Can slogans prevent gambling harm?
Authors: Angela Rintoul
Journal: The Lancet Public Health (2022)

Evidence of the range and magnitude of gambling-related harm is improving, highlighting the need for effective interventions. High quality evaluations of interventions to reduce harm in gambling studies are rare.1Livingstone C Rintoul A Francis L What is the evidence for harm minimisation measures in gambling venues?.Evidence Base. 2014; 2: 1-24Google Scholar In their study, Philip Newell and colleagues2Newall PWS Weiss-Cohen L Singmann H Walasek L Ludvig EA Impact of the “when the fun stops, stop” gambling message on online gambling behaviour: a randomised, online experimental study.Lancet Public Health. 2022; 7: e437-e446Summary Full Text Full Text PDF Scopus (4) Google Scholar contribute important evidence from their randomised, online experimental study that evaluated behavioural responses to a high profile safer gambling campaign in the UK: “When the fun stops, stop”. This message is widely deployed, but has been criticised (eg, by Gambling with Lives) for asserting that gambling is fun and that individuals are responsible for keeping it that way.3van Schalkwyk MCI Maani N McKee M Thomas S Knai C Petticrew M “When the Fun Stops, Stop”: an analysis of the provenance, framing and evidence of a ‘responsible gambling’ campaign.PLoS One. 2021; 16e0255145Crossref Scopus (12) Google Scholar Newell and colleagues found that exposure to the safer gambling message during realistic online gambling tasks did not reduce the willingness of experienced gamblers to bet nor the amount they bet, relative to control participants. The authors detected some evidence of a potential so-called backfire effect in their study, noting that this safer gambling slogan might represent a dark nudge,4Petticrew M Maani N Pettigrew L Rutter H Van Schalkwyk MC Dark nudges and sludge in big alcohol: behavioral economics, cognitive biases, and alcohol industry corporate social responsibility.Milbank Q. 2020; 98: 1290-1328Crossref PubMed Scopus (29) Google Scholar rather than a harm minimisation intervention.The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders categorises one of the defining features of a gambling disorder as the “continuation or escalation of gambling despite the occurrence of negative consequences.”5American Psychiatric AssociationDiagnostic and statistical manual of mental disorders.fifth edition, DSM-5. American Psychiatric Association, Washington DC2013Crossref Google Scholar Yet, environments in which gambling is provided, including those in the UK, do little to support people to simply stop gambling. Suggesting that a person with a gambling disorder stop gambling when it ceases to be fun might, arguably, do little to prevent harm. The point at which the transition from being in control to gambling compulsively occurs might be difficult to determine, given that the public is bombarded with enticements and opportunities to gamble. Moreover, systems that enable the limitation of losses, such as binding precommitment systems, are often unavailable. In the absence of upstream measures that might support people to stop gambling, by providing precommitment systems to support people to limit losses, as well as reduce enticements and opportunities to gamble, it is unsurprising that the “When the fun stops, stop” gambling message was found by Newall and colleagues to be ineffective.Safer gambling implies that a safe level of gambling exists. However, there is insufficient evidence to suggest that there is indeed a safe level for use of many gambling products. At a population level, the concept of a safe level of gambling could be misleading. At present, messages are not tailored effectively to individual circumstances. In addition, it is not possible to readily predict which individuals might experience gambling-related harm. Furthermore, the causes of gambling-related harm in individuals are not the same as the causes of incidence (ie, the rate of gambling harms within a population). The causes of incidence are, arguably, more important to address with population-level strategies. For these reasons, in the context of alcohol for instance, WHO does not promote a safe level of alcohol consumption. The same rationale for avoiding the promotion of safer gambling is relevant here. Similarly, the promotion of, for example, lower risk gambling limits6Hodgins DC Brunelle N Flores-Pajot M-C et al.Developing Lower-Risk Gambling Guidelines.https://gamblingguidelines.ca/app/uploads/2021/01/LRGG-Developing-Lower-Risk-Gambling-Guidelines-Report-in-Short-2021-en.pdfDate: 2021Date accessed: December 22, 2021Google Scholar might have no effect, or could even increase harm.When it comes to forms of betting like electronic gambling machines, there might be no level of use that is harm free.7Markham F Young M Doran B The relationship between player losses and gambling-related harm: evidence from nationally representative cross-sectional surveys in four countries.Addiction. 