Hing et al.

BMC Public Health (2024) 24:1270 BMC Public Health

https://doi.org/10.1186/s12889-024-18286-3

RESEARCH Open Access

‘Getting addicted to it and losing a lot

of money… it’s just like a hole.’ A grounded
theory model of how social determinants
shape adolescents’ choices to not gamble
Nerilee Hing1*, Hannah Thorne2, Lisa Lole1, Kerry Sproston3, Nicole Hodge3 and Matthew Rockloff1

Abstract
Background Gambling abstinence when underage lowers the risk of harmful gambling in later life. However, little
research has examined why many young people refrain from gambling, even though this knowledge can inform
protective strategies and lower risk factors to reduce underage gambling and subsequent harm. This study draws on
the lived experience of adolescent non-gamblers to explore how social determinants while growing up have shaped
their reasons and choices to not gamble.
Methods Fourteen Australian non-gamblers, aged 12–17 years, participated in an in-depth individual interview
(4 girls, 3 boys) or online community (4 girls, 3 boys). Questions in each condition differed, but both explored
participants’ gambling-related experiences while growing up, including exposure, attitudes and behaviours of parents
and peers, advertising, simulated gambling and motivations for not gambling. The analysis used adaptive grounded
theory methods.
Results The grounded theory model identifies several reasons for not gambling, including not being interested,
being below the legal gambling age, discouragement from parent and peers, concern about gambling addiction and
harm, not wanting to risk money on a low chance of winning, and moral objections. These reasons were underpinned
by several social determinants, including individual, parental, peer and environmental factors that can interact to
deter young people from underage gambling. Key protective factors were parental role modelling and guidance,
friendship groups who avoided gambling, critical thinking, rational gambling beliefs, financial literacy and having
other hobbies and interests.
Conclusions Choices to not gamble emanated from multiple layers of influence, implying that multi-layered
interventions, aligned with a public health response, are needed to deter underage gambling. At the environmental
level, better age-gating for monetary and simulated gambling, countering cultural pressures, and less exposure to
promotional gambling messages, may assist young people to resist these influences. Interventions that support
parents to provide appropriate role modelling and guidance for their children are also important. Youth education

*Correspondence:
Nerilee Hing
n.hing@cqu.edu.au
Full list of author information is available at the end of the article

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
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Hing et al. BMC Public Health (2024) 24:1270 Page 2 of 13

could include cautionary tales from people with lived experience of gambling harm, and education to increase young
people’s financial literacy, ability to recognise marketing tactics, awareness of the risks and harms of gambling, and
how to resist peer and other normalising gambling influences.
Keywords Youth, Adolescents, Gambling, Protective factors, Social determinants, Qualitative methods, Grounded
theory

Background Scotland and Wales. Those who reported no past-year

Most research into gambling amongst adolescents has gambling were asked: ‘You said that you have never
focused on the prevalence and predictors of harmful gambled or never spent your own money on gambling.
gambling [1, 2]. Since early engagement in gambling is Why is that?’ and were provided with multiple response
a risk factor for gambling problems in adulthood [3, 4], options. The most endorsed reasons were lack of inter-
studies have also examined the reasons that adolescents est in gambling (39%), because it is illegal or they thought
participate in gambling when underage [5, 6]. However, they were too young (37%), not wanting to play with
little attention has focused on understanding why many real money/rather play with free games (25%), not being
young people refrain from gambling. Approximately allowed to gamble by their parents (24%), and because it
50–70% of adolescents report no past-year gambling [7, may lead to future problems (22%). Less common reasons
8], even though underage access to many gambling prod- were expecting to lose more than they will win (21%),
ucts is reportedly easy [9]. Understanding why these because they ‘don’t agree with gambling and/or it is not
adolescents choose to refrain from gambling can inform right’ (21%), thinking they were unlikely to win money
protective strategies against underage gambling and sub- (19%), not knowing enough about gambling games (11%)
sequent gambling harm. and religious objections (10%). Girls tended to report less
Numerous theoretical models identify the key types of interest in gambling, while boys were more likely to cite
influences on youth developmental outcomes [10, 11], that gambling may lead to future problems. Younger par-
health outcomes [12, 13], and the development of gam- ticipants were more likely to endorse that they did not
bling behaviours and subsequent harms [14–17]. These agree with gambling and that their parents do not allow
models all recognise that these behaviours and outcomes them to gamble. These findings align with observations
are influenced by complex interactions between multiple that adolescent non-gamblers tend to be female and
factors (e.g., individual attributes; physical, cultural and younger, compared to adolescent gamblers [19–21].
social circumstances) and at multiple levels (e.g., indi-
viduals, relationships, organisations, society). This rec- Social determinants of adolescent non-gambling
ognition that multiple and multi-level factors impact on Social determinants of health are the non-medical factors
health behaviours and outcomes can inform an under- that influence health outcomes [22]. Several social deter-
standing of how various influences interact to shape minants may directly and indirectly shape the reasons for
young people’s decisions to refrain from gambling. not gambling that many young people report, although
this linkage has not previously been examined. None-
Young people’s self-reported reasons for not gambling theless, studies that compare non-gamblers to gamblers
To our knowledge, only two survey studies have exam- amongst adolescents provide some insights into social
ined reasons for not gambling amongst young people. factors associated with non-gambling.
Rash and McGrath [18] conducted a content analysis of In a survey of 506 students from six schools in South
responses to an open-ended survey question asked of Australia (mean age = 16.5, SD = 0.77 years), non-gam-
196 Canadian undergraduates (mean age = 21.2 years, blers rated gambling as more unprofitable, compared to
SD = 3.7) who reported no past-year gambling. They were gamblers, and were significantly less likely to have fam-
asked to ‘think about what motivates you to NOT gamble ily or friends who approved of gambling or who gambled
and briefly list the top three reasons in rank order.’ The a lot [23]. In another Australian study of students aged
most common motive was financial reasons and risk 12–17 years in Queensland and Victoria (N = 6377), those
aversion (33.1%), followed by disinterest/other priorities who had not gambled in the past month were signifi-
(21.1%), personal and religious objections (12.2%), addic- cantly more likely than past-month gamblers to report
tion concerns (9.6%), influence of others’ values (9.1%), having less spending money available, lower alcohol con-
awareness of the odds (8.9%), lack of access, opportunity sumption, less exposure to gambling advertisements,
or skill (2.1%) and emotional distress (1.7%). and fewer peers or family members who had recently
Another study focused specifically on young people gambled [20]. Also in Australia, unique predictors of
under the legal gambling age [7]. It surveyed a weighted past-year non-gambling identified in two non-probabil-
sample of 2559 students aged 11–16 years in England, ity samples of youth aged 12–17 years (N = 826, N = 843)
Hing et al. BMC Public Health (2024) 24:1270 Page 3 of 13

