(2018) 18:1381
https://doi.org/10.1186/s12889-018-6281-0

RESEARCH ARTICLE

Open Access

Strategies to customize responsible
gambling messages: a review and focus
group study
Sally M. Gainsbury1 , Brett L. L. Abarbanel2,3 , Kahlil S. Philander1,4*

and Jeffrey V. Butler5

Abstract
Background: Responsible gambling messages are widely used as a tool to enable informed choice and encourage
appropriate gambling behavior. It is generally accepted that gamblers have different levels of risk of developing gambling
problems and require various harm minimization tools and resources. Therefore, it is reasonable to expect that responsible
gambling messages should be customized and target specific groups of gamblers. This project aimed to understand
hypothesized differences between cohorts of gamblers and receive qualitative feedback on archetypal targeted messages
used to increase use of responsible gambling tools.
Methods: Focus groups were held to test messages for specific cohorts: young adults (18–24 years), seniors (60+ years),
frequent gamblers (weekly), and gamblers of skill-based games (poker, sports betting).
Results: Cohorts exhibited different preferences and responses to message archetypes. Seniors preferred messages about
limit setting, whilst young adults and frequent gamblers responded to messages about their own play and expertise. Skill
game gamblers were interested in the odds of winning and their own outcomes over time. However, all groups agreed
that using positive, non-judgmental language in messaging is important.
Conclusions: This research makes an important contribution to the field by demonstrating that the wording of message
content will likely influence the effectiveness of such messages differentially across various groups of gamblers
for engaging gamblers in harm reduction tools. Guidance is provided on themes that can be used by public
health marketers.
Keywords: Customized messaging, Targeting, Prevention messages, Problem gambling, Responsible gambling,
Education, Harm minimization, Youth, Seniors

Background
Many wellness oriented interventions are available for gamblers. Across jurisdictions, programs may include psychosocial treatment, awareness campaigns, player education
programs, self-exclusion programs, and play management
resources, such as limit-setting tools. But whilst programs
are often available, there are typically barriers to
help-seeking for those who would benefit from their use.
These issues include stigma, shame, lack of knowledge, unwillingness to admit a problem, and/or wishing to handle a
* Correspondence: kahlil.philander@wsu.edu
Brain and Mind Centre, School of Psychology, University of Sydney,
Camperdown, NSW, Australia
School of Hospitality Business Management, Carson College of Business,
Washington State University, Everett, WA, USA
Full list of author information is available at the end of the article

problem by oneself [1–3]. Effective interventions are important to assist gamblers at various levels of risk to acquire
and apply the requisite skills and knowledge necessary to
control their gambling to affordable levels. Encouraging
gamblers to seek help before their problems become severe
would minimize harm, as well as reduce the burden on
emergency and treatment services. However, individuals
who engage in risky gambling but are not experiencing serious problems may lack motivation to seek help proactively
and appear to be relatively hard to reach.
Given that modern player tracking systems can now display user-specific information on electronic gambling machine screens or personal electronic devices, there has
been substantial interest within the academic and responsible gambling (RG) community in using customized RG

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

(2018) 18:1381

messages to improve informed decision making [4]. Prevention messages are one of the most widely used public
health strategies for reducing harms from gambling. Messaging seeks to elicit direct changes in behaviors/beliefs
and may also inform the public of associated risks or RG
programs. With recent technological changes in gambling
products, institutions responsible for executing RG programs have hypothesized that customized messages
may be more effective than a one-size-fits-all messaging
program. RG messaging is typically a broad-spectrum
strategy that is often the first-point of contact with
gamblers. Even small improvements in the effectiveness
of communicating such messages may have large downstream impacts on harm.
In this paper, we explore the use of customized messages targeting various segments of gamblers. Messages
are framed to increase gamblers’ motivation to seek and
use relevant RG resources. As part of this study, we review the broader public health messaging literature for
its relevance to RG messages. We examine whether the
themes emerging from the broader literature also manifest in the content of focus group discussions within a
community sample of gamblers regarding a series of RG
messages presented to them. We make an academic contribution to the public health messaging literature by
framing categories by which gambling messages could
be customized in order to facilitate engagement with
harm minimization resources. We also make an applied
contribution by exploring message archetypes which,
after adaptation to regional idiosyncrasies, could be
adopted by prevention programs within a cohort of
end-users.
Responsible gambling

Gambling disorder is an addictive disorder described as,
“persistent and recurrent problematic gambling behavior
leading to clinically significant impairment or distress”
[5]. The disorder is characterized by a range of symptoms, including distorted cognitions, chasing losses, preoccupation with gambling, and inability to stop [2, 3, 6].
Research indicates that gamblers generally support the
availability of RG tools, particularly those that assist customers to play within their means, including player feedback and regular financial statements [7–12]. Despite
that, customer engagement with RG tools appears to be
relatively low.
Broadly, uptake of RG resources has been low. In a recent
British Columbia study, Cohen, McCormick, and Davies
[13] estimated that only 5% of the moderate to high-risk
population are enrolled in the province’s self-exclusion program. Within Australia, one site reported that only 1600
out of 200,000 active customers (0.8%) used the deposit
limit tool available, and only 900 self-excluded from the site
(0.45%) [14]. Reports from a European online site indicated

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that only 1.2% of users self-imposed limits on their expenditure [15], while another European site found only 13% of
users regularly engaged with a well-integrated RG tool [16].
Research on limit-setting tools suggests that the vast majority of gamblers respond positively to the concept of
pre-commitment, but need direction to make use of such
tools [17–19].
Research from the broader health messaging literature,
relating to sexual health, alcohol consumption, and nutrition behaviors, suggests that messages could have increased
effectiveness for such populations by communicating direct
and tailored content (e.g., RG tips), rather than simply providing information about the availability of programs and
resources [20–22]. Critical to the effectiveness of such messages are the type of content used, the way they are framed,
whether they engage consumers in self-referential processing, their level of specificity and applicability to use in the
real world, and the use of social norms to influence the behavior of the individual. Findings on the importance of
these factors from the broader public health messaging literature are now reviewed in order to consider their relevance to RG messaging.
Message content

Important elements of consumer communication include language, tonality, and message content [23, 24].
Message content refers to the simplicity, degree of directness, and comprehension of the words that communicate the appropriate level of danger, consequences,
and/or actions to avoid harm [25]. The type of language
used in warning messages may have varying impacts on
individuals, depending on culture, emotional state, level
of gambling problem, and the consumer’s sense of
self-esteem [26–28].
RG messages often inform gamblers of information
about the probabilities of winning, and how outcomes
are determined. These messages are predicated on the
use of warnings for alcohol and tobacco products,
informing consumers about the risks associated with excessive or inappropriate use. In the gambling context,
the use of informative or educational messages is based
on the concept of problem gambling being a result of irrational thoughts and beliefs. It was hypothesized that if
gamblers understood the games and probabilities of winning, they would be able to make informed decisions regarding their involvement [29–31]. Empirical research
suggests that effectively communicated information does
not consistently modify irrational beliefs or erroneous
estimations about the chances of winning [32–36].
The failure of such information to modify behavior is
likely due to cognitive biases that enable gamblers to
understand the low probabilities of winning, yet still believe that they may have a chance to win [36]. Even when
informative messages are accurately recalled, respondents

