about it would make more sense than just stats\\u0026rdquo;\\u003c/em\\u003e (YP1_F02).\\u003c/p\\u003e \\u003cp\\u003eSubtheme 3.3: Negative emotional appeals risk backfiring\\u003c/p\\u003e \\u003cp\\u003e Participants cautioned against fear-based campaigns, suggesting they could reinforce secrecy and guilt. One adult explained, \\u003cem\\u003e\\u0026ldquo;Scaring people just makes them hide it more. They won\\u0026rsquo;t talk about it if they feel judged\\u0026rdquo;\\u003c/em\\u003e (FG2_F01). Young people likewise argued that such approaches fail to engage their peers, with one noting, \\u003cem\\u003e\\u0026ldquo;If it\\u0026rsquo;s just scary stuff, people my age just switch off\\u0026rdquo;\\u003c/em\\u003e (YP2_F03). Participants suggested that such approaches could reinforce stigma or disengagement.\\u003c/p\\u003e \\u003cp\\u003eSubtheme 3.4: Structural interventions are essential alongside messaging\\u003c/p\\u003e \\u003cp\\u003eBoth groups insisted that messaging alone was insufficient without broader reforms. Adults called for stronger regulation of advertising and affordability checks, with one stating, \\u003cem\\u003e\\u0026ldquo;If you don\\u0026rsquo;t change the rules, nothing changes. The ads, the easy money\\u0026mdash;it just keeps people hooked\\u0026rdquo;\\u003c/em\\u003e (FG1_F05). Young people highlighted the need to disrupt the association between gambling and sport, arguing, \\u003cem\\u003e\\u0026ldquo;Stop putting betting on football shirts. It makes it look like part of the game\\u0026rdquo;\\u003c/em\\u003e (YP2_F01).\\u003c/p\\u003e \\u003cp\\u003eAdult-specific subtheme\\u003c/p\\u003e \\u003cp\\u003eSubtheme 3.5: Recognition and support for affected others\\u003c/p\\u003e \\u003cp\\u003eThis adult-specific subtheme demonstrates how affected others understand their position within the broader landscape of gambling harms (RQ1) and what they believe prevention and support strategies should address (RQ2). Adults uniquely stressed the importance of recognising and supporting those harmed by someone else\\u0026rsquo;s gambling. As one participant explained, \\u003cem\\u003e\\u0026ldquo;It\\u0026rsquo;s not just the gambler who needs help. Families need support too, but they\\u0026rsquo;re forgotten about\\u0026rdquo;\\u003c/em\\u003e (FG2_F02). Adults expressed concern that prevention and intervention strategies often overlook affected others.\\u003c/p\\u003e \\u003cp\\u003eYoung people-specific subtheme\\u003c/p\\u003e \\u003cp\\u003eSubtheme 3.6: Early, peer-led education\\u003c/p\\u003e \\u003cp\\u003eThis youth-specific subtheme sheds light on how young people view the relevance of prevention strategies (RQ2). Young people emphasised the value of education delivered early and through relatable messengers. One participant suggested, \\u003cem\\u003e\\u0026ldquo;It would help if people our age talked about it in schools, so it feels real and not just teachers telling you\\u0026rdquo;\\u003c/em\\u003e (YP1_F03). Young people called for prevention approaches that use peer-led, participatory formats.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTheme summary\\u003c/h2\\u003e \\u003cp\\u003eIn summary, participants agreed that prevention cannot rely on generic, industry-led slogans. Instead, they called for messaging that is tailored, credible, and emotionally resonant, supported by broader structural reforms to address exposure and access. Adults additionally emphasised the importance of recognition and support for affected others, while young people called for early, peer-led education. Participants across groups emphasised prevention strategies that combine individual-level communication with upstream interventions and that respond to the realities of different groups.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study explored the perspectives of two groups often overlooked in gambling research: adults affected by someone else\\u0026rsquo;s gambling and young people living in households where gambling occurs. It highlights how adults affected by others\\u0026rsquo; gambling and young people living in households where gambling occurs conceptualise gambling-related harms and prevention. Three overarching themes were identified: gambling-related harms are multifaceted and often hidden; the gambling industry is perceived as predatory by those affected by harms; and there is support among these groups for multi-level, targeted strategies for harm prevention.\\u003c/p\\u003e \\u003cp\\u003eOur analysis showed that some understandings of harm and prevention were shared across both adults and young people, while others reflected the distinctive contexts of each group. Shared subthemes included the breadth of harms, their concealment through stigma and denial, and scepticism toward industry-led responsibility messaging. Group-specific subthemes added depth. Adults emphasised delayed recognition of harm, the invisibility of affected others, and perceived government inaction, while young people described mistrust of gambling adults, the appeal of celebrity endorsements, and the value of peer-led education. This pattern suggests that while some concerns resonate across groups, others are shaped by lived realities that are rarely represented in gambling harm research.\\u003c/p\\u003e \\u003cp\\u003eThe accounts of both adults and young people are consistent with prior work demonstrating that gambling harms are wide-ranging, cumulative, and relational, extending beyond the individual gambler (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e). Stigma and secrecy emerged strongly, echoing research showing how shame inhibits both gamblers and families from seeking support (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Adults\\u0026rsquo; reflections on minimisation and delayed recognition align with earlier evidence on the hidden nature of gambling harms within families (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e). Young people\\u0026rsquo;s accounts of mistrust and disappointment in gambling adults add further weight to findings that harms are intergenerational and can undermine perceptions of family security (\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eBoth groups portrayed the gambling industry as predatory, highlighting