were parental disapproval of gambling, not gambling Table 1 Demographic details for participants in the individual
with their parents while growing up, not having friends interview condition
who gambled, and avoidance of simulated gambling [8]. Participant # Gender Age bracket Location
1 M 15–17 Regional
In New Zealand, Rossen [21] surveyed students from
2 M 12–14 Regional
12 secondary schools (N = 2005; mean age = 15.2 years,
3 M 12–14 Metro
SD = 1.45). Compared to gamblers, non-gamblers tended
4 F 15–17 Metro
to have lower rates of internet and computer game usage,
5 F 15–17 Regional
alcohol usage, and recall of seeing gambling advertis-
6 F 12–14 Regional
ing. They were also less likely to have family members or
7 F 12–14 Metro
friends who gambled or had a gambling problem. Further,
less liberal attitudes to gambling, lower perceived ease
Table 2 Demographic details for participants in the online
of access to gambling, and lower perceived role of skill
community condition
in gambling were associated with non-gambling status.
Participant # Gender Age bracket Location
Non-gambling was also associated with being required
8 M 12–14 Metro
to contribute to household chores, higher importance of
9 M 15–17 Metro
spiritual beliefs, higher parental attachment, trust and
10 M 15–17 Regional
communication, and lower maternal, paternal and peer
11 F 12–14 Metro
alienation. 12 F 12–14 Regional
In the US, a survey of 15,865 eighth-graders in Ore- 13 F 15–17 Metro
gon (mean age = 13.7 years, SD = 0.50) focused on health 14 F 15–17 Regional
behaviours, including gambling during the previous three
months [24]. Good personal safety habits, non-involve-
ment in antisocial behaviour, and strong personal health Recruitment
beliefs predicted non-gambling in both girls and boys. Participants were adolescents aged 12–17 years who
Amongst girls, non-gamblers were also more likely than lived in NSW and provided their own and their legal
gamblers to report less screen time on school nights, guardian’s informed consent. Due to ethical concerns
no tobacco use, and to speak English at home. Amongst surrounding anonymity, confidentiality, and minimising
boys, living in neighbourhoods with strong social control legal risk to underage participants, detailed information
and non-Hispanic ethnicity also predicted non-gambling. on participants was not collected. Sampling ensured rea-
Also in North America, a study of students aged 13–19 sonably even representation from younger (12–14 years)
years in Canada (N = 10,035) found that non-gamblers and older (15–17 years) ages, boys and girls, as well as
were less likely to engage in simulated gambling, com- regional and metropolitan locations (Tables 1 and 2).
pared to those who gambled [19]. Parents/guardians in the recruitment agency’s database
In summary, two studies have examined qualitative were the initial point of contact to recruit the adolescents
self-reported reasons given by young people for not gam- to participate in either an interview or online community.
bling, while quantitative research identifies social factors The funding agency requested these options be offered,
that differ between adolescent non-gamblers and gam- based on the rationale that the strengths and weaknesses
blers. However, a detailed exploration linking reasons of each method would complement each other. The par-
for not gambling with social factors is lacking. This study ents were contacted via email with an information sheet
therefore aims to draw on the lived experience of adoles- and invited to ask their adolescent to complete a brief
cent non-gamblers to explore how social determinants online recruitment screener, which included questions
can shape their reasons and choices to not gamble as they confirming no past-year adolescent gambling, basic
grow up. demographics, and confirmation of their and their par-
ent’s consent to participate in the study. Eligible candi-
Methods dates were fully informed of what was expected of them,
We use a grounded theory methodology in this study, that their participation was entirely voluntary, and that
which is appropriate when a research topic lacks a theo- they were free to withdraw from the study at any time
retical foundation. This approach allows us to expand without penalty.
upon previous reasons that adolescents report for not
gambling to also identify underlying social determinants Data collection
and processes. The study was approved by our institu- Seven participants opted for an interview. The interviews,
tional ethics committee (number 23,445). each lasting about 45 min, explored each participant’s
gambling-related experiences during their childhood
and adolescence. Participants were asked about their
Hing et al. BMC Public Health (2024) 24:1270 Page 4 of 13

