The politics and fantasy of the gambling education discourse: An analysis of gambling industry-funded youth education programmes in the United Kingdom

"Stop, don't touch, run away!": reconceptualizing firearm industry-funded youth education programs as corporate political activity

BACKGROUND

Injuries represent a major threat to child health globally. In the US, firearm injuries are the leading cause of death among children and adolescents. Despite limited evidence of their effectiveness industry-funded bodies promote the delivery of their youth education programs while lobbying against firearm control policies. This article analyzes how the National Rifle Association (NRA) frames issues of gun ownership, safety and the role of the Eddie Eagle GunSafe® program as an effective firearm safety intervention and examines how the design, promotion and delivery of the program serves the corporate political interests of the firearm industry at the expense of public health.

METHODS

We conducted an analysis of Eddie Eagle Gunsafe® program-related materials and the NRA's practices to promote the program's legitimacy and effectiveness, by applying published taxonomies of corporate framing and action strategies. Data were collected from the program-specific websites and other NRA outlets to capture the breadth of strategies used by the NRA.

RESULTS

The NRA's education-related practices support the firearm industry's political agenda. The NRA adopts framing and action strategies that present the presence of firearms in homes and communities as inevitable and normal, and the education of children through the delivery of their "lifesaving" program as the common-sense and effective way of keeping children safe from firearm injuries. They make misleading claims about the effectiveness of the Eddie Eagle Gunsafe® program while undermining the credibility of those who advocate for child safety, including mothers and public health actors.

CONCLUSION

The delivery of the Eddie Eagle GunSafe® program needs critical scrutiny as is increasingly applied to other industry-funded initiatives. Policies based on a recognition that children and adolescents are safest when their homes and communities are free of firearms are needed. Findings from this analysis are relevant beyond the US and can be used to inform the governance of child safety and injury prevention globally. Analysis of the firearm industry extends the literature on the commercial determinants of health to an important new sector with significant impacts on global health.

The UK Tobacco and Vapes Bill (2023/4): framing strategies used by tobacco and nicotine industry actors faced with an endgame policy (a generational sales ban of tobacco products) and nicotine product restrictions

BACKGROUND

In 2023, the UK government proposed a Bill introducing a generational ban on the sale of tobacco products and measures targeting youth nicotine product (NP) use. Industries' responses remain unexplored.

METHODS

We analysed 43 consultation and evidence submissions from tobacco and nicotine industry-linked actors, assessing their connections to transnational tobacco companies (TTCs) and using an evidence-based taxonomy to examine framing strategies.

RESULTS

TTCs and actors with known current TTC links accounted for 42% of submissions. Other actors-some with historic TTC ties-were other tobacco products (OTPs) specialists, NP specialists and retailers. Tobacco and nicotine industries were generally portrayed as 'good' with TTCs framing themselves as public health champions, while policymakers, the public health community and non-compliant sellers were depicted as 'bad' actors. TTCs, linked groups and additional OTP actors opposed the generational ban, arguing it lacked evidence and would harm the economy and increase violence against retailers. Proposed alternative approaches included exempting heated tobacco products (HTPs) and OTPs, and raising the age of sale to 21. TTCs, linked actors and NP actors opposed restrictions on NP flavours, packaging and display, arguing these would infringe on rights, harm retailers, stifle innovation, and increase smoking and illicit trade. They framed youth NP use as resulting from irresponsible individuals and advocated for education, stricter penalties and self-regulation.

CONCLUSION

When faced with tobacco endgame and nicotine control policies in the UK, tobacco and nicotine industries pushed back using framing strategies common to health-harming industries. Despite contradicting their 'transformation' narratives, TTCs still sought to position themselves as public health actors deserving policy access. Advocates, researchers and policymakers can anticipate opposition to endgame policies-such as a generational sales ban-and NP restrictions, proactively preparing to counter this opposition in order to safeguard public health policy from vested interests.

Social media and the spread of misinformation: infectious and a threat to public health

Misinformation has been identified as a major threat to society and public health. Social media significantly contributes to the spread of misinformation and has a global reach. Health misinformation has a range of adverse outcomes, including influencing individuals' decisions (e.g. choosing not to vaccinate), and the erosion of trust in authoritative institutions. There are many interrelated causes of the misinformation problem, including the ability of non-experts to rapidly post information, the influence of bots and social media algorithms. Equally, the global nature of social media, limited commitment for action from social media giants, and rapid technological advancements hamper progress for improving information quality and accuracy in this setting. In short, it is a problem that requires a constellation of synergistic actions aimed at social media users, content creators, companies, and governments. A public health approach to social media-based misinformation that includes tertiary, secondary, and primary prevention may help address immediate impacts, long-term consequences, and root causes of misinformation. Tertiary prevention to 'treat' this problem involves increased monitoring, misinformation debunking, and warning labels on social media posts that are at a high risk of containing misinformation. Secondary prevention strategies include nudging interventions (e.g. prompts about preventing misinformation that appear when sharing content) and education to build media and information literacy. Finally, there is an urgent need for primary prevention, including systems-level changes to address key mechanisms of misinformation and international law to regulate the social media industry. Anything less means misinformation-and its societal consequences-will continue to spread.