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still believe that their chances of winning are greater than
the information contained within the messages, and do
not modify their behavior [37, 38]. Whilst informative
messages can correct irrational beliefs, there is limited empirical understanding of how such messages may impact
gambling behavior [35, 36].
Message framing

Prospect theory suggests that people behave differently
when messages are framed as either gains or losses [39].
Positive or gain-framed messages focus on the benefits of
making improvements in a particular behavior, whilst
negative or loss-framed messages contain information
about harmful consequences and hazards related to risky
behaviors [27]. Although educating consumers about the
risks of a product is connected to informed choice, research on attitudes and persuasion suggests a focus on
negative impacts is too narrow [40], and a gambling limit
tool study showed that feedback about violating a limit
did not lead to the intended reduction in play [41]. Messages are more persuasive if they promote positive attitudes, and if the identified behaviors are mutually
exclusive (e.g., setting deposit limits vs. having no limits)
[42]. The use of positive framing of messages has been
found to have a greater impact than negative framing. For
example, neuroimaging research has found that
gain-framed messages are more effective in improving
risky choice behaviors than loss-framed messages amongst
individuals with substance-use disorders [43, 44]. When a
behavior is presented as a choice, positive messages are
more effective than negative messages [45]. Audiences
tend to respond with more enthusiasm to positive things
that they can do to prevent health problems [46], and research across multiple public health domains suggests that
positively-framed messages are more effective than
loss-framed messages when advocating health prevention
behavior [46].
Self-appraisal messages

Self-appraisal messages encourage consumers to reflect
on their own personal situation and take appropriate actions. Persuasion research shows that when individuals
generate arguments and conclusions themselves, they
are more convincing for the individual than statements
provided by external sources [47]. Self-generated arguments are often perceived as more accurate than information provided by external sources [48–50]. Messages
that imply an outcome but allow perceivers to draw their
own conclusions may reduce feelings of resentment and
enhance the persuasiveness of messages [51]. Several laboratory and in-venue trials of self-appraisal messages
on electronic gaming machines (e.g., “Have you spent
more than you intended?”) have found that such messages increase awareness of time spent playing and

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create more realistic thoughts about the chance of winning, increasing the likelihood of taking a break and reducing the duration of gambling sessions [38, 52].
Specific and action focused

Less abstract messages that include specific actions, such
as setting a deposit limit, can increase message compliance [53]. Research with smokers found that warning
messages should contain sufficient information and
identify steps to help smokers progress towards quitting
[54–56]. Online gambling messages that suggested specific information (e.g., “10 gambling commandments”)
generated five times more website “click-throughs” than
informative messages commonly used (e.g., “How problem gambling works”) [57]. A sense of urgency can also
be introduced by using phrases such as, “Have you…
yet?”. This is consistent with research on health warnings which has demonstrated that messages that are
positive and have a sense of urgency are felt to be strong
motivators for action [58].
Targeted messaging for gamblers

Attempts to warn players of risks associated with gambling and direct them to RG resources often use
in-venue signs with RG slogans and problem gambling
helpline numbers. Many studies have found that these
messages are largely ignored by gamblers [38, 59, 60].
The extent to which the message is read, absorbed, and
acted upon is dependent upon the personal relevance of
the message, the target recipient’s capacity to assimilate
the information, and their motivation to respond [25].
To be effective, RG messages should engage the gambler’s cognitive, emotional, and motivational faculties,
and alter the behaviors of concern [61–63]. It is plausibly unreasonable to expect that messages broadcast to
all gamblers can be impactful given the many differences
between players, including the type of resources they
would each benefit from using.
Whilst legacy gambling systems were more inflexible,
new technology linking player accounts can enable sophisticated RG strategies, including personalized messaging
that targets players based on individual characteristics and
patterns of play [64]. For example, gambling providers can
send direct emails, online messages, or SMS to customers.
Additionally, within venues where loyalty cards are used,
operators can send personalized RG messages to customers through electronic gaming machine screens. Tailored messaging has been shown to outperform traditional,
static health information strategies, and is more likely to be
read, remembered, and viewed as personally relevant [65].
Importantly, tailored messaging has been shown to be important in motivating change in problem drinkers and
problem gamblers, irrespective of whether they commence
treatment or not [66, 67].

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Segmenting gambling cohorts

Targeted messages should be particularly useful in populations where there is great variability between members
[68] and that information is accessible in marketing databases. One key difference between gamblers is age.
Young adults (aged 18–24) appear to manifest more
gambling-related problems [69–71]. The reception of
warning messages by young adults is often considered to
be different from the general population [24, 72]. In
their meta-analysis of evidence on warning message effectiveness, Argo and Main [23] argue that age correlates
negatively with warning perception, although they note
relatively limited empirical evidence to support this.
Young adults tend to perceive themselves as invulnerable to the negative consequences of risky behaviors,
and have difficulty relating to negative consequences
that may occur in the future [73–76]. Young people also
tend to underestimate the severity of their gambling, fail
to recognize and accept gambling problems, and are less
likely to seek help [77]. They do not necessarily have a
poorer understanding of gambling odds than adults, but
they are more prone to erroneous beliefs about gambling, as well as beliefs that gambling can be controlled
[78–80]. Due to the increased relevance of social norms
for youth, manipulating social context may increase the
effectiveness of messages for this target cohort [81]. For
example, smoking and drug prevention advertisements
highlighting social implications appear to be more persuasive than warnings of physiological illnesses with adolescents and young adults [82, 83].
In contrast, older adults are another group with unique
risks and importance. According to the 2014 Canadian
Community Health Survey [84], over 67% of persons aged
65 or older gamble. Many scholars have emphasized the importance of protecting this group from the harms of gambling, noting the risk factors associated with fixed-incomes,
social isolation, bereavement, and increased leisure time in
retirement [85–87]. One key difference between seniors and
other groups is that they show more obsessive passion for
gambling when their behavior is problematic [88]. They also
show a greater likelihood of responding to digital marketing
strategies than other sub-groups [89].
It is also plausible that different gambling product
users will receive messages differently. Gamblers who
engage in games with real or perceived skill (e.g., poker,
sports betting) view themselves as different, as they use
their ability to increase their odds of winning [90, 91].
Online poker players are generally less likely to chase
losses than online casino gamblers [92], respond better
to time limit tools than monetary limit-setting tools (unlike other gamblers [93]), and are a heterogenous group
in that more skillful online poker players have been
shown to respond less favorably to RG tools less skilled
players [7].

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Frequent gamblers – usually characterized by participation in gambling once a week or more – have been
identified as having greater risk for gambling problems.
Research has shown that frequency of participation is a
highly predictive risk-factor for gambling-related problems [94–96], and may be a behavioral marker for gambling disorder [97, 98]. Given the specific characteristics
of this group, frequent gamblers appear to be another
plausible target group to be studied for tailored RG messaging, alongside young adults, seniors, and skill game
gamblers.
There are several variables that can be considered in
designing and distributing RG messages, and message
impact is likely to differ between various segments of
gamblers due to their own needs and preferences. There
appears to be adequate evidence in the gambling literature to warrant customization of messages for young
adults, older adults, skill-game gamblers, and frequent
gamblers. While other risk groups exist, we examine
these categories as they can be identified in most marketing databases. Age is collected as part of the entry
control requirements in the registration processes, while
game type and frequency are variables controlled by the
operator. In the next section, the approach to exploring
thematic differences in these cohorts’ needs is described.