exposure to gambling, attitudes to and participation in and behaviours.’ Deductive consolidation of themes
gambling while growing up, factors that facilitated or into multiple levels of influence was informed by a pub-
hindered any gambling, motivations for not currently lic health, socio-ecological systems approach [12, 13] to
gambling, the impacts of gambling on their lives, their understand the complex multifaceted nature of factors
family and social environments, their experiences with that contribute to adolescent gambling beliefs, behav-
simulated gambling, and protective factors. Supplement iours and attitudes. This process allowed us to identify
A contains the full list of questions. Participants were meaningful patterns in the data. While there were some
compensated with an AU$60 GiftPay voucher. differences in wording and phrasing of codes between the
Seven additional participants participated in an online researchers at the preliminary, inductive stages of data
community. The online community was convened over analysis, there were no conflicts when consolidating and
seven days, using the Visions Live platform which resem- coding themes in later stages of the analysis.
bles a social media platform. Participants were asked to Trustworthiness of the research was enhanced by col-
participate for about one hour each day in activities and lecting data from participants with lived experience,
discussions designed to capture their gambling-related using open-ended questions, and allowing participants
experiences while growing up. Nine topics were covered: to have control over the experiences they shared. Mul-
(1) gambling behaviours and attitudes; (2) parental and tiple researchers reviewed each analysis draft to ensure
family gambling attitudes and behaviours; (3) peer influ- confirmability. Participants’ quotes increase authentic-
ence; (4) gaming and simulated gambling; (5) their ‘gam- ity. These are tagged by gender (male, female), age group
bling journey’, including key milestones and influences in years (12–14, 15–17), and data collection method
over time; (6) gambling advertising; (7) gambling harms; (IDI = interviews, OLC = online community).
(8) protective strategies; and (9) future gambling inten-
tions. Supplement B contains the full list of questions. Findings
All participants used anonymous avatars. Tiered com- Eight themes emerged from the analysis that were
pensation was based on the number of days they partici- grouped into four socio-ecological levels (Fig. 1). Envi-
pated, with a maximum of AU$140 in GiftPay vouchers ronmental influences that shaped reasons for not
available. gambling included age restrictions on gambling. Peer
Individual interviews enabled an in-depth oral and influences comprised having friendship groups with little
narrative account of developmental influences on each interest in gambling. Parental influences entailed paren-
participant’s choice to not gamble, while the online com- tal modelling, rules and guidance. Individual factors
munities enabled participants to consider their answers included having other interests and having little interest
over a more extended time period, to share information in sport, financial literacy and financial priorities, fear of
on sensitive topics in an anonymous way, and to discuss addiction and harmful consequences, reasoned percep-
the topics with the other participants. While the format tions about gambling and critical evaluations of adver-
of questions was adapted to suit the conversational vs. tising, and caution about simulated gambling. These
written format of these activities, all were designed to influences underpinned several reasons for not gambling
address the same research aims so the two datasets were articulated by the participants (Fig. 1).
combined for analysis.
Age restrictions are seen as an unequivocal barrier to
Analysis gambling
An adaptive grounded theory method was used which In Australia, it is illegal for people under 18 years to
combines inductive and deductive analysis [25]. We used gamble on commercial gambling products. Nearly all
inductive methods to initially openly code and anal- participants were quick to note that being under the legal
yse emergent findings from the data, which were also gambling age was the most obvious deterrent to them
informed by the literature review on sources of influence gambling. They appeared to accept these age restrictions
on young people’s gambling (parents, peers, marketing, as an unequivocal barrier, based on an implicit trust that
etc.). After data familiarisation, we used the constant the rules exist for a reason: ‘I always… thought that it’s a
comparative method to code phrases, sentences and grown-up thing’ (#1, male, 15–17, IDI). No participants
paragraphs in the data to identify relevant features, refine indicated any interest in circumventing age requirements
the codes as the analysis progressed, and group and col- for gambling, even though this was said to be easy:
lapse similar codes into broader themes. For example,
[Young people] probably could easily get a fake
codes related to ‘parents not gambling,’ ‘parents talking
licence or ID, could probably influence an adult or
about gambling risks and harm,’ and ‘parental restric-
an adult wants to let them into this… [and] some
tions’ were grouped into a broader theme of ‘parental
places don’t have the best security in the front
modelling, rules and guidance shape gambling attitudes
Hing et al. BMC Public Health (2024) 24:1270 Page 5 of 13