The influence of technology: Internet gambling among college students

Adolescent gambling, internet gambling among college students, and the impact of school bullying collectively form a complex web of challenges that significantly influence the well-being of today's youth. As technology continues to evolve, the accessibility of online platforms has heightened concerns regarding the occurrence and impact of online gambling among college students. This quantitative research investigates the interconnected dynamics of adolescent gambling prevention strategies, internet gambling among high school and college students, and the role of school bullying. Utilizing a purposive sampling technique, 800 valid responses were collected from a total distribution of 850 questionnaires (500 high school, and 300 college students). The data, analyzed using SPSS statistical software, yielded significant findings. The study validates a negative correlation between effective adolescent gambling prevention strategies and problematic gambling prevalence. It also reveals higher psychological distress and a negative correlation between academic performance and internet gambling frequency among college students engaged in internet gambling. Furthermore, a positive association exists between school bullying experience and adolescents' engagement in both offline and online gambling behaviors. Demographic factors such as socioeconomic status and ethnicity were found to moderate the relationship between adolescent gambling prevention strategies and gambling prevalence. A research novelty is introduced, demonstrating a positive correlation between exposure to pro-gambling advertisements on digital platforms and the frequency and severity of internet gambling among college students. This study offers insightful perspectives on the complex dynamics of adolescent behaviors, guiding the creation of specific prevention strategies and emphasizing the influence of digital advertising on internet gambling.

Youth perspectives on the promotional and public relations strategies of health harming industries

Public health researchers have investigated how youth are exposed to and influenced by traditional forms of commercial marketing from health-harming industries. Limited research has investigated youth opinions about the broader marketing and public relations strategies of these industries. This study aimed to understand youth perceptions of the impact and influence of a range of marketing and public relations strategies used by health harming industries. An online qualitative survey was conducted with n = 518, 16- to 24-year-olds living in Victoria, Australia. Participants were asked to consider the broad influence of marketing from health harming industries on youth, including the impacts of social media promotions, corporate social responsibility strategies including sponsorship and political donations, as well as their views on marketing restrictions. Reflexive thematic analysis was used to construct themes from the data. Participants stated that excessive marketing strategies had a significant influence on youth consumption of health harming products. Most felt that social media marketing had the most appeal and influence on youth. Most were critical of these strategies and were supportive of strong restrictions on marketing for health-harming products. However, many participants held more positive views about corporate social responsibility strategies, which they perceived could offset the negative impacts of these industries on health. Increased focus is needed from the public health and health promotion communities to ensure that youth are protected from the influence of the range of marketing strategies that are used by health-harming industries to promote their products and resist regulatory reform.

Industry influence on public health policy formulation in the UK: a complex systems approach

Unhealthy commodity industries (UCIs) such as tobacco, alcohol, gambling, ultra-processed food and beverage producers are known to influence policy-making to advance their interests, often to the detriment of public health goals. This study mapped the complex system underpinning UCI's influence on public health policy formulation in the UK and identified potential interventions to shift the system towards being able to better attain public health goals. We conducted a participatory systems mapping workshop with ten experts to build a causal loop diagram (CLD) and identify potential interventions to address UCI's influence on public health policy development. The resulting CLD depicts a highly interconnected and reinforcing system driving UCI's involvement in public health policy formulation across five thematic areas. Among the most connected elements were the 'dominance of market mechanisms', 'perception of partnership as good governance principle', 'industry involvement lending perceived legitimacy to the policy formulation process', 'industry is seen as part of the solution' and 'industry ties to policy-makers'. Participants identified a total of 22 interventions within this system. Analysis of the CLD and interventions identified the potential for two key paradigmatic changes in this complex system: de-normalizing the perception of unhealthy commodity industry actors as legitimate stakeholders in policy formulation; and prioritizing public health and wellbeing objectives over profit and economic gain. In order to shift the system towards better attaining public health goals, interventions should reinforce each other and be supportive of these two key paradigmatic shifts.

