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Loot boxes are products in videogames that is earned by playing a video game or by buying them. Loot boxes has similar mechanisms as a lottery and there is an ongoing debate if loot boxes are gambling. However, to understand the potential harm of loot boxes valid instruments are needed. An English study psychometrically evaluated an instrument focused on risky loot box use called the Risky Loot Box Index. The study evaluated 12 item scale and based on a factor analysis it was reduced to a five-item scale. The aim of our study is to evaluate a Swedish version of the 12-item instrument from a psychometric perspective. Two samples recruited via an online survey were used. The first sample was recruited from the gambling site Unibet. A mail with an invitation to participate was sent to esports bettors and sport bettors at the gambling site. The second sample was recruited from a Facebook forum focused on e-sports. An invitation was posted on the forum to partake in the study. A total of 195 of respondents (96% men and 4% women) with a mean age of 33.76 (SD = 12.34) answered the Unibet survey and 169 respondents (96% men and 4% women and non-binary) with a mean age of 23.89 (SD = 5.52) answered the Facebook survey. An exploratory factor analysis yielded a two-factor seven item solution. The factors were overconsumption regarding time spent on loot boxes and the other factor was focused on overconsumption of loot boxes in terms of spending money. The confirmatory factor analysis conducted in the Facebook sample validated the result from the exploratory factor analysis. The conclusion of the study is that the Swedish version of the Risky Loot Index has good psychometric properties and can used to measure risky loot box consumption., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This paper was funded by Svenska Spel's research council and the University of Bergen., (© 2022 The Authors.)

Gambling self-exclusion programs are under-utilised and barriers to entry include shame and embarrassment with face-to-face registration, and complex and effortful procedures. The current study aimed to facilitate self-exclusion from gambling venues via an online self-directed website. A co-design approach was used to elicit key stakeholders' perspectives on required website features, functionality, and to identify variables potentially impacting on development and implementation. Semi-structured focus groups and interviews were conducted across four stakeholders ( N  = 25): self-exclusion end users (consumers, n  = 5), gambling counsellors ( n  = 7), venue staff ( n  = 6), and policy makers ( n  = 7). Overall, stakeholder perspectives were consistent with content analysis indicating the importance of website user-friendliness, flexibility, supportiveness, and trustworthiness. Importantly, these attributes were linked to target end users': perceived vulnerabilities, diverse backgrounds and individual expectations. Participants believed that the entire self-exclusion process should be conducted online, including identity verification, whilst expecting high-level data security measures to protect their personal privacy. A separate webpage was also suggested containing relevant information and links to additional help services, such as counselling. This study describes an adaptable co-design framework for developing a usable and acceptable self-exclusion website. Future studies should empirically test system usability and acceptability to refine and maximise system uptake upon implementation. Findings may have broader implications for digital health intervention design., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Digital technology allows people to connect and share similar interests across geographical and temporal borders. Two behavioural disorders related to Internet use have been officially recognised as mental health disorders: Gambling Disorder by the American Psychiatric Association and Gaming Disorder by the World Health Organization. The prevalence estimates and risk indicators of developing problems associated with excessive technology use differ considerably across countries. Individual, structural and situational factors need to be taken into consideration when evaluating existing study outcomes. Based on the current evidence base regarding prevention of problematic technology use including gaming and online gambling and reducing harm, whilst paying attention not to overpathologise everyday behaviours, we recommend a multi-stakeholder approach, engaging researchers, clinicians, regulators and government bodies, community organisations and the industry. Implications for clinical practice include engaging in dialogue across experts and using evidence-based treatment approaches to support those in need of professional help., (© 2021 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Background and aims Social casino games (SCGs) are not technically considered a form of gambling but they do enable players to spend money in a game that is gambling themed or structurally approximate to gambling. It has been theorized that SCGs could be a gateway to gambling activities or otherwise normalize the experience of gambling for young people, particularly when money becomes involved. The aim of this study was to investigate whether adolescents' financial expenditure in SCGs was associated with broader gambling activity, including level of participation, expenditure, and problem gambling symptoms. Methods An online survey was administered to 555 adolescents, including 130 SCG players (78 non-paying and 52 paying users). Results Paying SCG users tended to be employed males who play more frequently and engage in more SCG activities, who report more symptoms of problem gambling and higher psychological distress than non-paying SCG users. Paying SCG users reported more frequent engagement and spending in monetary gambling activities, and two-thirds of SCG payers recalled that their SCG use had preceded involvement in financial gambling. Discussion and conclusions Spending in simulated gambling activities by adolescents may be a risk factor for problem gambling. Although SCGs may currently defy classification as a form of gambling, these activities will likely continue to be scrutinized by regulators for the use of dubious or exploitative payment features offered in a gambling-themed format that is available to persons of all ages.

Structural characteristics of gaming machines contribute to persistence in play and excessive losses. The purpose of this study was to evaluate the effectiveness of five proposed responsible gaming features: responsible gaming messages; a bank meter quarantining winnings until termination of play; alarm clock facilitating setting time-reminders; demo mode allowing play without money; and a charity donation feature where residual amounts can be donated rather than played to zero credits. A series of ten modified gaming machines were located in five Australian gambling venues. The sample comprised 300 patrons attending the venue and who played the gaming machines. Participants completed a structured interview eliciting gambling and socio-demographic data and information on their perceptions and experience of play on the index machines. Results showed that one-quarter of participants considered that these features would contribute to preventing recreational gamblers from developing problems. Just under half of the participants rated these effects to be at least moderate or significant. The promising results suggest that further refinements to several of these features could represent a modest but effective approach to minimising excessive gambling on gaming machines.