Methods
A series of online focus groups were conducted to gain
feedback on the wording of various RG messages created
based on the literature review for each of four selected
player cohorts. The study protocol was reviewed and approved by the Human Subjects Ethical Review Committee
at Southern Cross University. Focus groups were used because they are socially-oriented, in which participants listen to others’ opinions and understandings in forming
their own responses [99]. Whilst focus groups typically
have high face validity, group size may be small and the
results may not be statistically generalizable [99, 100]. The
results, however, still provide meaningful insights into
how participants respond to messages presented to them,
as well as feedback on message wording and content. As
any message used in actual marketing materials would
need to be adapted for its particular market, focus groups
are a useful method for exploring themes that a generic
strategy could consider.
The four player cohorts were identified based on a review of the literature and are groups that could be easily
identified in player databases for message distribution.
In total, 39 participants attended the four focus groups:
1. Young Adults – those aged 18–24 years old (N = 10,
6 male)
2. Seniors – those aged 60 years old or older (N = 10, 4
male)

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3. Skill Game Gamblers – those who play games
involving an element of skill, such as poker or
sports betting (no age qualification for this group)
(N = 10, 7 male)
4. Frequent Gamblers – those who have gambled once
per week or more often (no age qualification for
this group) (N = 9, 6 male)
Each of the authors independently generated potential
messages for the cohorts. That list of potential messages
was then reviewed by all authors for content and relevance within the literature framework and reduced to a
useful subset through consensus. Messages were selected
to be similar to archetypal messages used by RG programs, but also with consideration of the evidence for
their effectiveness found in the health messaging literature review. Messages were then reviewed for appropriate length before inclusion in the focus group moderator
guide, which can be viewed as supplementary file
Additional file 1.
Each message contained an action phrase connected
to an RG tool to prompt respondents to consider their
behavioral response. The Play Summary tool displays the
player’s play history. The Player Assessment Quiz is an
online quiz that helps gamblers better understand their
own gambling behavior within the scope of health
habits. The Responsible Gambling Tips are seven tips
that encourage players to gamble responsibly, such as
“Don’t chase losses,” and “Take frequent breaks”. The
Odds Knowledge Quiz is an online quiz that tests the
participant’s knowledge of gambling odds, such as the
roulette wheel landing on a given number. The Limit
Setting tool is a budgeting tool that allows players to set
a weekly limit on the total amount they can transfer into

their online gambling account. Table 1 below displays
the messages presented to the respective groups.
Participant recruitment

Participants were selected and screened by telephone
using a database comprised of randomly selected households in Manitoba, Canada. Participants qualified if they
were over the age of 18 and had reported gambling online during the prior 12 months, to ensure the groups
were formed with participants who were potential recipients of these types of messages. Table 2 below displays
core sample characteristics reported during the screening process, including gender, age, gambling activity, and
gambling frequency, which was measured as a simplified
dichotomous variable for screening into the frequent
gamblers group. During the recruitment and screening
process, all participants completed an informed consent
form. All participants were provided with a $50 incentive for their participation.
Data collection

The four online focus groups ranged from 60 to 78 min
in duration and were conducted via iTracks, an online
focus group platform. Research suggests online focus
groups may elicit more themes with sensitive topics than
in-person focus groups [101]. The iTracks platform conducts focus groups in a written format, similar to an online chat room. The online focus group was conducted
in a similar manner to an in-person focus group, with a
moderator leading a discussion among a small group of
participants. The participants submitted typed answers
to the group, and the moderator was able to communicate privately with individual participants. Through the
private messaging system, the moderator was able to ask

Table 1 Messages Presented to Each Focus Group, by RG Tool
RG Tool
Group

Play Summary

Player Assessment
Quiz

Limit Setting (a)

Limit Setting (b)

Young
Adults

Do you know how
much you are
spending? Check
your Play Summary.

What kind of player Play often? Check
are you? Take this out these 7
short quiz.
gambling tips.

Are you a gambling
expert? Test your
knowledge of
gambling odds.

All players need to
stick to their limits.
Have you set your
spend limit?

All players need to stick
to their limits. Do you
know how much you
have spent?

Seniors

Have you spent more What kind of player Play often? Check
than you can afford? are you? Take this out these 7
Check your Play
short quiz.
gambling tips.
Summary.

Are you a gambling
expert? Test your
knowledge of
gambling odds.

All players need to
stick to their limits.
Have you set your
spend limit?

All players need to stick
to their limits. Do you
know how much you
have spent?

Skill Game
Gamblers

Do you know how
much you are
spending? Check
your Play Summary.

What kind of player Play often? Check
are you? Take this out these 7
short quiz.
gambling tips.

Are you a gambling
expert? Test your
knowledge of
gambling odds.

All players need to
stick to their limits.
Have you set your
spend limit?

All players need to stick
to their limits. Do you
know how much you
have spent?

Frequent
Gamblers

Have you spent
more than you can
afford? Check your
Play Summary.

What kind of player Play often? Check
are you? Take this out these 7
short quiz.
gambling tips.

Are you a gambling
expert? Test your
knowledge of
gambling odds.

All players need to
stick to their limits.
Have you set your
spend limit?

Even frequent players
need to stick to their
limits. Do you know
how much you have
spent?

Included with each message is a link to the respective RG tool

Responsible Gambling Odds Knowledge
Tips
Quiz

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Table 2 Sample characteristics (N = 39)

Analysis
Percent

Gender

Age

Male

59.0

Female

41.0

18–24 Years

30.8

25–40 Years

17.9

41–59 Years

25.6

60 Years and older

25.6

Gambling Activity Online, Poker, Blackjack, and other
within Prior 12 Months
skill games

Gambling Frequency

46.2

Sports Betting (including fantasy
leagues)

51.3

Bingo

10.3

Lotteries

56.4

Chance-based table games
(e.g., roulette or craps)

5.1

Slots

38.5

Once per week or more often

43.2

Less often than once per week

56.8

individual follow-up questions whilst continuing the discussion in the main focus group.
Focus groups were structured to elicit responses to the
proposed messages, with an interest in collecting participant feedback on six pre-developed messages per group.
The messages were presented in five cases, one at a
time; each case focusing on a different RG tool (as displayed in Table 1). Participants were first asked for their
initial response to the message, and then asked why they
would or would not engage with the linked tool. Next,
the inquiry requested any proposed changes that participants would make to the message to make it more relevant to them. Where relevant, the moderator would
send follow-up messages to individual participants to
elicit further details on their response to the individual
messages. Finally, participants discussed the types of
messages they found most effective, and offered up their
own wording, themes, or specific phrases that would get
them to engage with RG tools.

