BackgroundHarm from gambling is known to impact individuals, families, and communities; and these harms are not restricted to people with a gambling disorder. Currently, there is no robust and inclusive internationally agreed upon definition of gambling harm. In addition, the current landscape of gambling policy and research uses inadequate proxy measures of harm, such as problem gambling symptomology, that contribute to a limited understanding of gambling harms. These issues impede efforts to address gambling from a public health perspective.MethodsData regarding harms from gambling was gathered using four separate methodologies, a literature review, focus groups and interviews with professionals involved in the support and treatment of gambling problems, interviews with people who gamble and their affected others, and an analysis of public forum posts for people experiencing problems with gambling and their affected others. The experience of harm related to gambling was examined to generate a conceptual framework. The catalogue of harms experienced were organised as a taxonomy.ResultsThe current paper proposes a definition and conceptual framework of gambling related harm that captures the full breadth of harms that gambling can contribute to; as well as a taxonomy of harms to facilitate the development of more appropriate measures of harm.ConclusionsOur aim is to create a dialogue that will lead to a more coherent interpretation of gambling harm across treatment providers, policy makers and researchers.

By far the most common strategy used in the attempt to modify negative attitudes toward vaccination is to appeal to evidence-based reasoning. We argue, however, that focusing on science comprehension is inconsistent with one of the key facts of cognitive psychology: Humans are biased information processors and often engage in motivated reasoning. On this basis, we hypothesised that negative attitudes can be explained primarily by factors unrelated to the empirical evidence for vaccination; including some shared attitudes that also attract people to complementary and alternative medicine (CAM). In particular, we tested psychosocial factors associated with CAM endorsement in past research; including aspects of spirituality, intuitive (vs analytic) thinking styles, and the personality trait of openness to experience. These relationships were tested in a cross-sectional, stratified CATI survey (N = 1256, 624 Females). Whilst educational level and thinking style did not predict vaccination rejection, psychosocial factors including: preferring CAM to conventional medicine (OR .49, 95% CI .36–.66), endorsement of spirituality as a source of knowledge (OR .83, 95% CI .71–.96), and openness (OR .86, 95% CI .74–.99), all predicted negative attitudes to vaccination. Furthermore, for 9 of the 12 CAMs surveyed, utilisation in the last 12 months was associated with lower levels of vaccination endorsement. From this we suggest that vaccination scepticism appears to be the outcome of a particular cultural and psychological orientation leading to unwillingness to engage with the scientific evidence. Vaccination compliance might be increased either by building general confidence and understanding of evidence-based medicine, or by appealing to features usually associated with CAM, e.g. ‘strengthening your natural resistance to disease’.

Controversy around the safety and efficacy of COVID-19 vaccines may lead to low vaccination rates. Survey data were collected in April and August 2020 from a total of 2343 Australian adults. A quarter (n = 575, 24%) completed both surveys. A generalized linear mixed model analysis was conducted to determine whether willingness to vaccinate changed in the repeated sample, and a multinominal logistic regression was conducted in all participants to determine whether willingness to vaccinate was associated with demographics, chronic disease, or media use. Willingness to vaccinate slightly decreased between April (87%) and August (85%) but this was not significant. Willingness to vaccinate was lower in people with a certificate or diploma (79%) compared to those with a Bachelor degree (87%), p < 0.01 and lower in infrequent users of traditional media (78%) compared to frequent users of traditional media (89%), p < 0.001. Women were more likely to be unsure if they would be willing to vaccinate (10%) compared to men (7%), p < 0.01. There were no associations between willingness to vaccinate and age, chronic disease, or social media use. Promotion of a COVID-19 vaccine should consider targeting women, and people with a certificate or diploma, via non-traditional media channels.

While the PGSI is indeed an established index of problem-gambling symptoms, it nevertheless does not quantify the degree of harm experienced by individuals at different points on the spectrum of gambling problems. The purpose of the present study was to establish the relationship between the PGSI category and health-related quality of life (HRQoL) decrements using a population health (PH) method. Harms reported by gamblers and affected others across the PGSI spectrums were transformed into 798 vignettes. A general population panel (N=786) and experts who work with gamblers (N=51) rated the impact of these vignette descriptions on quality of life using the Time Trade-Off task, and a Visual Analogue Scale incorporating 27 comparison conditions. Disability weights (DW) were then estimated for different levels of gambling symptoms. A DW of 0.44 was estimated for problem gamblers (PG), suggesting a reduction in the effective enjoyment of life by over 4 years for every 10 years in lifespan. Lower—but non-negligible—DWs of .14 and .29 were determined for low- and moderate-risk gamblers. Gambling is compared with a number of other conditions with respect to HRQoL impact. On average, PG harm appears to be similar to that of a manic episode of bipolar disorder and severe alcohol abuse disorder. We discuss advantages, and methodological challenges, in applying PH methods to measuring the severity of gambling problems in terms of HRQoL.Bien que l'indice du jeu excessif (PGSI) soit en effet un indice établi des symptômes liés aux problèmes de jeu, il ne quantifie pas le niveau de préjudice subi par les personnes situées à différents points sur le spectre des problèmes de jeu. Le but de l'étude a été d’établir la relation entre la catégorie PGSI et les écarts à la baisse en lien avec la qualité de vie liée à la santé (QVLS) en utilisant une méthode de santé de la population. Les torts signalés par les joueurs et les personnes touchées dans le spectre PGSI ont été transformés en 798 vignettes. Un groupe de population en général (N = 786) et des experts qui travaillent avec des joueurs compulsifs (N = 51) ont évalué l’incidence de ces descriptions de vignette sur la qualité de vie à l’aide de la tâche Time Trade-Off (marchandage de temps) et une échelle visuelle analogue intégrant 27 conditions de comparaison. Les poids d’incapacité (DW) ont ensuite été estimés pour différents niveaux de symptômes du jeu. Un DW de 0,44 a été estimé pour les joueurs compulsifs, ce qui laisse supposer une diminution de la jouissance réelle de la vie de plus de 4 ans pour chaque tranche de vie de 10 ans. Les DW inférieurs, mais non négligeables, de 0,14 et 0,29 ont été déterminés pour les joueurs à risque faible et modéré. Le jeu est comparé à un certain nombre d’autres conditions en ce qui concerne l’incidence de la qualité de vie liée à la santé (QVLS). En moyenne, le préjudice causé par un joueur compulsif s'apparente à celui d’un épisode maniaque de trouble bipolaire et d’un trouble sévère d’abus d’alcool. Nous discutons des avantages et des défis méthodologiques, en appliquant des méthodes de santé de la population pour mesurer la gravité des problèmes de jeu en termes de QVLS.