aggressive marketing, sports sponsorship, and the integration of gambling into digital environments. These perceptions reinforce critiques that industry practices normalise gambling and shift responsibility onto individuals (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). Discussions in the adult groups also conveyed a strong moral dimension, reflecting anger, distrust, and a sense of betrayal toward the gambling industry. Taken together, these accounts position gambling harm not only as a public health issue but also as a matter of social justice and corporate accountability. Young people focused particularly on the appeal of celebrity endorsements and the \\u0026ldquo;gamblification\\u0026rdquo; of gaming, consistent with evidence of children\\u0026rsquo;s and adolescents\\u0026rsquo; susceptibility to gambling promotion in sport and digital media (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e). Adults, meanwhile, expressed frustration at weak regulation and political reliance on gambling revenue, echoing critiques that structural and policy-level factors perpetuate harm across the population (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe third theme highlighted the need for prevention strategies that move beyond generic responsibility slogans to approaches that are targeted, credible, and multi-level. Both groups emphasised the value of lived-experience narratives over abstract warnings. While qualitative studies consistently suggest such narratives are perceived as relatable and meaningful, evidence on their effectiveness remains limited, despite one study showing that narrative-based harm prevention adverts led to stronger reductions than other prevention adverts on gambling urges (\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e). Participants also cautioned against fear-based appeals, which they felt could reinforce stigma rather than promoting behaviour change. This aligns with evidence from gambling research showing that fear or guilt-provoking messages can provoke defensiveness and stigma, limiting their effectiveness (\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e). Adults uniquely stressed the lack of recognition and support for affected others, while young people emphasised the importance of early, peer-led education integrated into schools and digital platforms.\\u003c/p\\u003e \\u003cp\\u003eThe study findings resonate with debates about the limitations of universal prevention strategies. A recent Finnish study examining the feasibility and acceptability of \\u0026ldquo;lower risk\\u0026rdquo; gambling guidelines found that although the guidelines were generally regarded as useful, participants often perceived them as directed at \\u0026ldquo;others\\u0026rdquo; and emphasising the need for contextual adaptation (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). Such evidence contributes to ongoing discussions about whether gambling harm prevention should prioritise broad awareness-raising or approaches tailored to the needs of specific groups (\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e). In our study, some insights were shared across adults and young people, while others reflected group-specific experiences, underscoring the importance of inclusive and differentiated approaches\\u0026mdash;consistent with earlier work on the distinct needs of affected others (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e) and young people (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). Taken together, this suggests that effective prevention will require both universal messaging that raises awareness of gambling as a public health issue and targeted strategies that address the lived realities of affected others and young people.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations\\u003c/h2\\u003e \\u003cp\\u003eThe study was based on a small and geographically localised sample, and the findings are not intended to, nor do we claim they can be taken to, reflect the experiences of participants in other regions or demographic groups. Instead, we argue that they highlight the importance of more representative and stratified sampling approaches in studies seeking to develop and test messaging that is effective at a population level, alongside the inclusion of diverse communities in targeted work to build a broader understanding of perspectives. Demographic groups are rarely homogenous, and we highlight that young people identified as particularly vulnerable (e.g., those supported by social care) were excluded from the present work due to ethical and resource constraints. This exclusion likely led to an underrepresentation of experiences associated with the most acute manifestations of gambling-related harm, emphasising the need for future research that explicitly incorporates these voices. While we anticipate that some of the specific learning is likely to be transferable to comparable samples with shared experiences, we invite researchers to continue to explore perspectives with these, and other, under- or unrepresented groups. Of particular note, a recent systematic review (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e) highlighted the underrepresentation of ethnically minoritised communities, and we echo their call for more work with these communities.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eImplications for policy and public health messaging\\u003c/h2\\u003e \\u003cp\\u003eThe findings suggest that effective gambling harm prevention strategies must extend beyond individuals who gamble to include affected others, whose needs remain largely overlooked. Participants stressed that public health messaging can be effective when it is credible, non-stigmatising, and grounded in the lived realities of its audiences. In addition, participants\\u0026rsquo; strong feelings of anger and distrust toward the gambling industry point to the importance of rebuilding public confidence. Credible, transparent communication and visible accountability from government and industry are essential to ensure prevention messages are not perceived as hollow or insincere. Messaging strategies may therefore need to focus less on individual responsibility and more on validation, hope, and systemic support. Tailored approaches are essential: young people called for participatory, peer-led education embedded in schools and digital environments, while adults highlighted the invisibility of affected others and the need for early recognition tools.