Fig. 1 Social determinants of reasons for not gambling amongst adolescents

Hing et al. BMC Public Health (2024) 24:1270 Page 6 of 13

entrances, so someone could probably sneak in if As well as protecting their child from socialisation into
they looked a bit older. (#8, male, 12–14, OLC) gambling through the family, educating them on the risks
and harms of gambling was another protective paren-
Participating only in age-appropriate activities was also tal influence that participants recalled. They typically
an expectation set out by their parents. These young recounted that early childhood messages from their par-
people appeared eager to meet their parents’ expecta- ents focused mostly on conveying a general disapproval
tions and to not break any rules. Accepting that gambling of gambling, and then progressed to more detailed con-
when underage was forbidden was said to lower their versations about gambling risks and harms as the partici-
interest in gambling. pants became older. They particularly remembered the
cautionary tales that their parents related, usually dur-
I don’t gamble because I don’t find it interesting and
ing the participants’ early adolescence when their expo-
it is illegal for someone my age, my parents would
sure to gambling was increasing. These conversations
not want me to gamble. (#13, female, 15–17, OLC)
were often reactive, in response to an external cue such
I’ve always been told to not go anywhere near it. I
as a gambling advertisement. Participants recalled being
mean I’m also underage so not allowed to, but then
especially responsive to stories based on real experiences.
it’s also like I’ve always been told that it’s bad and
that you could lose a lot of money. (#4, female, My mum is a police officer, so I’ve heard… sto-
15–17, IDI.) ries about the dark sides of gambling… and getting
addicted to it… [Gambling] hasn’t really interested
me that much because I know what can go wrong.
(#1, male, 15–17, IDI)
Parental modelling, rules and guidance shape gambling
attitudes and behaviours
In the current study, parental influence was said to be Some participants reported that witnessing harm from
critically important in shaping the participants’ gambling gambling made an impression by raising their aware-
attitudes and behaviours from early childhood onwards. ness of the likelihood of gambling losses and the risk of
Most participants reported that their parents did not addiction.
gamble or did so only occasionally. This limited paren-
I know now that… you’re more likely to lose lots of
tal gambling was usually associated with having negative
money than win lots of money… when I saw my Pop
opinions of gambling which, in turn, were said to shape
losing heaps of money, I’m like, ‘Oh, it’s not all win,
the young person’s attitudes and behaviours.
win, win.’ (#2, male, 12–14, IDI).
My parents always despised gambling as my uncle Going to Las Vegas, seeing people betting and all the
wasted all his money on it and went off the rails. So machines… It made me realise how addicted people
that early instilling of the bad rep of gambling has are. (#12, female, 12–14, OLC)
stuck with me. (#10, male, 15–17, OLC) On a school excursion, we had a guest speaker who
I think that my parents don’t gamble, and don’t have had experienced gambling… he had taken money
anything good to say about gambling, has influ- out of his workplace… then gambled the money…
enced me a lot… Parents think it’s a waste of money then he was trying to get it back through gambling…
as much more likely to lose money than win it… it his experience of how that really forced him to expe-
makes me feel like it’s all fake and everyone who goes rience a lot of hardship with his family and trying
there comes back home with empty pockets. (#12, to find support with that. So, I’d seen, through those
female, 12–14, OLC) kind of things, the ways that it can negatively impact
on people and the way that you can lose control. (#5,
female, 15–17, IDI)
Because the participants tended to recognise how their
parents’ opinions, advice and behaviour have influenced
their own aversion to gambling, some were highly critical Most participants reported parental monitoring and con-
of parents who gambled in front of children. trol over their gambling, online gaming and simulated
gambling. One participant described how his parents
It sucks that people think it’s ok to do this kind of
had a ‘no gambling’ rule, and another reported that his
stuff around kids, who are largely influenced by their
mother monitored and limited his spending on in-game
parents, as they will view them as heroic figures,
items when playing video games. Some parents were also
and will adopt these bad traits onto themselves. (#8,
aware of simulated gambling elements in online games
male, 12–14, OLC)
and were cautious about their child’s engagement.
Hing et al. BMC Public Health (2024) 24:1270 Page 7 of 13