The transcriptions of the focus groups were subjected to
content analysis with a focused coding approach. Content analysis was used because it provides a “careful, detailed, systematic examination of a particular body of
material in order to identify patterns, themes, biases,
and meanings” [102]. In focused coding, researchers identify themes and look for associated data fitting under categories of interest [103]. Coding categories were established
based on the literature review and focused on message
tone, potential engagement, personalization options, numbers, and terminology (e.g., gambling vs. gaming, player vs.
gambler). The message tone theme was used to assess participant interpretation of the tone of the message (e.g., encouraging, condescending), and their emotional response
(positive, negative, neutral) to that tone. The potential engagement category was used to code how participants indicated they would or would not engage with the RG tool
associated with the message. The personalization options
theme covered participant suggestions of how the messages
could be individualized for different people or player types.
The numbers theme described inclusion of numbers from
individual play behaviors, such as amount of time or money
spent gambling. Finally, the terminology code was used to
identify where participants identified qualities of the vocabulary used.
To establish inter-rater reliability, two researchers independently coded the data set (98.6% agreement across
76 entries), then together reviewed and settled the only
discrepancy in coding by considering its content, theme
definitions, and extant literature support.

Results
The messages recommended for each specific group as a
result of the analysis is presented in Table 3. Within all
groups, there was no difference in message preference
between genders.
Young adults

Young Adults were particularly responsive to message tone,
especially messages that were perceived as condescending.

Table 3 Recommended messages for Young Adults, Seniors, Skill Game Gamblers, and Frequent Gambler group types
Group

Generic

Message 1

Message 2

Young Adults

Only spend what you can afford to lose.
Check out the play management tools.

Are you a gambling expert? Test your
knowledge of gambling odds.

Keep it a game. Check out these 7 tips
to become a more responsible gambler.

Seniors

Only spend what you can afford to lose.
Check out the play management tools.

How much have you spent gambling?
Check out your play summary here.

Stick to your limits and keep gambling
fun. Have you set a spending limit?

Skill Game Gamblers

Only spend what you can afford to lose.
Check out the play management tools.

Check out your gambling odds. Test
your game knowledge here.

Check out your play summary. Click here
to see your spending habits.

Frequent Gamblers

Only spend what you can afford to lose.
Check out the play management tools.

What kind of gambler are you? Take
this short assessment quiz here.

Even frequent players should have limits.
Have you set your spend limit?

Included with each message is a link to the respective RG tool

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One participant requested messaging that “does not sound
like it is ‘blaming you,’” and several others followed along
the same train of thought, asking for messages that were
not accusatory or patronizing, but rather were straightforward and honest in their phrasing. Simple messages were
preferred, as one participant explained, and not “dressed up
in language.”
Young Adults also indicated a preference for messaging that provided tips to show how they can save
money, by using the linked RG skills and tools. Some
follow-up comments suggested that participants were interested in messages with tips that helped them become
more successful gamblers (i.e., to win more money).
Other tools that drew a positive response from Young
Adults included the Play Summary tool, which was identified as a useful tool for accurately recording play when
gamblers’ own perception might be distorted, and the
quiz testing knowledge of gambling odds, which was labeled as “beneficial.” Conversely, the Young Adult group
indicated a distinct lack of interest in the self-assessment
quiz, which they viewed as not useful.
The idea of presenting negative realities was also suggested – the discussion turned to the potential harms of
problem gambling and a proposal for warning messages
similar to those on cigarette packs was presented as an
option for messaging.
Older adults

Like the Young Adults, Older Adults were also concerned about tone, with one participant stating that they
wanted messages that “treats [one] like a responsible
adult,” and not like “my mother wagging her finger at
me.” Other participants suggested avoiding “condescending messages,” and that it felt “insulting” to “imply that
[they are] foolish to not set a limit”, when provided a
message on limit-setting tools. Beyond this concern, the
group was positive about the use of messages in general,
suggesting that they be clever, upbeat, and humorous,
with reminders to keep the game fun. Some participants
suggested that additional messages that show negative
consequences of problem gambling would also be useful,
as well as information on where to get help if a gambler
thinks they are losing control.
Older Adults identified the Play Summary as a useful
tool, though many indicated they already set limits when
they play. In addition, the quiz to test gambling knowledge and the limit setting tools were selected as tools
that the group would seek out if they received a message
promoting the tool.
Skill game gamblers

Skill Game Gamblers were largely interested in blunt,
straightforward language in their messages, with one
participant requesting messages that “[call] a spade a

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spade.” Messages that were simple and direct were preferred, such as those that included specific values for
time and money spent gambling. Matching this preference, Skill Game Gamblers indicated that the Play Summary was a valuable tool for them, making them think
about their own budget. The group also requested individualized messages with their personal spend numbers,
as “seeing real numbers tells the story.”
The quiz testing gambling knowledge was also considered useful, primarily for the purpose of confirming their
own knowledge. One participant also indicated that a
message promoting this kind of quiz would get them to
engage with the tool to enhance their knowledge of responsible gambling, stating, “if I could learn something
that could help me place a responsible bet, I’d read on.”
Skill Game Gamblers also suggested that messages
should include reminders of the ramifications of overspending, as well as that the odds are against winning and
that in the long run, the house always wins. In addition,
Skill Game Gamblers were the only group to speak to terminology use in describing those who gamble, suggesting
that use of the terms “gamble” or “gambler” instead of
“play” or “player” would be useful reminders that wagers
involve at least some chance component.
Frequent gamblers

As with the other groups, Frequent Gamblers emphasized the need for positive language in RG messaging,
and to avoid any language that might be accusatory or
might make someone feel guilty about their gambling
behavior. Simple, short messages were preferred, such as
reminders to “keep it a game.” One participant further
recommended messaging include information to educate
family and friends who might need the RG tools. Individual spend numbers were requested as a reminder of
play behaviors, paralleling the request of Skill Game
Gamblers.
Frequent Gamblers were the only group to not positively endorse the Play Summary tool, with most participants indicating they were already aware of their limits
and spend, and thus felt they did not need the tool. Also,
distinct from other groups, Frequent Gamblers responded
positively to the self-assessment tool, expressing curiosity
about their classification. Several participants noted that
they “love taking short quizzes” and that they were interested into which player type they would fall.

