Abstract
This scoping review draws on the latest available evidence (peer-review and grey literature) to explore gambling harms within the LGBTQ+ population. The resulting paper presents findings from across existing research around prevalence of gambling amongst LGBTQ+ communities, the impact of gambling harm, and associated risk factors. The review also considers questions about help-seeking, the barriers LGBTQ+ people may experience to accessing healthcare services, protective factors, and possible interventions for these communities. An intersectional approach is taken to exploring gender identity and sexual orientation (considering age, ethnicity, and migrant status), and the unique needs and experiences of these communities as reflected across gambling and health behaviour research.
Research to date on the topic of gambling harm amongst LGBTQ+ communities has focused only on peer-reviewed literature. This research synthesis brings together the latest known evidence from across published and grey literature, the latter being of particular importance when considering minority populations. The review was commissioned by GambleAware with the aim of providing evidence to inform practice, and to highlight any gaps in existing evidence with a view to shape the focus and priorities of future primary research.
Key questions
Guided by the following question - ‘What is known about gambling in LGBTQ+ communities?’ the review considers these linked areas of focus:
i) the prevalence of gambling harm amongst LGBTQ+ communities;
ii) the lived experience of LGBTQ+ people, reflecting the impacts of gambling harm;
iii) interventions for LGBTQ+ people to reduce gambling harm;
iv) the barriers LGBTQ+ people may experience in accessing services and healthcare provision to address gambling harm; and,
iv) protective factors that mitigate harm in these communities.
Results
The results follow in relation to the key questions where relevant information was available.
Prevalence: The results yielded mixed evidence regarding the prevalence of gambling and gambling harms amongst sexual minority populations. There was evidence of higher burdens of gambling harms amongst sexual minority individuals, particularly in relation to sexual minority men and LGBTQ+ youth. However, other studies reported that sexual minority individuals reported lower prevalence (Bush et al., 2020; Bush et al., 2021). There is, however, consistent evidence that trans and gender diverse people might experience higher levels of gambling harms compared to cisgender people. One study found that trans and gender diverse youth were more likely to experience gambling harms compared to their cisgender peers, with trans youth assigned ‘male’ at birth being at particular risk (Rider et al., 2019). A further study (Mattelin et al., 2022) found that trans people with refugee status were at highest risk of gambling harm compared to other sub-groups.
Gambling harms: There is limited research focussing on the lived experience of gambling harm amongst LGBTQ+ communities in GB. In addition, few studies have examined the wider impact of gambling (e.g., financial harm, negative impact on relationships and work) amongst LGBTQ+ people. The studies which did examine gambling-associated harms found that sexual minority men reported high rates of participation in gambling activities associated with greater gambling harms, such as electronic gambling machines, horse/greyhound racing, and sports betting (Bush et al., 2021).
Risk and protective factors: The literature highlighted risk factors including minority stress, societal stigma and/or discrimination, isolation, and victimisation that was framed in some instances as a hate crime. Emerging evidence suggests that perceived stigma may play a role both in terms of the severity of gambling harms experienced and the related impact amongst sexual minority men (Bush et al., 2021). There is some evidence to suggest that general anxiety around everyday disclosures of gender identity or sexual orientation, and anticipated stigma, may be a risk factor for gambling harms where gambling offers a form of escapism. There is also some evidence linking higher levels of drug and alcohol use to gambling harms (Birch et al., 2015; Mattelin et al., 2022). In terms of protective factors higher levels of support, positive social interaction, and mainstream community connectedness predicted lower levels of gambling harm for sexual minority men, but not for heterosexual cisgender men (Bush et al., 2021). Accordingly, social support emerged as a protective factor unique to the LGBTQ+ population (Bush et al., 2020; Bush et al., 2021).
Gambling-related help-seeking, service barriers, and interventions: No studies were identified in the current review which looked at services or interventions for LGBTQ+ people experiencing gambling harms. The limited research that was available focused instead on accessing mental health and social care services (Bush et al., 2020). General health service barriers included professionals’ heteronormative attitudes that became apparent in the use of pathologising language, and/or a lack of cultural competency and education around LGBTQ+ issues (Bush et al., 2020; Mattelin et al., 2022). Elsewhere, there is some evidence suggesting that LGBTQ+ people who gamble may experience shame both based on their LGBTQ+ status as well as their gambling habits, which can, in turn, act as a barrier to help-seeking.
Conclusions and Recommendations
There is evidence of an additional burden and compounding gambling harms for some groups within the LGBTQ+ community. However, research on LGBTQ+ gambling harm remains distinctly limited, and is barely established in the UK. Even less is known about gambling harm for LGBTQ+ people where gender, sexuality, ethnicity, disability and other factors intersect. Research demonstrating underlying drivers of gambling harm, the risk factors, the lived experience of gambling harm, as well as the needs of LGBTQ+ people who access support services, are all limited in the UK and further afield.
The mixed findings over prevalence highlight the need for large-scale, population-based surveys, and more cross-sectional work around gambling harms, risk, help-seeking, and protective factors across minority LGBTQ+ populations. Longitudinal research is urgently needed to examine gambling over the life course, and to identify any emerging trends for population subsets with associated demographic indicators. In addition, qualitative research is required to enable a better understanding of the lived experiences of gambling harm, and to establish the drivers of burdens for gambling harm amongst LGBTQ+ communities. The results of this review highlight the requirement to consider the unique support needs and perspectives of minority groups within the LGBTQ+ umbrella. Future research should be undertaken with greater community involvement and in collaboration with LGBTQ+ peers. Better understanding of gambling could inform a whole systems approach including health promotion initiatives and the development of targeted interventions to protect against gambling harm in LGBTQ+ people and, ultimately, work towards greater health equity.