Despite the negative consequences associated with gambling, few problem gamblers seek professional help. This study aimed to examine awareness of professional sources of help and help-seeking behaviour amongst regular and problem gamblers. Australian gamblers (N = 730) were recruited from the general population, multicultural gambling venues, and gambling helplines and treatment services. Surveys measured awareness of professional help services, help-seeking behaviour and motivators and barriers to seeking help. Gamblers demonstrated low awareness of professional help services. Problem gamblers born in Australia or who were divorced were more likely to seek help. Problem gamblers who were reluctant to seek help due to a desire solve the problem on their own and feeling ashamed for themselves or their family pride were more likely to have overcome these barriers to seek help. However, significant barriers related to denial of problem severity and concerns about the ability to access low cost services that cater for multicultural populations predicted a lower likelihood of having sought help. Public education should aim to de-mystify the treatment process and educate gamblers about symptoms of problem gambling to reduce shame, stigma, and denial and encourage help-seeking. Ongoing education and promotion of help services is required to increase awareness of the resources available, including targeted promotions to increase awareness of relevant services among specific populations.

Although most gamblers set a monetary limit on their play, many exceed this limit--an antecedent of problematic gambling. Responsible gambling tools may assist players to gamble within their means. Historically, however, the impact of such tools has been assessed in isolation. In the current research, two responsible gambling tools that target adherence to a monetary limit were assessed among 72 electronic gaming machine (EGM) players. Participants watched an educational animation explaining how EGMs work (or a neutral video) and then played an EGM in a virtual reality environment. All participants were asked to set a monetary limit on their play, but only half were reminded when that limit was reached. Results showed that both the animation and pop-up limit reminder helped gamblers stay within their preset monetary limit; however, an interaction qualified these main effects. Among participants who did not experience the pop-up reminder, those who watched the animation stayed within their preset monetary limits more than those who did not watch the animation. For those who were reminded of their limit, however, there was no difference in limit adherence between those who watched the animation and those who did not watch the animation. From a responsible gambling perspective, the current study suggests that there is no additive effect of exposure to both responsible gambling tools. Therefore, for minimal disruption in play, a pop-up message reminding gamblers of their preset monetary limit might be preferred over the lengthier educational animation.

The prevention of gambling-related problems amongst Aboriginal communities has been neglected by most public health strategies which concentrate on mainstream populations. Research indicates that rates of problem gambling are higher for Aboriginal groups than the general population. Specific cultural, familial, and social patterns influence gambling by Aboriginal groups, which are individually different, making it difficult to implement a cohesive strategy to address gambling-related harms. Because of this complexity, a thorough literature review is necessary to identify gaps in policy and research. This paper uses a public health framework to consider multi-dimensional influences (personal, environmental, economic, cultural and social) that affect gambling uptake. Such analysis is also important for identifying risk factors which facilitate the development and maintenance of problem gambling and potentially for underpinning protection, prevention and treatment programs. It is advised that strategies be developed in consultation with Aboriginal peoples to guide public health policy and research to minimise any gambling-related harms.

Traditional therapies for addictions are underutilized and characterized by high attrition rates suggesting they may not meet the needs of a proportion of individuals with addiction-related problems including problem drinking, smoking, substance use and problem gambling. Internet-based therapy has emerged as a new treatment modality for psychological disorders and health issues and this review is the first attempt to summarize and evaluate the evidence of the effectiveness of Internet therapy for addictions. Extensive literature searches were conducted to identify studies meeting the criteria of delivering structured Internet-based treatment programs for addictions that incorporated a component of trained therapist interaction. Only nine studies met criteria for inclusion with seven representing a randomized controlled trial. These included seven papers reporting on tobacco-cessation programs, one Internet-based therapy for pathological gambling, and one treatment program for substance abuse. A range of therapeutic models, treatment components and outcome measures was included across these studies. Positive treatment effects were reported following completion of therapy and at longer-term follow-up. The review concluded that Internet-based therapies for addictions are effective in achieving positive behavioral changes but that more research is required to determine the comparative effectiveness of various Internet-based therapies and their components., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Increased recognition of the risks associated with gambling has resulted in a greater focus on empirical research to increase the understanding of gambling and design appropriate response strategies. Laboratory studies are a popular mode of research due to their relative ease and lower costs compared to field research; however such studies may be limited in the extent to which results can be generalized to real gambling scenarios. The current research investigated the validity of a laboratory research study using 127 university students (male = 97, mean age = 20.4) investigating the impact of harm-minimisation measures by replicating the study in gambling venues with 124 club patrons (male = 89, mean age = 44.1). The main results and effects of both studies were in the same direction, but fewer significant results were found in the venue study. Venue participants provided much less information in response to survey questions than student participants and were less likely to return follow-up questionnaires. It was concluded that both laboratory and field studies provide valuable contributions to the field, but caution should be taken in interpreting results, and where possible both methodologies should be used to verify conclusions.