Discussion
This research is the first study to empirically consider
the content of RG messages in identifiable cohorts. In
this study, thematic differences were found between subgroups of players. This was observed in both message
wording (e.g., tone) and in the action response (i.e., RG
tool) that they were prompted to consider. Young Adults

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gravitated towards tips to help them be ‘better’ gamblers,
which could be used to provide suggestions for losing less
money (e.g., not chasing losses). This is consistent with research suggesting that young people are more prone to erroneous beliefs about gambling, such as the idea that
gambling can be controlled [78–80]. The focus group supported this, with participants reporting that they would
find the information in the quiz and list “beneficial,” and
that they would use the tools to “gain a greater understanding of what [they’re] looking at” when they’re placing
bets. In contrast, Older Adults looked for more lighthearted messages, focused on keeping gambling fun.
Older Adults were also attracted to limit-setting features
that were not as popular among other groups. Older
Adults, many of whom are on a fixed income, may benefit
from tools that help them be mindful of how much money
they spend on gambling [104, 105].
The self-assessment test of gambling behaviors and
limit setting tools were viewed more positively by Frequent Gamblers. Frequency of gambling has been identified as predictive of problem gambling [106], and these
messages prompt the recipient to assess their own level
and style of gambling, and also suggest a tool that can
be used to help them keep their gambling within affordable levels [105].
Skill Game Gamblers preferred more direct communication, seeing themselves as able to incorporate information into their gambling, including about potential risks
of gambling. Frequent Gamblers were interested in resources to assist them in keeping track of their expenditure – such as activity statements in the Play Summary
tool. This is consistent with Philander and Gainsbury
[105] who suggest that because those who play games
with an element of skill are more likely to develop illusions of control about their skill [107], messages for
these gamblers should encourage gamblers to be mindful
of the element of chance in games. The Play Summary
message also serves as a reminder to Skill Game Gamblers to be mindful of their sessions and expenditure.
Recreational Skill Game Gamblers can exhibit impulsive
personality traits and may demonstrate signs of chasing
behaviors [108–110], and this message may encourage
them to use the Play Summary tool as a means of keeping themselves aware of expenditure resulting from such
behavior.
Messages were found to be more likely to be persuasive if they promote positive attitudes towards the desired behavior. Motivation can be enhanced by reducing
the ‘cost’ of compliance, increasing the perceived ability
to perform a specific action, using a positively-framed
message, and appealing to the individual’s sense of value.
Gamblers may be more likely to engage with RG resources if they believe that these resources are typically
used by their peers, and those that they respect. Focus

Page 8 of 11

group participants consistently discussed the importance
of messages not being patronizing or judgmental.
Educational- and awareness-based messaging is a tool
that the gambling field has adopted from the wider public health field, with mixed success. Customizing RG
messages and pairing RG tools based on age, gambling
frequency, and type of gambling activities may enhance
the effectiveness of messages and subsequent engagement with RG resources. Literature supports the use of
messages that encourage gamblers to consider their own
gambling, rather than providing explicit directions or information; a finding reinforced by participants in this
study. When individuals generate arguments and conclusions themselves, they are more convinced than by statements provided from external sources.
Limitations & future research

Whilst focus groups are highly useful for the in-depth exploration of topics, attitudes, and concerns, the findings
may not be generalizable due to the limited sample. In
addition, with only one group per segment type, the ability
to draw conclusions from the data is limited, as data saturation may not have been reached. Third-person bias may
be at play, where messages that focus group participants
think will be persuasive may be influenced by participants
considering what is effective for other people, rather than
themselves. The results are also limited in that they only
considered four cohorts, each with some degree of overlap. It is likely that gambling operators can segment their
player databases in more sophisticated manners.
Further research should aim to analyze player databases
of gamblers to identify at-risk gamblers using more complex segmentation, connected to a theoretical understanding of persuasive messages and experimental design. Such
an approach could include qualitative research more specific to the given jurisdiction, followed by field experiments testing multiple message options. Future work
should also consider how to deliver messages, in terms of
mode of delivery, frequency, and duration. Each of these
factors is important to effective communication.
Last, it is important to note that gambler preferences
are not the only consideration in the design of public
health strategies. Although gamblers may prefer one RG
tool to another, that does not mean that this is the tool
from which they would most likely benefit [111]. As
such, one important role for RG messages and public
health communication strategies is to effectively describe
available resources to enhance understanding among
relevant groups and evaluate related outcomes, even
where there is not intrinsic interest in their use.

Conclusions
By focusing messages on a specific intended audience,
messages can be developed to elicit greater individual

(2018) 18:1381

responsiveness and compliance. Our research suggests
that there are some commonalities in message components that are perceived to be most effective in encouraging uptake of preventative and harm-minimizing
behaviors. This includes promoting positive attitudes towards the desired behavior and reducing the perceived
cost of compliance – that is, positive framing, and making behaviors easier and simpler to complete. Increasing
specificity of messages also enhances engagement, particularly if a sense of urgency is conveyed. Personalizing
messages to target specific population subgroups and
understanding the characteristics of those subgroups is
advantageous and likely to enhance the presentation of
health information.

Additional file
Additional file 1: Focus Group Moderator Guide for Strategies to
Customize Responsible Gambling Messages: A Review and Focus Group
Study. Moderator guide information for focus groups conducted,
including research background, initial questions, and proposed RG
messages for testing. (PDF 112 kb)
Abbreviation
RG: Responsible Gambling
Acknowledgements
Not applicable.
Funding
This research was funded by the Manitoba Gambling Research Program of
Manitoba Liquor and Lotteries Corporation; however, the findings and
conclusions of this paper are those solely of the author(s) and do not
necessarily represent the views of Manitoba Liquor and Lotteries Corporation.
This work was supported by an Australian Research Council Discovery Early
Career Research Award [DE1060100459] awarded to Dr. Sally Gainsbury. The
funding bodies had no role in the design of the study, collection, analysis, and
interpretation of data or in writing the manuscript.
Availability of data and materials
Deidentified transcripts available upon request from the corresponding
author for approved projects.
Authors’ contributions
SG contributed to study design, data analysis, and report writing. BA
contributed to study design, data analysis, and report writing. KP contributed
to study design and report writing. JB contributed to study design and
report editing. All authors have read and approved the manuscript.
Ethics approval and consent to participate
The study protocol was reviewed and approved by the Human Subjects
Ethical Review Committee at Southern Cross University [ECN-15-347]. All
participants were provided with information sheets prior to the focus groups
and provided written informed consent during the focus group before these
commenced.
Consent for publication
Not applicable.
Competing interests
SG has received direct and indirect funding over the last three years for
research projects, consultancy and to cover travel expenses including from
NSW Office of Liquor, Gaming and Racing; Australian Media and
Communication Authority; British Columbia Lottery Corporation; National
Council of Problem Gambling Singapore; Australian Research Council;

Page 9 of 11

Australian Department of Social Services; GambleAware; Gambling Research
Australia; Victorian Responsible Gambling Foundation; National Association
for Gambling Studies; Manitoba Gambling Research Program; Ontario
Problem Gambling Research Centre; Gambling Research Exchange Ontario;
Star/Echo Entertainment; Sportsbet; Crown Melbourne; Community Clubs
Victoria; Alberta Gambling Research Institute, Responsible Gambling Council;
Financial and Consumer Rights Council.
KP was previously the Director of Social Responsibility at the British
Columbia Lottery Corporation. In the past three years, he has received
funding from the British Columbia Lottery Corporation, Manitoba Gambling
Research Program, Responsible Gambling Council of Canada, UNLV
International Center for Gaming Regulation, U.S.-Japan Business Council,
Wynn Resorts, Board of Regents of the Nevada System of Higher Education,
and iDevelopment and Economic Association. He has received
reimbursement for travel from the National Council for Problem Gambling,
International Association of Gaming Advisors, National Centre for
Responsible Gambling, North American State and Provincial Lottery
Association, and Alberta Gambling Research Institute.
BA has received funding (2013–2018) from the Manitoba Gambling Research
Program, GP Consulting, U.S.-Japan Business Council, Wynn Las Vegas,
Victoria Responsible Gambling Foundation, Bermuda Casino Gambling
Commission, the State of Nevada, Canadian Partnership for Responsible
Gambling, iDevelopment and Economic Association, Majestic Star Casinos,
Oakland Raiders/National Football League, MGM Resorts International, and
Caesars Entertainment. She has received reimbursement for travel from
Association cluster sport international, British Columbia Lottery Corporation,
International Association of Gaming Advisors, GambleAware, Las Vegas
Convention and Visitors Authority, Ultimate Media Ventures, Canadian
Partnership for Responsible Gambling, and IGT Latin America. She is a
member of the Singapore National Council on Problem Gambling
International Advisory Panel.
JB has no competing interests, apart from funding mentioned in this study.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
Brain and Mind Centre, School of Psychology, University of Sydney,
Camperdown, NSW, Australia. 2International Gaming Institute, University of
Nevada, Las Vegas, Box 456037, 4505 S. Maryland Pkwy, Las Vegas, NV
89154-6037, USA. 3UCLA Gambling Studies Program, University of California,
Los Angeles, USA. 4School of Hospitality Business Management, Carson
College of Business, Washington State University, Everett, WA, USA.
Department of Economics, School of Social Sciences, Humanities and Arts,
University of California, Merced, Merced, CA, USA.
Received: 18 April 2018 Accepted: 29 November 2018

