A systematic review of educational programs and consumer protection measures for gambling: an extension of previous reviews

Besides supply reduction, preventive interventions to reduce harm from gambling include interventions for the reduction of demand and to limit negative consequences. Several interventions are available for gamblers, e.g. limit-setting. Reviews have been published examining the evidence for specific measures as well as evaluating the effect of different measures at an overall level. Only a few of these have used a systematic approach for their literature review. The aim of this systematic review and meta-analysis is twofold. First, to assess the certainty of evidence of different preventive measures in the field of educational programs and consumer protection measures, including both land-based and online gambling. The second is to present shortcomings in eligible studies to highlight what type of information is needed in future studies. This systematic review included measures administered in both real-life settings and online. Twenty-eight studies fulfilled our inclusion criteria and had low or moderate risk of bias. The results showed that only two measures (long term educational programs and personalized feed-back) had an impact on gambling behavior. Follow-up period was short, and measures did not include gambling as a problem. The certainty in most outcomes, according to GRADE, was very low. Several shortcomings were found in the studies. We concluded that the support for preventive measures is low and that a consensus statement regarding execution and methods to collect and analyze data for preventive gambling research is needed. Our review can serve as a starting point for future responsible gambling reviews since it evaluated certainty of evidence.

除减少赌博供给外，用于降低赌博危害的预防性干预措施还包括两类：一类旨在减少赌博需求，另一类则用于限制赌博带来的负面后果。针对赌客的预防性干预手段已不乏可选方案，例如额度设定（limit-setting）。现有相关综述文献，既针对特定干预措施的证据开展分析，也从全局层面评估各类措施的整体效果，但其中仅有少数采用了系统的文献综述方法。本项系统综述与元分析（meta-analysis）的研究目标兼具双重性：其一，评估教育项目与消费者保护领域各类预防性干预措施的证据确定性，研究场景涵盖线下博彩（land-based gambling）与线上博彩；其二，梳理纳入研究的局限性，以此明确未来相关研究亟需补充的信息方向。本系统综述纳入了在现实场景与线上环境中实施的干预措施，最终共有28项研究符合纳入标准，且其偏倚风险处于低或中等水平。研究结果显示，仅有两项干预措施——长期教育项目（long-term educational programs）与个性化反馈（personalized feedback）——对赌博行为产生了显著影响。此外，纳入研究的随访周期普遍较短，且未将问题赌博作为核心研究对象。根据推荐分级的评估、制订与评价（GRADE）标准，绝大多数研究结局的证据确定性均处于极低水平。本综述纳入的诸多研究均存在不同程度的局限性。经综合分析，我们得出如下结论：现有证据对赌博预防性干预措施的支持度较低，且亟需形成一套关于赌博预防研究的实施规范、数据收集与分析方法的共识性声明。鉴于本综述对证据确定性进行了系统评估，其可作为未来负责任赌博（responsible gambling）相关综述研究的参考起点。