Australian parents' perceptions of the risks posed by harmful products to the health of children

Cigarettes, alcohol, vaping and gambling products can cause significant harm to children and young people. The industries that make these products employ a range of tactics that aim to normalize their products and resist policy and regulatory reform. This includes 'responsibility' framing, in which parents are often held responsible for educating their children about the risks of these products. However, there has been very little research, which has investigated parents' perceptions of these industries. A qualitatively led online panel survey was conducted with n = 455 Australian parents who had at least one child aged between 11 and 17 years. Participants were asked questions relating to concerns about harmful products; what they talked about with their children; other potential sources of risk information; and who were responsible for protecting young people from these industries. Four themes were constructed. (i) Parents identified that parental influence, peer pressure, social media and advertising influenced children's attitudes towards these products. (ii) They had concerns about the short- and long-term consequences of these products. (iii) Parents actively engaged in educating their children about these products but recognized that it was difficult to counter industry messages. (iv) Parents emphasized the need for a collective approach, advocating for increased information and government regulations, particularly relating to marketing. This study demonstrates that parents are concerned about these industries and do their best to protect their children from harm but recognize that they need more support. Evidence-based education and comprehensive regulations particularly around marketing are needed to de-normalize products and protect young people.

Protocol for a pilot cluster randomised controlled trial of PRoGRAM-A (preventing gambling-related harm in adolescents): a secondary school-based social network intervention

BACKGROUND

In the UK, recent evidence of young people and gambling indicates a higher prevalence of gambling in comparison to other addictive behaviours. Engaging in gambling-related behaviour at a young age is associated with short and long-term consequences, including financial, emotional, academic, interpersonal, and physical and mental health detriments; otherwise known as gambling-related harms (GRH). Given the unique vulnerability of this younger group, early interventions aimed at delaying or preventing gambling are critical. PRoGRAM-A (Preventing Gambling-Related Harm in Adolescents) is a school-based, social network intervention to protect young people from future GRH, by delaying or preventing gambling experimentation.

METHODS

Pilot cluster RCT with an embedded process evaluation and health economic scoping study.

PARTICIPANTS

PRoGRAM-A will be delivered in four schools, with two control schools acting as a comparator. All are secondary schools in Scotland. Baseline surveys were conducted with students in S3 (ages 13-14). Follow-up surveys were conducted with the same cohort, six months post-baseline.

INTERVENTION

PRoGRAM-A trainers will deliver a 2-day, out-of-school training workshop to Peer supporters. Peer supporters will be nominated by peers among their school year group (S3, age 13-14). Workshops will provide peer supporters with information on four gambling-related topics: (1) what is gambling? (2) gambling and gaming, (3) gambling marketing, (4) identifying harm and reducing risk. Peer supporters will disseminate the information (message diffusion) they have learned among their friends and family over a 10-week period. After the 2-day workshop, PRoGRAM-A trainers will conduct × 3 in-school follow-up sessions with peer supporters to offer support, encouragement, and advice to Peer Supporters as well as monitor and explore the extent of their message diffusion.

PRIMARY OUTCOME

The primary outcome of the pilot cluster RCT (cRCT) will be whether progression to a phase III RCT is justified.

DISCUSSION

This will be the first pilot cluster RCT (cRCT) of an intervention to prevent gambling-related harms among young people within the UK. If findings indicate feasibility and acceptability, funding will be sought for a phase III RCT of effectiveness.

TRIAL REGISTRATION

Researchregistry8699. Registered 21st February 2023.

"It's changing our lives, not for the better. It's important that we have a say". The role of young people in informing public health and policy decisions about gambling marketing

BACKGROUND

Marketing has a significant impact on the normalisation of gambling for youth across the globe. This has included shaping positive attitudes towards gambling, as well as increasing the social and cultural acceptance of gambling - particularly aligned with valued activities such as sport. Because of this, public health experts argue that gambling marketing poses a significant risk to the health and wellbeing of youth. While young people are increasingly exposed to, and impacted by marketing for gambling products, they are rarely consulted about policy issues and options. This study aimed to explore young Australians' perceptions of current policy responses to gambling advertising, whether they thought young people should be involved in discussions and decisions about gambling marketing regulations, and their perceptions of the duty of governments to protect young people from gambling industry marketing strategies.

METHODS

Qualitative focus groups (n = 22) were held with n = 64, 12-17 year olds in the Australian states of Victoria and New South Wales. Participants were asked to reflect on current gambling policies, particularly relating to marketing, what they thought should be done about gambling marketing, and if and how young people should be included in public health responses to gambling. An interpretivist 'Big Q' approach to reflexive thematic analysis was used.