References
1. Hing N, Nuske E, Gainsbury S, Russell AMT. Perceived stigma and self-stigma
of problem gambling: perspectives of people with gambling problems. Int
Gambl Stud. 2016;16:31–48.
2. Kim HS, Wohl MJ, Salmon M, Santesso D. When do gamblers help
themselves? Self-discontinuity increases self-directed change over time.
Addict Behav. 2017;64:148–53.
3. Suurvali H, Cordingley J, Hodgins DC, Cunningham J. Barriers to seeking
help for gambling problems: a review of the empirical literature. J Gambl
Stud. 2009;25:407–24.
4. Langham E, Rockloff M, Browne M, Best T. Could EGM player-tracking
systems help link gamblers to treatment services in Australia: a thematic
analysis of counsellor and community educators’ perspectives. Int Gambl
Stud. 2017;17:471–89.
5. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington.
D.C.: American Psychiatric Publishing; 2013.
6. Hodgins DC, Stea JN, Grant JE. Gambling disorders. Lancet. 2011;378:1874–84.
7. Gainsbury S, Parke J, Suhonen N. Consumer attitudes towards internet
gambling: perceptions of responsible gambling policies, consumer
protection, and regulation of online gambling sites. Comput Human Behav.
2013;29:235–45.

8.

9.

10.

11.

12.

13.

14.
15.

16.

17.

18.
19.

20.

21.

22.

23.
24.

25.
26.

27.
28.

29.
30.
31.
32.

(2018) 18:1381

Gainsbury S, Russell A, Blaszczynski A, Hing N. Greater involvement and
diversity of internet gambling as a risk factor for problem gambling. Eur J
Pub Health. 2015;25:723–8.
Griffiths MD, Wood RT, Parke J. Social responsibility tools in online
gambling: a survey of attitudes and behavior among internet gamblers.
Cyberpsychology Behav. 2009;12:413–21.
Wood RT, Griffiths MD. Why Swedish people play online poker and factors
that can increase or decrease trust in poker websites: a qualitative
investigation. J Gambl Issues. 2008;21:80–97.
Forsström D, Jansson-Fröjmark M, Hesser H, Carlbring P. Experiences of
Playscan: interviews with users of a responsible gambling tool. Internet
Interv. 2017;8:53–62.
Wohl MJA, Davis CG, Hollingshead SJ. How much have you won or lost?
Personalized behavioral feedback about gambling expenditures regulates
play. Comput Human Behav. 2017;70:437–45.
Cohen IM, McCormick AV, Davies G. BCLC’s voluntary self-exclusion program
from the perspective and experiences of program participants. University of
the Fraser Valley. 2017.
Gainsbury S. Responsible gambling strategies. In: Internet gambling: Current
research findings and implications. New York: Springer; 2012. p. 103–12.
Nelson SE, LaPlante DA, Peller AJ, Schumann A, LaBrie RA, Shaffer HJ. Real
limits in the virtual world: self-limiting behavior of internet gamblers. J
Gambl Stud. 2008;24:463–77.
Forsström D, Hesser H, Carlbring P. Usage of a responsible gambling tool: a
descriptive analysis and latent class analysis of user behavior. J Gambl Stud.
2016;32(3):889–904.
Bernhard BJ, Lucas AF, Dongsuk J. Responsible gaming device research
report. Las Vegas: International gambling institute, University of Nevada;
2006.
Nova Scotia player card research project. Stage III research report. Halifax:
Nova Scotia Gaming Corporation; 2007.
Lucar C, Wiebe J, Philander KS. Monetary limits tools for internet gamblers: a
review of their availability. Toronto: Implementation and Effectiveness
Online; 2013. https://www.responsiblegambling.org/docs/research-reports/
monetary-limits-tools-for-internet-gamblers.pdf?sfvrsn=8
Gold J, Lim MS, Hellard ME, Hocking JS, Keogh L. What’s in a message?
Delivering sexual health promotion to young people in Australia via text
messaging. BMC Public Health. 2010;10:792.
Haug S, Kowatsch T, Castro RP, Filler A, Schaub MP. Efficacy of a web- and
text messaging-based intervention to reduce problem drinking in young
people: study protocol of a cluster-randomised controlled trial. BMC Public
Health. 2014;14:809.
Kerr DA, Pollard CM, Howat P, Delp EJ, Pickering M, Kerr KR, et al.
Connecting health and technology (CHAT): protocol of a randomized
controlled trial to improve nutrition behaviours using mobile devices and
tailored text messaging in young adults. BMC Public Health. 2012;12:477.
Argo JJ, Main KJ. Meta-analyses of the effectiveness of warning labels. J
Public Policy Mark. 2004;23:193–208.
Cox EP III, Wogalter MS, Stokes SL, Tipton Murff EJ. Do product warnings
increase safe behavior? A meta-analysis. J Public Policy Mark. 1997;16:195–
204.
Wogalter MS. Purposes and scope of warnings. In: Handbook of warnings.
Philadelphia: Lawrence Erlbaum Associates; 2006. p. 3–10.
Rothman AJ, Kelly KM, Hertel AW, Salovey P. Message frames and illness
representations: implications for interventions to promote and sustain
healthy behavior. In: The self-regulation of health and illness behaviour.
New York: Routledge Taylor & Francis Group; 2003. p. 278–96.
Rothman AJ, Salovey P. Shaping perceptions to motivate healthy behavior:
the role of message framing. Psychol Bull. 1997;121:3.
Rothman AJ, Stark E, Salovey P. Using message framing to promote healthy
behavior: a guide to best practices. In: Best practices in the behavioral
management of chronic diseases. Los altos: Institute for Disease Management;
2006. p. 31–48.
Blaszczynski A, Ladouceur R, Shaffer HJ. A science-based framework for
responsible gambling: the Reno model. J Gambl Stud. 2004;20:301–17.
Blaszczynski A, Nower L. A pathways model of problem and pathological
gambling. Addiction. 2002;97(5):487–99.
Sharpe L. A reformulated cognitive–behavioral model of problem gambling:
a biopsychosocial perspective. Clin Psychol Rev. 2002;22:1–25.
Benhsain K, Taillefer A, Ladouceur R. Awareness of independence of events
and erroneous perceptions while gambling. Addict Behav. 2004;29:399–404.