2016; 111: 320-330Crossref PubMed Scopus (54) Google Scholar Public health interventions that target individuals who gamble at levels that are considered at high risk of harm might cultivate stigma and shame,8Livingstone C Rintoul A Moving on from responsible gambling: a new discourse is needed to prevent and minimise harm from gambling.Public Health. 2020; 184: 107-112Crossref PubMed Scopus (32) Google Scholar and compound existing problems for people who might, as a consequence, be deterred from seeking help. Increased supply of gambling (via promotions and increased accessibility) will increase the number of people who gamble, and thus the number of people who experience gambling-related harms. Messages that identify and warn the population about the harms associated with gambling, and that identify high-risk gambling products, are needed.Alcohol9Anderson P Chisholm D Fuhr DC Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.Lancet. 2009; 373: 2234-2246Summary Full Text Full Text PDF PubMed Scopus (751) Google Scholar and tobacco control10Hammond D Health warning messages on tobacco products: a review.Tob Control. 2011; 20: 327-337Crossref PubMed Scopus (691) Google Scholar studies show that counter-advertising can be effective in warning populations about the harm caused by these products, dispel myths promoted by industry and their affiliates, and ultimately discourage harmful use.11Livingstone C Rintoul A de Lacy-Vawdon C et al.Identifying effective policy interventions to prevent gambling-related harm. Victorian Responsible Gambling Foundation, Melbourne2019Google Scholar For instance, warning messages in tobacco directly link the product with graphic harms caused by the product, including graphic depictions of gangrene and cancers.10Hammond D Health warning messages on tobacco products: a review.Tob Control. 2011; 20: 327-337Crossref PubMed Scopus (691) Google Scholar Analogies of this approach for gambling are readily conceivable.Evidence from alcohol policy research shows that responsible drinking campaigns can be effective at persuading the casual public observer that something is being done to address harmful consumption of alcohol. But they typically have a low impact on actual rates of alcohol consumption compared with measures such as restrictions on promotion, price, or accessibility of alcohol. Responsible drinking campaigns shift responsibility to the individuals themselves, rather than those who market and profit from harmful commodities, or those responsible for regulation.8Livingstone C Rintoul A Moving on from responsible gambling: a new discourse is needed to prevent and minimise harm from gambling.Public Health. 2020; 184: 107-112Crossref PubMed Scopus (32) Google Scholar Similarly, safer gambling interventions that emphasise individual responsibility, like the “When the fun stops, stop” campaign, might have distracted from implementing effective, upstream regulation.12Wardle H Reith G Dobbie F Rintoul A Shiffman J Regulatory resistance? Narratives and uses of evidence around “black market” provision of gambling during the British gambling act review.Int J Environ Res Public Health. 2021; 1811566Crossref PubMed Scopus (2) Google ScholarPublic education campaigns can also be expensive, relative to other interventions that might be more directly effective at reducing harm. If designed by industry actors and affiliates, they are generally ineffective, reflecting the conflict of interest of such actors, and support the narrative that only a small minority experiences harm.3van Schalkwyk MCI Maani N McKee M Thomas S Knai C Petticrew M “When the Fun Stops, Stop”: an analysis of the provenance, framing and evidence of a ‘responsible gambling’ campaign.PLoS One. 2021; 16e0255145Crossref Scopus (12) Google Scholar Even at high visibility, such campaigns have miniscule exposure compared with advertising and the promotion of gambling. It should be unnecessary to argue that harm prevention campaigns should not be developed by those who derive revenue from the product. The conflict of interest is clear and concerning. “When the fun stops, stop” is, in my opinion, not harm prevention, but a slogan, and one that shows not only no evidence of reducing gambling harms, but that could even have the counterproductive effect of promoting gambling. Evidence of the range and magnitude of gambling-related harm is improving, highlighting the need for effective interventions. High quality evaluations of interventions to reduce harm in gambling studies are rare.1Livingstone C Rintoul A Francis L What is the evidence for harm minimisation measures in gambling venues?.Evidence Base. 2014; 2: 1-24Google Scholar In their study, Philip Newell and colleagues2Newall PWS Weiss-Cohen L Singmann H Walasek L Ludvig EA Impact of the “when the fun stops, stop” gambling message on online gambling behaviour: a randomised, online experimental study.Lancet Public Health. 