RESULTS

Young people highlighted the need for more effective regulations around the content and frequency of gambling marketing. They also wanted to see more realistic representations of the negative impacts of gambling to counter persistent positive commercial marketing messages. Most thought that young people should be given an opportunity to have a say about responses to gambling due to their unique experiences. Participants identified mechanisms to increase young people's engagement in decision making, such as direct lines of communication to different levels of government, involvement in research, and diversifying ways of engagement. Specific recommendations included more regulatory action such as bans on gambling advertising.

CONCLUSIONS

Creating formal structures that facilitate the inclusion of young people's perspectives in decisions made about gambling can result in more innovative and effective strategies to prevent the harms from gambling industry products, promotions, and practices.

Characteristics of commercial determinants of health research on corporate activities: A scoping review

INTRODUCTION

Business practices have influenced human health for centuries, yet an overarching concept to study these activities across nations, time periods, and industries (called 'the commercial determinants of health' (CDH)) has emerged only recently. The purpose of this review was to assess the descriptive characteristics of CDH research and to identify remaining research gaps.

METHODS

We systematically searched four databases (Scopus, OVID Medline, Ovid Embase, and Ovid Global Health) on Sept 13, 2022 for literature using CDH terms that described corporate activities that have the potential to influence population health and/or health equity (n = 116). We evaluated the following characteristics of the literature: methods employed, industries studied, regions investigated, funders, reported conflicts of interest, and publication in open-access formats.

RESULTS

The characteristics of the articles included that many were conceptual (50/116 articles; 43%) or used qualitative methods (37; 32%). Only eight articles (7%) used quantitative or mixed methods. The articles most often discussed corporate activities in relation to the food and beverage (51/116; 44%), tobacco (20; 17%), and alcohol industries (19; 16%), with limited research on activities occurring in other industries. Most articles (42/58 articles reporting a regional focus; 72%) focused on corporate activities occurring in high-income regions of the world.

CONCLUSIONS

Our findings indicate that literature that has used CDH terms and described corporate practices that influence human health has primarily focused on three major industries in higher-income regions of the world. Qualitative methods were the most common empirical method for investigating these activities. CDH-focused investigations of corporate practices conducted by less-studied industries (e.g., social media) and in lower-income regions are recommended. Longitudinal quantitative studies assessing the associations between corporate practices and a range of health outcomes is also a necessary next step for this field.

Agnogenic practices and corporate political strategy: the legitimation of UK gambling industry-funded youth education programmes

Agnogenic practices-designed to create ignorance or doubt-are well-established strategies employed by health-harming industries (HHI). However, little is known about their use by industry-funded organizations delivering youth education programmes. We applied a previously published framework of corporate agnogenic practices to analyse how these organizations used them in three UK gambling industry-funded youth education programmes. Evidential strategies adopted previously by other HHI are prominent in the programmes' practitioner-facing materials, evaluation design and reporting and in public statements about the programmes. We show how agnogenic practices are employed to portray these youth education programmes as 'evidence-based' and 'evaluation-led'. These practices distort the already limited evidence on these educational initiatives while legitimizing industry-favourable policies, which prioritize commercial interests over public health. Given the similarities in political strategies adopted by different industries, these findings are relevant to research and policy on other HHI.

Children, young people and the Commercial Determinants of Health

The commercial determinants of health (CDoH) have a significant impact on the health and well-being of children and young people (subsequently referred to as young people). While most research has focused on the influence of harmful industry marketing on young people, more recent CDoH frameworks have emphasized that a range of commercial systems and practices may influence health and well-being. Focusing on the impact of traditional and digital media, contemporary marketing strategies and corporate production and consumption processes, the following article outlines the impact of the CDoH on the health and wellbeing of young people. The article also provides evidence about how young people conceptualize the impact of corporate actors on health, and their involvement in advocacy strategies to respond. The article recommends that when collaborating with young people to understand the impacts of and responses to the CDoH, we should seek to diversify investigations towards the impact of a range of corporate tactics, systems and structures, rather than simply focusing on the impacts of advertising. This should include considering areas and priorities that young people identify as areas for action and understanding why some young people are more vulnerable to commercial tactics than others. Youth are powerful allies in responding to the CDoH. Public health and health promotion stakeholders could do more to champion the voices of young people and allow them to be active participants in the decisions that are made about harmful commercial practices and health.

