Alcohol, Drugs and Tobacco Division, Public Health England, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Alcohol, Drugs and Tobacco Division, Public Health England, London, UK.
Lancet Public Health. 2022 Aug;7(8):e705-e717. doi: 10.1016/S2468-2667(22)00137-2.
There is increasing public health concern about harmful gambling, but no consensus on effective policies and interventions to reduce risk and prevent harm has been reached. Focusing on policies and interventions (ie, measures), the aim of this study was to determine if expert consensus could be reached on measures perceived to be effective that could be implemented successfully. Our work involved a pre-registered, three-round, independent Delphi panel consensus study and an implementation rating exercise. A starting set of 103 universal and targeted measures, which were sourced from several key resources and inputs from public health stakeholders, were grouped into seven domains: price and taxation; availability; accessibility; marketing, advertising, promotion, and sponsorship; environment and technology; information and education; and treatment and support. Across three rounds, an independent panel of 35 experts individually completed online questionnaires to rank each measure for known or potential effectiveness. A consensus was reached if at least 70% of the panel judged a measure to be either not effective, moderately effective, or highly effective. Then, each measure that reached a consensus for effectiveness was evaluated on four implementation dimensions: practicability, affordability, side-effects, and equity. A summative threshold criterion was used to select a final optimal set of measures for England. The panel reached consensus on 83 (81%) of 103 measures. Two measures were judged as ineffective by the panel. The remaining 81 effective measures were drawn from all domains (14 of 15 measures in the the marketing, advertising, promotion, and sponsorship domain were judged as effective, whereas five of ten measures in the information and education domain were judged as effective). During the evaluation exercise, the 81 measures were assessed for likelihood of implementation success. This assessment considered the practicality, affordability, ability to generate unanticipated side-effects, and ability to decrease differences between advantaged and disadvantaged groups in society of each measure. We identified 40 universal and targeted measures to tackle harmful gambling (three measures from the price and taxation domain; ten from the availability domain; five from the accessibility domain; six from the marketing, advertising, promotion, and sponsorship domain; eight from the environment and technology domain; three from the information and education domain; and five from the treatment and support domain). Implementation of these measures in England could substantially strengthen regulatory controls while providing new resources. The findings of our work offer a blueprint for a public health approach to preventing harms related to gambling.
公众越来越关注有害赌博对健康的危害，但尚未就减少风险和预防危害的有效政策和干预措施达成共识。本研究聚焦于政策和干预措施（即措施），旨在确定专家是否能够就可成功实施的被认为有效的措施达成共识。我们的工作涉及一项预先注册的三轮独立德尔菲小组共识研究和一项实施评估。一组 103 项通用和有针对性的措施，这些措施来源于多个关键资源和公共卫生利益相关者的投入，被分为七个领域：价格和税收；供应；可及性；营销、广告、促销和赞助；环境和技术；信息和教育；以及治疗和支持。在三轮中，一个独立的 35 名专家小组通过在线问卷对每个措施的已知或潜在有效性进行单独排名。如果至少 70%的小组判断一项措施无效、中度有效或高度有效，则达成共识。然后，对达成有效性共识的每项措施，从可操作性、可负担性、副作用和公平性四个实施维度进行评估。使用综合门槛标准来为英格兰选择最终的最佳措施集。小组就 103 项措施中的 83 项（81%）达成共识。两项措施被小组判定为无效。其余 81 项有效措施来自所有领域（营销、广告、促销和赞助领域的 15 项措施中有 14 项被判定为有效，而信息和教育领域的 10 项措施中有 5 项被判定为有效）。在评估过程中，对 81 项措施的实施成功率进行了评估。这一评估考虑了每个措施的可操作性、可负担性、产生意外副作用的能力，以及减少社会中优势和劣势群体之间差异的能力。我们确定了 40 项通用和有针对性的措施来解决有害赌博问题（价格和税收领域的三项措施；供应领域的十项措施；可及性领域的五项措施；营销、广告、促销和赞助领域的六项措施；环境和技术领域的八项措施；信息和教育领域的三项措施；以及治疗和支持领域的五项措施）。在英格兰实施这些措施可以大大加强监管控制，同时提供新的资源。我们工作的结果为预防赌博相关危害的公共卫生方法提供了蓝图。