Page 10 of 11

33. Monaghan S. Review of pop-up messages on electronic gaming machines
as a proposed responsible gambling strategy. Int J Ment Health Addict.
2008;6:214–22.
34. Monaghan S, Blaszczynski A, Nower L. Do warning signs on electronic
gaming machines influence irrational cognitions? Psychol Rep. 2009;105:
173–87.
35. Steenbergh TA, Whelan JP, Meyers AW, May RK, Floyd K. Impact of warning
and brief intervention messages on knowledge of gambling risk, irrational
beliefs and behaviour. Int Gambl Stud. 2004;4:3–16.
36. Williams RJ, Connolly D. Does learning about the mathematics of gambling
change gambling behavior? Psychol Addict Behav. 2006;20:62–8.
37. Monaghan S, Blaszczynski A. Recall of electronic gaming machine signs: a
static versus a dynamic mode of presentation. J Gambl Issues. 2007;20:253–67.
38. Monaghan S, Blaszczynski A. Impact of mode of display and message
content of responsible gambling signs for electronic gaming machines on
regular gamblers. J Gambl Stud. 2010;26:67–88.
39. Tversky A, Kahneman D. Judgment under uncertainty: Heuristics and biases.
Science (80- ). 1974;185:1124–31.
40. Leventhal H. Findings and theory in the study of fear communications. Adv
Exp Soc Psychol. 1970;5:119–86.
41. Broda A, LaPlante DA, Nelson SE, LaBrie RA, Bosworth LB, Shaffer HJ. Virtual
harm reduction efforts for internet gambling: effects of deposit limits on
actual internet sports gambling behavior. Harm Reduct J. 2008;5(27).
42. Strahan EJ, White K, Fong GT, Fabrigar LR, Zanna MP, Cameron R. Enhancing
the effectiveness of tobacco package warning labels: a social psychological
perspective. Tob Control. 2002;11:183–90.
43. Fukunaga R, Bogg T, Finn PR, Brown JW. Decisions during negatively-framed
messages yield smaller risk-aversion-related brain activation in substancedependent individuals. Psychol Addict Behav. 2013;27:1141–52.
44. Krawitz A, Fukunaga R, Brown JW. Anterior insula activity predicts the
influence of positively framed messages on decision making. Cogn Affect
Behav Neurosci. 2010;10:392–405.
45. Rothman AJ, Bartels RD, Wlaschin J, Salovey P. The strategic use of gain-and
loss-framed messages to promote healthy behavior: how theory can inform
practice. J Commun. 2006;56:S202–20.
46. Wansink B, Pope L. When do gain-framed health messages work better
than fear appeals? Nutr Rev. 2014;73:4–11.
47. Glock S, Müller BC, Krolak-Schwerdt S. Implicit associations and compensatory
health beliefs in smokers: exploring their role for behaviour and their change
through warning labels. Br J Health Psychol. 2013;18:814–26.
48. Hoch SJ, Deighton J. Managing what consumers learn from experience. J
Mark. 1989;53:1–20.
49. Levin IP, Chapman DP, Johnson RD. Confidence in judgments based on
incomplete information: an investigation using both hypothetical and real
gambles. J Behav Decis Mak. 1988;1:29–41.
50. Mussweiler T, Neumann R. Sources of mental contamination: comparing the
effects of self-generated versus externally provided primes. J Exp Soc
Psychol. 2000;36:194–206.
51. Kardes FR, Kim J, Lim JS. Moderating effects of prior knowledge on the
perceived diagnosticity of beliefs derived from implicit versus explicit
product claims. J Bus Res. 1994;29:219–24.
52. Gainsbury S, Aro D, Ball D, Tobar C, Russell A. Optimal content for warning
messages to enhance consumer decision making and reduce problem
gambling. J Bus Res. 2015;68:2093–101.
53. Wright P. Concrete action plans in TV messages to increase reading of drug
warnings. J Consum Res. 1979;6:256–69.
54. Guillaumier A, Bonevski B, Paul C. Tobacco health warning messages on
plain cigarette packs and in television campaigns: a qualitative study with
Australian socioeconomically disadvantaged smokers. Health Educ Res.
2014;30:57–66.
55. Vallone DM, Duke JC, Mowery PD, McCausland KL, Xiao H, Costantino JC, et
al. The impact of EX®: results from a pilot smoking-cessation media
campaign. Am J Prev Med. 2010;38:S312–8.
56. Vallone DM, Niederdeppe J, Richardson AK, Patwardhan P, Niaura R, Cullen
J. A national mass media smoking cessation campaign: effects by race/
ethnicity and education. Am J Health Promot. 2011;25(5 Suppl):S38–50.
57. Matulewicz N. How do players use a responsible gambling tool? Why user
interface design matters; 2015.
58. Yank V, Tribett E, Green L, Pettis J. Learning from marketing: rapid
development of medication messages that engage patients. Patient Educ
Couns. 2015;98:1025–34.