2022; 7: e437-e446Summary Full Text Full Text PDF Scopus (4) Google Scholar contribute important evidence from their randomised, online experimental study that evaluated behavioural responses to a high profile safer gambling campaign in the UK: “When the fun stops, stop”. This message is widely deployed, but has been criticised (eg, by Gambling with Lives) for asserting that gambling is fun and that individuals are responsible for keeping it that way.3van Schalkwyk MCI Maani N McKee M Thomas S Knai C Petticrew M “When the Fun Stops, Stop”: an analysis of the provenance, framing and evidence of a ‘responsible gambling’ campaign.PLoS One. 2021; 16e0255145Crossref Scopus (12) Google Scholar Newell and colleagues found that exposure to the safer gambling message during realistic online gambling tasks did not reduce the willingness of experienced gamblers to bet nor the amount they bet, relative to control participants. The authors detected some evidence of a potential so-called backfire effect in their study, noting that this safer gambling slogan might represent a dark nudge,4Petticrew M Maani N Pettigrew L Rutter H Van Schalkwyk MC Dark nudges and sludge in big alcohol: behavioral economics, cognitive biases, and alcohol industry corporate social responsibility.Milbank Q. 2020; 98: 1290-1328Crossref PubMed Scopus (29) Google Scholar rather than a harm minimisation intervention. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders categorises one of the defining features of a gambling disorder as the “continuation or escalation of gambling despite the occurrence of negative consequences.”5American Psychiatric AssociationDiagnostic and statistical manual of mental disorders.fifth edition, DSM-5. American Psychiatric Association, Washington DC2013Crossref Google Scholar Yet, environments in which gambling is provided, including those in the UK, do little to support people to simply stop gambling. Suggesting that a person with a gambling disorder stop gambling when it ceases to be fun might, arguably, do little to prevent harm. The point at which the transition from being in control to gambling compulsively occurs might be difficult to determine, given that the public is bombarded with enticements and opportunities to gamble. Moreover, systems that enable the limitation of losses, such as binding precommitment systems, are often unavailable. In the absence of upstream measures that might support people to stop gambling, by providing precommitment systems to support people to limit losses, as well as reduce enticements and opportunities to gamble, it is unsurprising that the “When the fun stops, stop” gambling message was found by Newall and colleagues to be ineffective. Safer gambling implies that a safe level of gambling exists. However, there is insufficient evidence to suggest that there is indeed a safe level for use of many gambling products. At a population level, the concept of a safe level of gambling could be misleading. At present, messages are not tailored effectively to individual circumstances. In addition, it is not possible to readily predict which individuals might experience gambling-related harm. Furthermore, the causes of gambling-related harm in individuals are not the same as the causes of incidence (ie, the rate of gambling harms within a population). The causes of incidence are, arguably, more important to address with population-level strategies. For these reasons, in the context of alcohol for instance, WHO does not promote a safe level of alcohol consumption. The same rationale for avoiding the promotion of safer gambling is relevant here. Similarly, the promotion of, for example, lower risk gambling limits6Hodgins DC Brunelle N Flores-Pajot M-C et al.Developing Lower-Risk Gambling Guidelines.https://gamblingguidelines.ca/app/uploads/2021/01/LRGG-Developing-Lower-Risk-Gambling-Guidelines-Report-in-Short-2021-en.pdfDate: 2021Date accessed: December 22, 2021Google Scholar might have no effect, or could even increase harm. When it comes to forms of betting like electronic gambling machines, there might be no level of use that is harm free.7Markham F Young M Doran B The relationship between player losses and gambling-related harm: evidence from nationally representative cross-sectional surveys in four countries.Addiction. 2016; 111: 320-330Crossref PubMed Scopus (54) Google Scholar Public health interventions that target individuals who gamble at levels that are considered at high risk of harm might cultivate stigma and shame,8Livingstone C Rintoul A Moving on from responsible gambling: a new discourse is needed to prevent and minimise harm from gambling.Public Health. 