Research to date on the topic of gambling harm amongst LGBTQ+ communities has focused only on peer-reviewed literature. This research synthesis brings together the latest known evidence from across published and grey literature, the latter being of particular importance when considering minority populations. The review was commissioned by GambleAware with the aim of providing evidence to inform practice, and to highlight any gaps in existing evidence with a view to shape the focus and priorities of future primary research.
Key questions
Guided by the following question - ‘What is known about gambling in LGBTQ+ communities?’ the review considers these linked areas of focus:
i) the prevalence of gambling harm amongst LGBTQ+ communities;
ii) the lived experience of LGBTQ+ people, reflecting the impacts of gambling harm;
iii) interventions for LGBTQ+ people to reduce gambling harm;
iv) the barriers LGBTQ+ people may experience in accessing services and healthcare provision to address gambling harm; and,
iv) protective factors that mitigate harm in these communities.
Results
The results follow in relation to the key questions where relevant information was available.
Prevalence: The results yielded mixed evidence regarding the prevalence of gambling and gambling harms amongst sexual minority populations. There was evidence of higher burdens of gambling harms amongst sexual minority individuals, particularly in relation to sexual minority men and LGBTQ+ youth. However, other studies reported that sexual minority individuals reported lower prevalence (Bush et al., 2020; Bush et al., 2021). There is, however, consistent evidence that trans and gender diverse people might experience higher levels of gambling harms compared to cisgender people. One study found that trans and gender diverse youth were more likely to experience gambling harms compared to their cisgender peers, with trans youth assigned ‘male’ at birth being at particular risk (Rider et al., 2019). A further study (Mattelin et al., 2022) found that trans people with refugee status were at highest risk of gambling harm compared to other sub-groups.
Gambling harms: There is limited research focussing on the lived experience of gambling harm amongst LGBTQ+ communities in GB. In addition, few studies have examined the wider impact of gambling (e.g., financial harm, negative impact on relationships and work) amongst LGBTQ+ people. The studies which did examine gambling-associated harms found that sexual minority men reported high rates of participation in gambling activities associated with greater gambling harms, such as electronic gambling machines, horse/greyhound racing, and sports betting (Bush et al., 2021).
Risk and protective factors: The literature highlighted risk factors including minority stress, societal stigma and/or discrimination, isolation, and victimisation that was framed in some instances as a hate crime. Emerging evidence suggests that perceived stigma may play a role both in terms of the severity of gambling harms experienced and the related impact amongst sexual minority men (Bush et al., 2021). There is some evidence to suggest that general anxiety around everyday disclosures of gender identity or sexual orientation, and anticipated stigma, may be a risk factor for gambling harms where gambling offers a form of escapism. There is also some evidence linking higher levels of drug and alcohol use to gambling harms (Birch et al., 2015; Mattelin et al., 2022). In terms of protective factors higher levels of support, positive social interaction, and mainstream community connectedness predicted lower levels of gambling harm for sexual minority men, but not for heterosexual cisgender men (Bush et al., 2021). Accordingly, social support emerged as a protective factor unique to the LGBTQ+ population (Bush et al., 2020; Bush et al., 2021).
Gambling-related help-seeking, service barriers, and interventions: No studies were identified in the current review which looked at services or interventions for LGBTQ+ people experiencing gambling harms. The limited research that was available focused instead on accessing mental health and social care services (Bush et al., 2020). General health service barriers included professionals’ heteronormative attitudes that became apparent in the use of pathologising language, and/or a lack of cultural competency and education around LGBTQ+ issues (Bush et al., 2020; Mattelin et al., 2022). Elsewhere, there is some evidence suggesting that LGBTQ+ people who gamble may experience shame both based on their LGBTQ+ status as well as their gambling habits, which can, in turn, act as a barrier to help-seeking.
Conclusions and Recommendations
There is evidence of an additional burden and compounding gambling harms for some groups within the LGBTQ+ community. However, research on LGBTQ+ gambling harm remains distinctly limited, and is barely established in the UK. Even less is known about gambling harm for LGBTQ+ people where gender, sexuality, ethnicity, disability and other factors intersect. Research demonstrating underlying drivers of gambling harm, the risk factors, the lived experience of gambling harm, as well as the needs of LGBTQ+ people who access support services, are all limited in the UK and further afield.
The mixed findings over prevalence highlight the need for large-scale, population-based surveys, and more cross-sectional work around gambling harms, risk, help-seeking, and protective factors across minority LGBTQ+ populations. Longitudinal research is urgently needed to examine gambling over the life course, and to identify any emerging trends for population subsets with associated demographic indicators. In addition, qualitative research is required to enable a better understanding of the lived experiences of gambling harm, and to establish the drivers of burdens for gambling harm amongst LGBTQ+ communities. The results of this review highlight the requirement to consider the unique support needs and perspectives of minority groups within the LGBTQ+ umbrella. Future research should be undertaken with greater community involvement and in collaboration with LGBTQ+ peers. Better understanding of gambling could inform a whole systems approach including health promotion initiatives and the development of targeted interventions to protect against gambling harm in LGBTQ+ people and, ultimately, work towards greater health equity.
| Original language | English |
|---|---|
| Number of pages | 40 |
| Publication status | Published - 2 Jan 2024 |