(2018) 18:1381

59. Hing N. An assessment of member awareness, perceived adequacy and
perceived effectiveness of responsible gambling strategies in Sydney clubs.
Lismore: Southern Cross University; 2003.
60. Schrans T, Grace J, Schellinck T. 2003 NS VL responsible gaming features
evaluation: final report. Halifax; 2004.
61. Hadden SG. Regulating product risks through consumer information. J Soc
Issues. 1991;47:93–105.
62. Wogalter H, Dejoy D, Laughery KR. Warnings and risk communication.
London: Taylor & Francis; 1999.
63. Harris A, Griffiths MD. A critical review of the harm-minimisation tools
available for electronic gambling. J Gambl Stud. 2017;33(1):187–221.
64. Gainsbury S. Player account-based gambling: potentials for behaviour-based
research methodologies. Int Gambl Stud. 2011;11:153–71.
65. Bennett GG, Glasgow RE. The delivery of public health interventions via the
internet: actualizing their potential. Annu Rev Public Health. 2009;30:273–92.
66. Cunningham JA, Sdao-Jarvie K, Koski-Jännes A, Breslin FC. Using self-help
materials to motivate change at assessment for alcohol treatment. J Subst
Abus Treat. 2001;20:301–4.
67. Wood RT, Williams RJ. Internet gambling: Prevalence, patterns, problems
and policy options. Guelph: Ontario Problem Gambling Research Centre;
2009.
68. Bull FC, Kreuter MW, Scharff DP. Effects of tailored, personalized and general
health messages on physical activity. Patient Educ Couns. 1999;36:181–92.
69. Carbonneau R, Vitaro F, Brendgen M, Tremblay RE. Variety of gambling
activities from adolescence to age 30 and association with gambling
problems: a 15-year longitudinal study of a general population sample.
Addiction. 2015;110:1985–93.
70. Volberg RA, Gupta R, Griffiths MD, Ólason DT, Delfabbro P. An international
perspective on youth gambling prevalence studies. Int J Adolesc Med
Health. 2010;22:3–38.
71. Blinn-Pike L, Worthy SL, Jonkman JN. Adolescent gambling: a review of an
emerging field of research. J Adolesc Health. 2010;47:223–36.
72. Rogers WA, Lamson N, Rousseau GK. Warning research: an integrative
perspective. Hum Factors. 2000;42:102–39.
73. Fischer PM, Krugman DM, Fletcher JE, Fox RJ, Rojas TH. An evaluation of
health warnings in cigarette advertisements using standard market research
methods: what does it mean to warn? Tob Control. 1993;2:279.
74. Fox RJ, Krugman DM, Fletcher JE, Fischer PM. Adolescents’ attention to beer
and cigarette print ads and associated product warnings. J Advert. 1998;27:
57–68.
75. Leventhal H, Glynn K, Fleming R. Is the smoking decision an “informed choice”?
Effect of smoking risk factors on smoking beliefs. JAMA. 1987;257:3373–6.
76. Mazanov J, Byrne D. Changes in adolescent smoking behaviour and
knowledge of health consequences of smoking. Aust J Psychol. 2007;59:
176–80.
77. Hardoon K, Derevensky JL, Gupta R. Empirical measures vs. perceived
gambling severity among youth: Why adolescent problem gamblers fail to
seek treatment. Addict Behav. 2003;28:933–46.
78. Delfabbro PH, Winefield AH. Predictors of irrational thinking in regular slot
machine gamblers. J Psychol. 2000;134:117–28.
79. Dowling NA, Smith D, Thomas T. Electronic gaming machines: are they the
‘crack-cocaine’ of gambling? Addiction. 2005;100:33–45.
80. Gupta R, Derevensky JL. Adolescents with gambling problems: from
research to treatment. J Gambl Stud. 2000;16:315–42.
81. Arthur D, Quester P. Who’s afraid of that ad? Applying segmentation to the
protection motivation model. Psychol Mark. 2004;21:671–96.
82. Ho R. The intention to give up smoking: disease versus social dimensions. J
Soc Psychol. 1998;138:368–80.
83. Schoenbachler DD, Whittler TE. Adolescent processing of social and physical
threat communications. J Advert. 1996;25:37–54.
84. Canada S. Canadian community health survey. Cycle. 2014;1:1 http://www.
statcan.gc.ca/concepts/health-sante/index-eng.htm.
85. Stitt BG, Giacopassi D, Nichols M. Gambling among older adults: a
comparative analysis. Exp Aging Res. 2003;29:189–203.
86. Tirachaimongkol LC, Jackson AC, Tomnay JE. Pathways to problem
gambling in seniors. J Gerontol Soc Work. 2010;53:531–46.
87. Tira C, Jackson AC, Tomnay JE. Pathways to late-life problematic gambling
in seniors: a grounded theory approach. Gerontologist. 2014;54:1035–48.
88. Philippe F, Vallerand RJ. Prevalence rates of gambling problems in Montreal,
Canada: a look at old adults and the role of passion. J Gambl Stud. 2007;23:
275–83.

Page 11 of 11

89. Lewis RA, Reiley DH. Advertising effectively influences older users: how field
experiments can improve measurement and targeting. Rev Ind Organ. 2014;
44:147–59.
90. Bjerg O. Problem gambling in poker: money, rationality and control in a
skill-based social game. Int Gambl Stud. 2010;10:239–54.
91. Abarbanel B, Bernhard B, Singh AK, Lucas A. Impact of virtual atmospherics
and functional qualities on the online gambler’s experience. Behav Inf
Technol. 2015;34:1005–21.
92. Gainsbury S, Suhonen N, Saastamoinen J. Chasing losses in online poker
and casino games: characteristics and game play of internet gamblers at
risk of disordered gambling. Psychiatry Res. 2014;217:220–5.
93. Auer M, Griffiths MD. Voluntary limit setting and player choice in most
intense online gamblers: an empirical study of gambling behaviour. J
Gambl Stud. 2013;29:647–60.
94. Afifi TO, LaPlante DA, Taillieu TL, Dowd D, Shaffer HJ. Gambling
involvement: considering frequency of play and the moderating effects of
gender and age. Int J Ment Health Addict. 2014;12:283–94.
95. Currie SR, Hodgins DC, Wang J, El-Guebaly N, Wynne H, Chen S. Risk of
harm among gamblers in the general population as a function of level of
participation in gambling activities. Addiction. 2006;101:570–80.
96. Hodgins DC, Schopflocher DP, Martin CR, El-Guebaly N, Casey DM, Currie SR,
et al. Disordered gambling among higher-frequency gamblers: who is at
risk? Psychol Med. 2012;42:2433–44.
97. Braverman J, Shaffer HJ. How do gamblers start gambling: identifying
behavioural markers for high-risk internet gambling. Eur J Pub Health. 2010;
22:273–8.
98. LaPlante D, Nelson S, and Gray H. Breadth and depth involvement:
Understanding internet gambling involvement and its relationship to gambling
problems. Psychol Addict Behav. 2014;28(2):396–403.
99. Marshall C, Rossman GB. Designing qualitative research. 5th ed. Thousand
Oaks: SAGE; 2011.
100. Creswell JW. Research design: qualitative, quantitative and mixed methods
approaches. 2nd ed. London: SAGE; 2003.
101. Woodyatt CR, Finneran CA, Stephenson R. In-person versus online focus
group discussions: a comparative analysis of data quality. Qual Health Res.
2016;26:741–9.
102. Lune H, Berg BL. Qualitative research methods for the social sciences. 7th
ed. London: Pearson Education; 2009.
103. Saldaña J. The coding manual for qualitative researchers. Thousand Oaks:
SAGE; 2016.
104. Shaffer HJ, Hall MN, Vander Bilt J. Estimating the prevalence of disordered
gambling behavior in the United States and Canada: a research synthesis.
Am J Public Heal. 1999;89(9):1369–76.
105. Philander K, Gainsbury S. Customised responsible gambling messages.
Vancouver: British Columbia Lottery Corporation; 2014.
106. Holtgraves T. Gambling, gambling activities, and problem gambling. Psychol
Addict Behav. 2009;23:295–302.
107. MacKay TL, Bard N, Bowling M, Hodgins D. Do pokers players know how
good they are? Accuracy of poker skill estimation in online and offline
players. Comput Human Behav. 2014;31:419–24.
108. Barrault S, Varescon I. Cognitive distortions, anxiety, and depression among
regular and pathological gambling online poker players. Cyberpsychol
Behav Soc Netw. 2013;16:183–8.
109. Hopley AA, Nicki RM. Predictive factors of excessive online poker playing.
Cyberpsychol Behav Soc Netw. 2010;13:379–85.
110. McCormack A, Griffiths M. What differentiates professional poker players
from recreational poker players? A qualitative study. Int J Ment Health
Addict. 2012;10:243–57.
111. Ladouceur R, Blaszczynski A, Lalande DR. Pre-commitment in gambling: a
review of the empirical evidence. Int Gambl Stud. 2012;12:215–30. https://
doi.org/10.1080/14459795.2012.658078.