It looked like a pokies machine. That’s why my mum (#12, female, 12–14, OLC). Alternatively, some partici-
was concerned with me playing it because you pants commented that gambling could distract young
pulled down the lever and the thing spun, and then people from more productive interests and pursuits.
if you collected three of those things then you got a Participants recognised that having gambling-related
reward. (#4, female, 15–17, IDI) interests might override an adolescent’s interest in other
activities, including schoolwork: ‘People start gambling
from a young age and set this as their future job [instead]
Protective influences from friendship groups with little of… focusing on school and their studies and setting a
interest in gambling good career’ (#11, female, 12–14, OLC).
As young people enter and advance through their teen- Further, an interest in following professional sport was
age years, peer influences on gambling tend to become said to expose young people to gambling influences and
more significant. However, while the participants rec- act as a ‘gateway’ to an interest in gambling. Some partic-
ognised that peer influences could encourage gambling, ipants commented that their own lack of interest in sport
most reported that their friends did not gamble or that helped to protect them from frequent exposure to betting
gambling was not part of the interests, activities or con- influences and activities. They did not see the point in
versations in their friendship groups: ‘Me and my friends betting on sporting competitions that they had no inter-
never really bring up the topic “gambling” and I have est in. Other participants did report an interest in sport
never seen them talk about it to anyone else’ (#11, female, but resisted its gambling influences, possibly due to other
12–14, OLC). protective factors such as parental influences.
One participant explained that the moral values associ-
ated with her cultural background were her main deter- Financial literacy and financial priorities
rent. Having friends with a similar background also Numerous participants referred to gambling as ‘a waste
limited her interest in gambling because this friendship of money’, a view most said had been conveyed by their
group shared other hobbies. parents. These adolescents did not see the point of engag-
ing in chance activities where they risked losing their
My friends come from backgrounds where gambling
money: ‘Why waste your money on something that won’t
is highly discouraged and they have carried that out
necessarily work?’ (#14, female, 15–17, OLC). Several
through our friendship, we don’t talk about gambling
explained they understood there was a greater chance of
often and so I tend not to associate with it, this has
losing than winning.
also discouraged me from gambling. We have other
interests and activities to do that don’t involve gam- If I were to work hard every day, I would not want
bling. (#13, female, 15–17, OLC) to waste it on a low chance of winning more and a
Peers were also said to influence the participants’ high chance of losing most of my money… The closest
attitudes to gambling through vicarious experiences thing I have done to gambling is just carnival stuff.
of gambling losses. For example, this participant (#8, male, 12–14, OLC)
reported that seeing or hearing about friends losing
increased his awareness of the negative consequences
These participants typically reported they had better
that gambling could have: ‘I saw my friends… if they
things to spend their money on, both now and in the
lost then they’d be all like upset… so I started to see
future. Older participants, in particular, appeared to
like the downsides of it as well’ (#1, male, 15–17,
have a well-developed sense of financial literacy, finan-
IDI). Some older participants noticed increased peer
cial responsibility and future orientation. They believed
involvement in gambling in their later teens, along-
that their appreciation of the value of money had been
side more opportunities to gamble. However, the
instilled by their parents. The following participant’s
attendant risks appeared to be offset by other envi-
views on money demonstrate her high level of financial
ronmental, parental and peer protective factors.
responsibility and her financial priorities that discour-
aged her from gambling.
I’m very like cautious about where my money goes…
Having other interests, and little interest in sport
I don’t want to lose a lot of money because I like to
Many participants discussed how having other hobbies
save all of my money… I very much like to keep my
and activities left them with little time or interest in gam-
money, because I love to travel and at the end of
bling. These activities included dancing, painting, draw-
school, I want to travel around the world a bit. And
ing, music and skateboarding, which they might do alone
then I also need to save up for uni and everything,
or with friends: ‘My activities outside of school keep me
because I don’t want to have a lot of debts… I very
occupied and less likely to take an interest in gambling’
Hing et al. BMC Public Health (2024) 24:1270 Page 8 of 13