Protecting children and young people from contemporary marketing for gambling

Around the world, children are being exposed to intensive marketing for gambling products. This normalizes perceptions that gambling is essentially a harmless form of entertainment, despite mounting evidence of the harms it causes. Young people and their parents are supportive of strategies to protect children from being exposed to gambling marketing. Yet existing regulatory efforts are inconsistent and inadequate, and have not protected children from exposure to the many forms of marketing now being developed and exploited by the gambling industry. We outline existing knowledge about strategies used by the gambling industry to market its products, with a specific focus on the potential impact of gambling marketing on young people. We provide a definition of gambling marketing and outline the different forms of promotion that are currently used to market gambling, current regulatory responses, and the impact of marketing on children and young people. We then argue that a comprehensive public health approach to gambling is urgently required, which must include effective action to limit the influence of marketing for gambling products, while recognizing that it is never possible to insulate children entirely from their reach.

The impact of responsible gambling framing on people with lived experience of gambling harm

BACKGROUND

The framing of health issues influences how people think about and respond to these topics. Gambling has largely been framed as an issue of personal responsibility, with the gambling industry, governments and some researchers promoting responsible gambling strategies as a way to address gambling harm. While there is evidence that the internalization of personal responsibility can negatively impact gamblers, this study aimed to explore how people who have experienced gambling harm interpret and apply personal responsibility frames and 'gamble responsibly' messages in their lives.

METHODS

In-depth semi-structured interviews were conducted via Zoom and telephone with 15 gamblers who had been harmed by their own gambling and six affected others who had been harmed by someone else's gambling. This study was informed by public health and critical qualitative approaches to inquiry. The data were analyzed using reflexive thematic analysis.

RESULTS

Four themes were constructed from the data. First, gamblers and affected others generally conceptualized gambling and gambling harm as being the responsibility of the individual because it was perceived as the outcome of individual behavior. Second, they attempted to apply responsibility to their own experience either as gamblers who tried to stop or reduce their gambling, or affected others who felt responsible for helping the gambler in their lives. Third, gamblers and affected others were negatively impacted when it was perceived the gambler could not 'control' their gambling or had not done enough to take responsibility. Finally, gamblers and affected others recommended responsible gambling strategies be reframed to be more effective at addressing gambling harm.

CONCLUSION

This study provides evidence further supporting research demonstrating that personal responsibility frames may have unintended or negative consequences for gamblers and affected others. It underscores the need to reframe public messages about gambling away from responsible gambling, and toward research-based messages that can complement broader legislative changes and other measures to protect individuals.

A comparative study of industry responses to government consultations about alcohol and gambling in the UK

BACKGROUND

There is growing evidence that common strategies are used across unhealthy commodity industries (UCIs) to influence policy decisions in line with their commercial interests. To date, there have been relatively few studies comparing corporate political activity (CPA) across UCIs, especially comparing the alcohol and gambling industries.

METHODS

A comparative and inductive thematic analysis of alcohol and gambling industry submissions to two House of Lords (HoL) inquiries in the UK was conducted. Themes in the framing, arguments and strategies used by the alcohol and gambling industries in CPA were compared.

RESULTS

Alcohol and gambling industry responses largely used the same framings, both in terms of the problems and solutions. This included arguing that harms are only experienced by a 'minority' of people, emphasising individual responsibility and shifting blame for harms to other industry actors. They promoted targeted or localised solutions to these harms, in place of more effective population level solutions, and emphasised the perceived harms of introducing regulation not in the industries' interests.

CONCLUSIONS

These findings are consistent with previous literature suggesting that UCIs use the same framing and arguments to shape the narrative around their harms and solutions to those harms. This study also identified novel strategies such as shifting blame of harms to other industry actors. Policy makers should be aware of these strategies to avoid undue industry influence on policy decisions and understanding commonalities in strategies may help to inform more effective public health responses across all UCIs.

A Longitudinal Examination of Young People's Gambling Behaviours and Participation in Team Sports

This paper develops and expands upon social identity theory as an explanation for gambling among youth engaged in team sport. Analysing longitudinal data for over 4500 20-year-olds from the Growing Up in Ireland study, reveals that online gambling increased from 2.6 to 9.3% between 17 and 20 years in the cohort, with the increase driven by males. A statistically significant positive association is uncovered between playing team sports and regularly gambling, as well as online gambling behaviour, independent of socio-demographic and other risk factors for males but not for females. The findings provide support for a dose-response like effect for males, where a longer period of participation in team sports is associated with a higher likelihood of engaging in gambling behaviour compared to shorter periods. Implications of the findings for policy and practice are discussed.