\\u003c/p\\u003e \\u003cp\\u003eFor young people, the embedding of gambling within sport, digital platforms, and youth-oriented spaces highlights the need for stricter regulation of advertising and sponsorship. Importantly, both groups emphasised that messaging must be accompanied by upstream measures such as affordability checks and advertising restrictions, ensuring that communication strategies are supported by structural reforms. Overall, the findings suggest that public health messaging must be embedded within a broader policy framework that tackles the structural drivers of gambling-related harm.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThis study provides an in-depth, multi-perspective analysis of gambling-related harm, illustrating the complex interplay between personal vulnerability, industry influence, and the policy environment. Adults affected by others\\u0026rsquo; gambling and young people in our study described harms as cumulative, relational, and often concealed. The gambling industry\\u0026rsquo;s normalisation of risk through advertising, gamification, and digital access was perceived as a key driver of harm, particularly among youth. Significantly, participants identified substantial gaps in support, especially for affected others who remain largely invisible in many policy and service responses.\\u003c/p\\u003e \\u003cp\\u003eThe study also highlights the moral and emotional dimensions shaping public perceptions of gambling harm. Participants expressed anger, distrust, and a sense of betrayal toward the gambling industry, viewing its practices as exploitative and unethical. Acknowledging these sentiments is important for designing credible prevention efforts and restoring public confidence in the institutions responsible for regulating gambling.\\u003c/p\\u003e \\u003cp\\u003eOur findings underscore the need for prevention strategies that are targeted, developmentally appropriate, and systemically grounded. Such strategies should combine public messaging that validates lived experience with structural policies that reduce risk exposure, alongside early recognition tools that empower affected individuals and communities.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\" \\u003cp\\u003e \\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e \\u003cp\\u003e Ethical approval for this study was obtained from the Newcastle University Faculty of Medical Sciences Ethics Review Committee (reference number 2623/35307). During recruitment, all participants completed an informed consent form. All participants received shopping vouchers worth \\u0026pound;30 at the end of the session.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e \\u003cp\\u003eNot applicable.\\u003c/p\\u003e \\u003c/p\\u003e\\u003cp\\u003e \\u003ch2\\u003eCompeting interests\\u003c/h2\\u003e \\u003cp\\u003eThe authors declare that they have no competing financial or non-financial interests.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003e This project is funded by the National Institute for Health and Care Research (NIHR) [Policy Research Unit Behavioural and Social Sciences (project reference NIHR206124)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eDR (first and corresponding author) contributed to the protocol, study design, data collection, data analyses, first manuscript draft, and manuscript review. LM contributed to the study design, data collection, data analysis, and manuscript review. PN contributed to the first manuscript draft and manuscript review. AG contributed to manuscript review. MK contributed to the protocol, study design, manuscript review, and funding acquisition. EO contributed to the protocol, study design, data analyses, first manuscript draft, manuscript review, and funding acquisition. MK and EO are joint last authors.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\u003cp\\u003eThe research team thanks Dr Lesley Hall, manager of the NIHR Policy Research Unit in Behavioural Science, for project oversight and support. We are grateful to two members of the Unit\\u0026rsquo;s Patient and Public Involvement and Engagement Strategy Group and to members of the young people\\u0026rsquo;s advisory group at GenerationR (https://generationr.org.uk) for their valuable input on the development of the focus group topic guides. We also thank Neha Jain, NIHR School for Public Health Research Pre-doctoral Fellow, Newcastle University, who co-facilitated one of the young people\\u0026rsquo;s focus groups alongside the lead researcher. Finally, we thank all focus group participants for generously sharing their time and perspectives.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eWardle H, Degenhardt L, Marionneau V. The Lancet Public Health Commission on gambling. Lancet Public Health. 2024;9(11):e950\\u0026ndash;94.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003evan Schalkwyk MC, Petticrew M, Cassidy R, Adams P, McKee M, Reynolds J, et al. A public health approach to gambling regulation: countering powerful influences. Lancet Public Health. 2021;6(8):e614\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNewall P, Rawat V, Hing N, Browne M, Tulloch C, Russell AM et al. 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BMC Public Health. 2018;18(1):1\\u0026ndash;11.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRay D, Thomson K, Beyer FR, Williams O, Stoniute A, Arisa O et al. Effectiveness of Public Messaging Within the Gambling Domain: A Systematic Review. Int J Mental Health Addict. 2024.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThomas S, van Schalkwyk M, Daube M, Pitt H, McGee D, McKee M. Protecting children and young people from contemporary marketing for gambling. Health Promot Int. 2023;38(2):daac194.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcCarthy S, Thomas S, Pitt H, Warner E, Roderique-Davies G, Rintoul A, et al. They loved gambling more than me. Women's experiences of gambling‐related harm as an affected other. Health Promotion J Australia. 2023;34(2):284\\u0026ndash;93.