much like to know where my money is… Because I’m kind of a person who’s very interested in things…
money is very valuable, especially now when houses ‘So how does it work? What are the odds– how like
cost like tonnes of money, and you need to save up the statistically point whatever percent of people win
to buy a lot of things, and like inflation is making something?’ And dad will bring up those things and
things more expensive. (#4, female, 15–17, IDI) you go, ‘Why do people even play that? It just seems
silly’… When you’re saying there’s an opportunity
to get millions of dollars, you’d be like, ‘Of course I
Fear of addiction and harmful consequences
want that.’ But… ‘what are the odds of that?’ It’s
Participants reported that fear of addiction and the nega- pretty slim. (#5, female, 15–17, IDI)
tive consequences of gambling were powerful deterrents.
They recognised a wide range of potential harms, includ- Some participants noted an increased awareness of
ing to finances, relationships, mental health, anti-social gambling risks and harms as they got older, due to their
behaviour and vocational performance. increased “mental capability” (#5, female, 15–17, IDI).
Several participants reported that they applied their criti-
Gambling at this age can also lead to higher rates
cal thinking skills when considering the design of gam-
of depression and anxiety, loss of friendship with
bling products and their marketing. They felt in control
non-gambling peers, and can also take you away
of their choices and able to see through promotional
from your family… taking money from your par-
messages about gambling. Two participants mentioned
ents, changes in sleep patterns, low energy levels,
an interest in the psychology of advertising, which they
changes in mood, and can be involved in risk-taking
felt helped them resist the appeal of gambling.
behaviour like fights, vandalism or shoplifting. (#11,
female, 12–14, OLC) As a design student, and looking at the way design-
Getting addicted to it and losing a lot of money… ers and marketers will try and advertise and appeal
using possessions and stuff even, betting those when to people, I think it’s allowed me to pick up on those
you have nothing left even. Like, it’s just like a hole things and understand why they’re doing some of the
(#1, male, 15–17, IDI). things they’re doing to try and engage an audience in
a certain way. (#5, female, 15–17, IDI)
There was widespread recognition in this cohort that,
while gambling harm could be immediate, it could also These participants also recognised that the design of
have long-lasting impacts. Participants tended to view gambling environments, including their sounds, lights
the harm from gambling as extreme and potentially life- and colours, is an industry tactic to encourage people
changing: ‘it can ruin lives and families, it puts people in to gamble. Some participants recalled being attracted to
debt and ruins whatever they have built their life up to’ and intrigued by the design features of gaming rooms
(#8, male, 12–14, OLC). they saw as children when they dined at a venue with
their family.
Reasoned perceptions about gambling and critical
I could hear the noises, and I could hear, like, the
evaluations of advertising
sounds of the money… then when people opened the
Amongst the participants, rational beliefs about gam-
doors, I saw the colourful lights and I was, like, ‘Oh, I
bling were evident, particularly in their understanding of
want to go in there,’ because, you know, I was a kid–
the relative chances of winning and losing. Even though
it’s colourful. (#4, female, 15–17, IDI)
some acknowledged the appeal of gambling, they resisted
its excitement and financial opportunity because they
were aware of the likelihood of losing.
Caution about simulated gambling
I can see how gambling might be fun due to the
Like most young people, many participants regularly
adrenaline it can produce or the money which some-
played video games, including games with simulated
one could gain, but in my opinion the risk is not
gambling elements such as loot boxes and wheel spin-
worth it. (#9, male, 15–17, OLC)
ning. However, they tended to view spending real money
in games, including on simulated gambling features, with
More commonly, participants said that they were just a great deal of caution and had very low expectations of
not interested in gambling, which they often attributed a worthwhile return. Some also recognised the poten-
to their rational mindset and ability to think critically, as tial for addiction to gaming and that simulated gambling
well as parental advice on how gambling works. could encourage young people to engage in monetary
gambling.
Hing et al. BMC Public Health (2024) 24:1270 Page 9 of 13

Spending real money for skins and things is practi- opportunity as a reason for refraining from gambling.
cally gambling… By spending money on skins and This may reflect the widespread availability of gambling
things worth no real-life value, the same person in Australia, including through online and mobile devices
might be interested in spending money gambling and thousands of land-based venues, and opportunities
with the chance to get real life money… A great to engage in private gambling.
example is the FIFA video game franchise, whereby Figure 1 also identifies several social determinants
you can either purchase ‘packs’ with an in-game cur- that provide deeper insights into factors that underpin
rency or real money. Many of my friends decided to the participants’ reasons for not gambling. In line with
use in-game currency until they ran out but by then a socio-ecological perspective on health behaviour [12,
they were hooked and resorted to using their real 13], these social determinants include multiple layers of
money. (#9, male, 15–17, OLC) influence.
Parental factors appear to be the main formative
The participants reported that their engagement in simu- influence on the participants’ gambling. Research has
lated gambling had not aroused temptations to engage in consistently found that parents play a crucial role in
monetary gambling. However, they believed that other transferring gambling attitudes, knowledge and skills to
young people might not be so resistant. They saw the their children, in educating them on the risks and harms
potential for simulated gambling to be a ‘gateway’ to real- of gambling, and in restricting their gambling and online
world gambling, and that its heavy marketing and tar- activities [2, 8, 26]. Qualitative research has drawn on
geting of young people were harmful. Many were highly social learning theory to explain how parents can trans-
critical of the proliferation and extensive advertising of fer knowledge and skills to their children, so that they
simulated gambling games, including through sponsored learn how to gamble and assign positive meanings to the
online influencers who typically show young people win- activity [27–28]. The current study shows how parents
ning on these games in order to encourage real-money can have a converse effect through role modelling and
expenditure and persistent play. other protective influences that deter their children from
gambling. Parents were said to convey negative attitudes
They show in ads all the time, people just winning
towards gambling, discourage gambling by their chil-
constantly but never really show how much money
dren, engage in no or limited gambling themselves, and
people use and how they get nothing in return and
advise their adolescents on the negative consequences of
somehow people fall for the trick thinking that they
gambling. By limiting their own gambling, these parents
will get loaded with money. I think the game/apps
helped to protect their children from being exposed to
are worse because it shows that they’re winning a lot,
and involved in gambling, and from learning to gamble
which makes people play it more and that’s when the
during childhood [27, 28]). Moreover, while harmful
addiction begins. (#12, female, 12–14, OLC)
parental gambling increases the risk of gambling prob-
lems in children [8, 29], being exposed to harmful conse-
quences in others, outside the nuclear family, may instead
Grounded theory model have an educative effect.
Figure 1 presents the grounded theory model derived Social learning also occurs through peers, particu-
from the study’s findings. Key findings are discussed larly in early and later adolescence, when friendship
below. groups can introduce young people to gambling activi-
ties, encourage them to gamble, and provide the social
Discussion rewards of in-group status and peer bonding [30, 31].
This study has provided insights into the lived experi- Peers can influence an adolescent’s gambling behaviour,
ences of adolescents who refrain from gambling and depending on how normalised, encouraged or discour-
how numerous social determinants when growing up aged gambling is in their social group [30]. The current
interact to shape their reasons and choices to not gam- research found that when gambling is not an accepted or
ble. As Fig. 1 indicates, the participants’ accounts high- shared activity in friendship groups, peers can be a dis-
light several reasons for not gambling. This study, and couraging influence on gambling through their disap-
previous research, identify not being interested in gam- proval and avoidance of gambling and by sharing other
bling, being below the legal gambling age, discourage- non-gambling interests.
ment from parent and peers, concern about gambling Environmental factors also shape youth gambling
addiction and harm, not wanting to risk money on a low behaviour. Age restrictions on gambling are an impor-
chance of winning, and moral objections, as reasons that tant deterrent, as found in this and previous research [7].
some young people do not gamble [7, 18]. Unlike earlier While these age restrictions apply to all underage adoles-
research, however, no participants cited lack of access or cents, the non-gamblers in this study accepted them as
Hing et al. BMC Public Health (2024) 24:1270 Page 10 of 13