2020; 184: 107-112Crossref PubMed Scopus (32) Google Scholar and compound existing problems for people who might, as a consequence, be deterred from seeking help. Increased supply of gambling (via promotions and increased accessibility) will increase the number of people who gamble, and thus the number of people who experience gambling-related harms. Messages that identify and warn the population about the harms associated with gambling, and that identify high-risk gambling products, are needed. Alcohol9Anderson P Chisholm D Fuhr DC Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.Lancet. 2009; 373: 2234-2246Summary Full Text Full Text PDF PubMed Scopus (751) Google Scholar and tobacco control10Hammond D Health warning messages on tobacco products: a review.Tob Control. 2011; 20: 327-337Crossref PubMed Scopus (691) Google Scholar studies show that counter-advertising can be effective in warning populations about the harm caused by these products, dispel myths promoted by industry and their affiliates, and ultimately discourage harmful use.11Livingstone C Rintoul A de Lacy-Vawdon C et al.Identifying effective policy interventions to prevent gambling-related harm. Victorian Responsible Gambling Foundation, Melbourne2019Google Scholar For instance, warning messages in tobacco directly link the product with graphic harms caused by the product, including graphic depictions of gangrene and cancers.10Hammond D Health warning messages on tobacco products: a review.Tob Control. 2011; 20: 327-337Crossref PubMed Scopus (691) Google Scholar Analogies of this approach for gambling are readily conceivable. Evidence from alcohol policy research shows that responsible drinking campaigns can be effective at persuading the casual public observer that something is being done to address harmful consumption of alcohol. But they typically have a low impact on actual rates of alcohol consumption compared with measures such as restrictions on promotion, price, or accessibility of alcohol. Responsible drinking campaigns shift responsibility to the individuals themselves, rather than those who market and profit from harmful commodities, or those responsible for regulation.8Livingstone C Rintoul A Moving on from responsible gambling: a new discourse is needed to prevent and minimise harm from gambling.Public Health. 2020; 184: 107-112Crossref PubMed Scopus (32) Google Scholar Similarly, safer gambling interventions that emphasise individual responsibility, like the “When the fun stops, stop” campaign, might have distracted from implementing effective, upstream regulation.12Wardle H Reith G Dobbie F Rintoul A Shiffman J Regulatory resistance? Narratives and uses of evidence around “black market” provision of gambling during the British gambling act review.Int J Environ Res Public Health. 2021; 1811566Crossref PubMed Scopus (2) Google Scholar Public education campaigns can also be expensive, relative to other interventions that might be more directly effective at reducing harm. If designed by industry actors and affiliates, they are generally ineffective, reflecting the conflict of interest of such actors, and support the narrative that only a small minority experiences harm.3van Schalkwyk MCI Maani N McKee M Thomas S Knai C Petticrew M “When the Fun Stops, Stop”: an analysis of the provenance, framing and evidence of a ‘responsible gambling’ campaign.PLoS One. 2021; 16e0255145Crossref Scopus (12) Google Scholar Even at high visibility, such campaigns have miniscule exposure compared with advertising and the promotion of gambling. It should be unnecessary to argue that harm prevention campaigns should not be developed by those who derive revenue from the product. The conflict of interest is clear and concerning. “When the fun stops, stop” is, in my opinion, not harm prevention, but a slogan, and one that shows not only no evidence of reducing gambling harms, but that could even have the counterproductive effect of promoting gambling. AR has received research funding from Federation University, the Victorian Responsible Gambling Foundation, Australia's National Research Organisation for Women's Safety, and the Australian Commonwealth Department of Social Services. She has been employed on grants funded by the Australian Research Council and Deakin University, and has received travel funding from the Turkish Green Crescent Society, Monash University, and the Winston Churchill Memorial Trust, all outside of the submitted work. Impact of the “when the fun stops, stop” gambling message on online gambling behaviour: a randomised, online experimental studyIn our study, no evidence was found for a protective effect of the most common UK safer gambling message. Alternative interventions should be considered as part of an evidence-based public health approach to reducing gambling-related harm. Full-Text PDF Open Access