School of Health and Related Research, University of Sheffield, Sheffield, UK.
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Lancet Public Health. 2021 Jan;6(1):e50-e63. doi: 10.1016/S2468-2667(20)30230-9.
Recognition is growing that gambling, although highly profitable for corporations and governments, is a source of serious and unevenly distributed harm. This recognition has led to demands for public health strategies at the local, national, and international levels. We aimed to identify review-level evidence for interventions to address or prevent gambling-related harms and explore policy implications, using stakeholder consultation to assess the evidence base, identify gaps, and suggest key research questions. We opted for a systematic mapping review and narrative synthesis for all forms of gambling in any setting. We included participants from the whole population, identified gamblers including self-defined, and specific populations at risk (eg, children and young people). We included all outcome measures relating to prevention or treatment of gambling-related harms that were reported by review authors. After duplication, the searches generated 1080 records. Of 43 potential papers, 13 were excluded at the full paper stage and 30 papers were included in the Review. We identified whole-population preventive interventions, such as demand reduction (n=3) and supply reduction (n=4) interventions, and targeted treatment interventions for individuals addicted to gambling, such as therapeutic (n=12), pharmacological (n=5), and self-help or mutual support (n=4) interventions. We also reviewed studies (n=2) comparing these approaches. Interventions to screen, identify, and support individuals at risk of gambling-related harms and interventions to support ongoing recovery and prevent relapse for individuals with a gambling addiction were not represented in the review-level evidence. A public health approach suggests that there are opportunities to reduce gambling-related harms by intervening across the whole gambling pathway, from regulation of access to gambling to screening for individuals at risk and services for individuals with an identified gambling problem. The dearth of evidence for some interventions means that implementation must be accompanied by robust evaluation.
越来越多的人认识到，赌博虽然对公司和政府来说利润丰厚，但也是造成严重且分布不均的危害的一个来源。这种认识促使人们在地方、国家和国际各级呼吁采取公共卫生策略。我们旨在确定针对解决或预防赌博相关危害的干预措施的综述级证据，并利用利益攸关方协商来评估证据基础、确定差距和提出关键研究问题，以探索政策含义。我们选择对任何环境中的所有形式的赌博进行系统映射综述和叙述性综合。我们纳入了来自整个人群的参与者，包括自我定义的赌徒和特定的高危人群（例如，儿童和年轻人）。我们纳入了所有与预防或治疗赌博相关危害有关的报告由综述作者的结果测量。在重复搜索后，共生成了 1080 条记录。在 43 篇潜在论文中，有 13 篇在全文阶段被排除，30 篇论文被纳入综述。我们确定了全人群预防干预措施，例如需求减少（n=3）和供应减少（n=4）干预措施，以及针对赌博成瘾个体的靶向治疗干预措施，例如治疗性（n=12）、药理学（n=5）和自助或互助支持（n=4）干预措施。我们还回顾了比较这些方法的研究（n=2）。在综述级证据中没有发现针对赌博相关危害风险个体进行筛查、识别和支持以及针对有赌博问题的个体进行持续康复和预防复发的干预措施。公共卫生方法表明，通过干预整个赌博途径，从赌博准入的监管到对有风险的个体进行筛查以及为有明确赌博问题的个体提供服务，可以有机会减少赌博相关危害。一些干预措施缺乏证据意味着实施必须伴随着强有力的评估。