an unequivocal barrier, even though other adolescents they prioritised spending their money on other inter-
might choose to circumvent them. This suggests that it ests or tangible goods, and older participants tended to
is not just the presence of these restrictions, but instead have savings goals for future acquisitions and activities.
how young people respond to them, that impacts on Research has consistently found a significant relation-
their subsequent gambling involvement. These responses ship between erroneous gambling cognitions and gam-
may reflect more generalised attitudes to compliance bling problems in youth and, conversely, the protective
with rules and parental restrictions. Nonetheless, better influence of rational gambling beliefs [42–45]. Financial
enforcement of age and identity requirements may fur- literacy, that is, being able to make effective decisions
ther assist in preventing gambling by minors, given that about expenditure, saving and budgeting, has an inverse
underage access to some commercial gambling products relationship with gambling frequency [46, 47], and may
is reportedly easy [9]. therefore deter young people from gambling. The par-
Previous studies have also examined other environ- ticipants’ awareness that people are most likely to lose
mental influences on youth gambling, although mainly at gambling was often instilled by parents, who also
in relation to those that encourage gambling. A key focus conveyed cautionary tales and guidance that gambling
has been on the role of advertising in fostering youth could lead to addiction and harmful consequences. These
gambling [8, 32–34] and how simulated gambling can young people appeared to take these messages seri-
normalise and be a training ground for monetary gam- ously and were fearful that gambling would lead to life-
bling [35, 36]. Like most young people in Australia, the changing harms. Participants recognised a wide range
adolescent non-gamblers in this study reported wide- of potential harms, including to finances, relationships,
spread exposure to gambling advertising and simulated mental health, anti-social behaviour and vocational per-
gambling [8, 20]. However, many explained they were formance, as also identified in models of gambling harm
sceptical about gambling marketing claims and cautious [15, 48, 49]. Overall, the participants indicated little
about simulated gambling, particularly spending real interest in gambling and instead reported having a wide
money on this activity. This reasoned and critical think- variety of other interests that they pursued alone or with
ing about industry tactics and the odds of winning were family and friends. This aligns with previous findings that
said to temper their responses to these marketing influ- extra-curricular activities and social connectedness are
ences. Other Australian research has found that children protective influences for youth gambling [2].
are exposed to and can recall the sights and sounds of Several implications arise from the study’s findings.
gambling in venues, even when gambling products are in Protective factors implicated in the participants’ reasons
restricted areas [37, 38]. and choices to not gamble emanated from multiple layers
Social connectedness, fostered by extracurricular activ- of influence. This implies that multi-layer interventions,
ities, positive parent-child relationships and pro-social in line with a public health response, are likely to be opti-
behaviour, is said to lower the likelihood of youth gam- mal in deterring underage gambling– including to young
bling [2]. Many participants also had little interest in pro- people who already gamble and are likely to experience
fessional sport, so they may be somewhat protected from gambling harm. While not all risk and protective factors
the associated advertising and other gambling influences for gambling and gambling harm are modifiable, those
that occur when people watch sports broadcasts and suggested here are practical strategies aimed at prevent-
share an interest in sport with family and friends [39, 40]. ing and reducing harm amongst young people. At the
Consistent with previous research [41], having gambling- environmental level, better age-gating for both monetary
related interests might override an adolescent’s interest and simulated gambling, along with less exposure of chil-
in other activities, including schoolwork. However, it is dren to promotional gambling messages, can help protect
unclear whether the social connectedness and diversion to young people who might otherwise struggle to resist
of having other hobbies and interests is a cause, conse- these influences. Since young people are less able to criti-
quence or co-occurring feature of gambling involvement. cally assess gambling marketing, regulation to prevent
Research into adolescents who watch sports but do not the advertising of gambling to children and adolescents
gamble is required to better understand factors that help is a vital strategy [50]. Interventions that support paren-
them resist gambling influences in this context. tal role modelling and guidance for their children can
Several individual factors were implicated in the rea- include raising awareness about how parents influence
sons these young people refrained from gambling which, their children’s gambling, and the provision of advice and
in turn, may have been shaped by factors such as their resources they can use to deter them [27, 51].
personality, parental discipline and friendship groups. Youth education is also needed using evidence-based
Aligned with their tendency for reasoned and critical programs. The current study indicates that potentially
thinking, the participants saw gambling as a waste of useful elements include cautionary tales based on the
money because of the low chances of winning. Instead, lived experience of people harmed by gambling, as well
Hing et al. BMC Public Health (2024) 24:1270 Page 11 of 13