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGambling Commission. 2021. 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Int Gambl Stud. 2016;16(1):31\\u0026ndash;48.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAbbott M. Gambling and gambling-related harm: recent World Health Organization initiatives. Public Health. 2020;184:56\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"harm-reduction-journal\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"harj\",\"sideBox\":\"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)\",\"snPcode\":\"12954\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12954/3\",\"title\":\"Harm Reduction Journal\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Gambling-related harm, Affected others, Gambling harm prevention, Gambling marketing, Qualitative research\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9131253/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9131253/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cb\\u003eBackground\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eGambling is increasingly recognised as a public health concern, with harms extending beyond individuals who gamble to their families, peers, and communities. However, young people and adults affected by others\\u0026rsquo; gambling remain under-represented in research on harm prevention messaging.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eMethods\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eA critical qualitative inquiry approach was employed, involving four focus groups: two with adults affected by another person\\u0026rsquo;s gambling (n\\u0026thinsp;=\\u0026thinsp;10, aged 18\\u0026ndash;75 years) and two with young people living in households where an adult gambled (n\\u0026thinsp;=\\u0026thinsp;10, aged 13\\u0026ndash;18 years). Participants were recruited through community networks and online platforms. Data were analysed thematically using the Framework Method.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eResults\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eThree themes were identified. The first theme, \\u003cem\\u003eGambling-related harms are multifaceted and often hidden\\u003c/em\\u003e, highlights how harms extend beyond financial loss to include impacts on mental health, relationships, and family security, often reinforced by stigma and secrecy. Adults highlighted delayed recognition and minimisation of harm, while young people described diminished trust in adults who gambled. The second theme, \\u003cem\\u003ePredatory tactics of the gambling industry\\u003c/em\\u003e, captures participants\\u0026rsquo; perceptions of aggressive marketing, celebrity endorsements, and the normalisation of gambling through sports and digital platforms. Adults expressed moral outrage and distrust, viewing the industry as exploitative and unethical, whereas young people emphasised the influence of celebrity and gaming-related promotions. The third theme, \\u003cem\\u003eHarm prevention requires multi-level, targeted strategies\\u003c/em\\u003e, reflects participants\\u0026rsquo; views that industry slogans are ineffective and that prevention should instead emphasise credible, audience-specific messaging, lived-experience narratives, and systemic reforms. Adults underscored the invisibility of affected others and called for recognition and early support, while young people advocated for peer-led education integrated into schools and digital environments.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eConclusions\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe findings underscore the need for targeted approaches to messaging that reflect the experiences of different groups affected by gambling and associated harms. Prevention strategies should combine tailored communication with upstream interventions\\u0026mdash;such as stricter regulation of advertising and affordability checks\\u0026mdash;to address the structural drivers of gambling-related harm. Acknowledging the moral and emotional dimensions of gambling-related harm is essential for rebuilding trust and ensuring that prevention messages are credible, compassionate, and effective.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Affected others’ perspectives on the burden, drivers, and prevention of gambling- related harms: a qualitative study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-07 11:02:18\",\"doi\":\"10.21203/rs.3.rs-9131253/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewerAgreed\",\"content\":\"19214312451837709374427059366867632189\",\"date\":\"2026-05-15T17:50:00+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"218260082590207985306555266335569828781\",\"date\":\"2026-05-12T08:17:51+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-04-29T12:32:14+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-03-16T16:56:55+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-03-16T16:56:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Harm Reduction Journal\",\"date\":\"2026-03-15T21:42:47+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"harm-reduction-journal\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"harj\",\"sideBox\":\"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)\",\"snPcode\":\"12954\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12954/3\",\"title\":\"Harm Reduction Journal\",\"twitterHandle\":\"@BioMedCentral\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"0bca0b58-6773-444a-a610-777f3ba24d0f\",\"owner\":[],\"postedDate\":\"May 7th, 2026\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"reviewerAgreed\",\"content\":\"19214312451837709374427059366867632189\",\"date\":\"2026-05-15T17:50:00+00:00\",\"index\":11,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"218260082590207985306555266335569828781\",\"date\":\"2026-05-12T08:17:51+00:00\",\"index\":9,\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"4\",\"date\":\"2026-04-29T12:32:14+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-07T11:02:19+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-07 11:02:18\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9131253\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9131253\",\"identity\":\"rs-9131253\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}