Gambling in Italy: Epidemiological Evidence and Public Health Implications

Gambling represents an increasingly relevant public health concern. This doctoral project was developed to address the scarcity of independent population-based evidence on gambling in Italy, integrating multiple data sources to quantify its burden and explore its determinants. The research was articulated through a sequence of empirical studies ranging from local school-based surveillance to large national surveys of adults and adolescents, complemented by a methodological study on health monitoring in university populations. The findings show that gambling in Italy remains widely accessible to underage individuals despite formal legal restrictions, including through formats considered among the most addictive and those that should be subject to stricter regulatory controls. During adolescence, gambling behaviour tends to co-occur with other risk-taking activities and psychosocial vulnerabilities, indicating the need for multifaceted prevention strategies that address interconnected behavioural and environmental determinants. Gambling-related harm was shown to occur along a continuum of severity, with specific gambling formats and patterns of engagement associated with higher levels of adverse outcomes. Furthermore, the analyses indicate that digital gaming monetisation systems, such as loot boxes, likely exploit psychological vulnerabilities similar to those involved in gambling and may also function as a gateway to gambling among adolescents. Within the broader framework of the doctoral project, a rapid e-Delphi consensus study was also conducted to design a survey that will enable the longitudinal assessment of gambling trajectories and the evaluation of interventions aimed at influencing them during the major life transition represented by the entry into university life. Overall, the evidence produced supports the adoption of population-level strategies and evidence-informed preventive policies addressing the structural and commercial drivers of gambling-related harm.