as education to increase young people’s financial literacy, determinants and processes that can underpin these rea-
ability to recognise marketing tactics, awareness of the sons amongst young people. The resulting grounded the-
risks and harms of gambling, and how they might resist ory can inform protective strategies and further research.
peer and other normalising gambling influences. Youth This study found that the most potent social determi-
gambling education programs should also be informed nants of non-gambling were from the individual, paren-
by previous research evidence. For example, a system- tal and peer levels. Research that explores how social and
atic review of behavioural change techniques directed commercial determinants at the community, systems,
at youth gambling indicate that the most successful pro- industry and societal levels impact on young people’s
grams include information of the harm from gambling to gambling choices would also be valuable.
relationships, finances, and mental health [52]. Donati et
al. [44] found that a brief, online, school-based psychoed- Conclusion
ucational intervention, that comprised a gambling-spe- This study has provided a detailed exploration of adoles-
cific skills training program, increased awareness about cent non-gamblers and how their reasons and choices
gambling, undermined gambling-related cognitive dis- to not gamble are shaped by social determinants as they
tortions, and reduced gambling frequency and gambling grow up. It concludes that multiple factors and layers of
problems. influence interact to deter young people from underage
Naturally, this study has limitations. It focused on gath- gambling. While the environmental factor of age restric-
ering in-depth information to provide detailed insights tions on gambling is an important deterrent, parental
into the lived experiences of a small sample of par- influences through appropriate role modelling, rules
ticipants, so the findings may not be generalisable to all and guidance, as well as peer influences from friend-
adolescent non-gamblers. Data saturation may not have ship groups with little interest in gambling, appear to be
been achieved, and future research could obtain larger stronger influences. These influences shape and interact
samples. The findings may also be influenced by social with individual factors to act as deterrents to gambling.
desirability bias and recall bias, although the memo- Individual factors include having other interests, little
ries people have and how they interpret them are likely interest in sport, financial priorities, fear of addiction
to influence their subsequent attitudes and behaviours. and harm from both gambling and simulated gambling,
Given that participants were compensated for their time, reasoned perceptions about gambling, and the ability to
the sample may also be skewed towards adolescents critically evaluate gambling advertising. Research into
who had a greater need for money. A self-selection bias adolescent gambling lacks a focus on interventions to
due to the need for parental consent may be present, as reduce gambling harm [2]. The present findings, there-
consenting parents may have attitudes to gambling and fore, contribute knowledge to inform preventive strat-
parenting approaches that differ from the broader popu- egies such as youth education programs and parental
lation. Future research could examine whether this bias resources and support, that can help to deter underage
exists and how differences in parent-child relationships gambling through reducing modifiable risk factors and
and attachment styles affect the learning about gambling enhancing modifiable protective factors. Importantly
that occurs in childhood and adolescence. It is also pos- however, strategies are also needed to reduce environ-
sible that some parents may have monitored their child’s mental risk factors for gambling harm, such as wide-
responses to the OLC activities and impacted their spread child exposure to gambling advertising and the
responses, or that OLC participants sourced other infor- normalising influences from simulated gambling. Since
mation to inform their responses. early uptake of gambling increases the risk of harmful
Future research could collect more detailed demo- gambling and subsequent mental disorders in later life
graphic data to better understand how adolescents’ [4], multi-layered public health interventions are impor-
decision to not gamble intersect with factors such as tant to discourage gambling in adolescents. This explor-
socioeconomic status, family circumstances, health, eth- atory study has provided some preliminary insights into
nicity, religious beliefs, and school grades, which have the social determinants that shape some adolescents’ rea-
been implicated in pathways into gambling and gambling sons for not gambling, but further research is needed to
harm [29, 53–58]. optimise evidence-based interventions.
Grounded theory methodology is necessarily subjec-
tive in nature, with the findings shaped by how par- Supplementary Information
ticipants interpret and share their experiences and how The online version contains supplementary material available at https://doi.
org/10.1186/s12889-024-18286-3.
the researchers interpret the data. While generalis-
ability is therefore limited, the current study helps to Supplementary Material 1
advance understanding beyond simple self-reported
Supplementary Material 2
reasons for not gambling to identify multi-layered social
Hing et al. BMC Public Health (2024) 24:1270 Page 12 of 13

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