Introduction

Gambling is relatively common activity among adolescents [1]. Despite age restrictions [2], adolescents participate in multiple types of gambling including on lotteries [3], on the internet [4], in video games [5], on electronic-gambling [slot] machines [6], in poker games [7], and in casinos [8]. As gambling becomes more normalized and accessible—and with new gambling opportunities emerging, being heavily advertised and receiving extensive media coverage—adolescents have considerable exposure to gambling. The practice of competitive video gaming, also known as eSports [e.g., using video games as platforms for competition between two or more persons [9], sometimes organized into leagues and tournaments [10], is rapidly becoming popular in public schools across the country [11–13]. Connecticut was the first state to officially welcome eSports into high schools in 2017. High consumption of video games and eSports have been linked to gambling, particularly among male youth [14, 15]. Recent legislative changes regarding the legalization of retail sports and online betting in many U.S. jurisdictions, including Connecticut [16], highlight the need to pay specific attention to gambling among adolescents in current contexts [17]. Some of these changes were preceded by similar gambling-like activities. For instance, before sports gambling was legalized in Connecticut in 2021, daily fantasy sports had been legalized in 2017. Although not legally classified as gambling, the legalization and heavy promotion of daily fantasy sports through various media may have influenced sports-related gambling behaviors, particularly among adolescent males who closely follow sports. Indeed, companies initially involved in daily fantasy sports have now moved into online sports gambling, which was legalized and made available in Connecticut in 2021. After gambling participation by adolescents steadily declined from 2007 to 2017, Connecticut adolescents demonstrated increased gambling participation in 2019 [17].

The growing exposure to and availability of gambling opportunities may pose a significant risk to adolescents, who might not fully understand potential consequences. Although underage gambling can significantly impact adolescents’ lives, it often remains unrecognized by teachers and parents until it reaches problematic levels [18]. Estimates of problem gambling for adolescents have varied. Some studies suggest that between 50% and 70% of adolescents, depending on the country studied, have taken part in some form of gambling at least annually [19], with 0.2%–12.3% of adolescents meeting criteria for problem gambling and 0.2–8.1% among adolescents meeting diagnostic criteria for gambling disorder worldwide [20, 21]. Among Connecticut adolescents, 17.4% were classified as having at-risk gambling and 10.4% as having problem/pathological gambling [22]. Among participants classified as having problem/pathological gambling, 52.3% met full criteria for a gambling disorder [22]. Another survey of Connecticut high school students found that among youth gambling on the internet, 57.5% were classified as having problem/pathological gambling, and among the non-internet-gambling group, 27.7% were classified as having problem/pathological gambling. Almost 11% of Connecticut adolescents acknowledged gambling in casinos in the mid-2000’s [8].

Adolescence is a transitional period from childhood to adulthood marked by biological, cognitive, social, emotional, and behavioral changes [23]. Brain developmental changes during adolescent years have important implications for behavior [24]. Cognitive control is not fully developed and hormonal changes may generate emotional lability and greater responsivities to rewards or stress [25]. Having limited life experience and being more vulnerable to peer influences [26] and marketing campaigns [27, 28], young people may inadequately assess risk levels of activities such as gambling [21, 29]. Changes in adolescents’ lives are also observed in increased social pressure, modifying expectations and needs, formation of new health-related habits, and development of new adaptive skills [30, 31]. Developmental changes during adolescence can link to engagement in problem behaviors [32]. Gambling practices appear to be an early risk behavior, often preceded by experiments with tobacco and illicit drugs or risky sex practices [21], as adolescents may consider gambling less risky than alcohol or cigarettes, and more available than alcohol or marijuana [33]. Adolescence is a time when many youths learn how to regulate their emotions and develop personal coping skills for dealing with stress. Some adolescents may deal with stress by engaging in risky behaviors. In such cases, gambling may appear as an attractive means to escape from stressors.

According to the problem behavior theory [PBT] that describes behavioral patterns in adolescents [34], risky behaviors, including gambling, result from person-environmental interactions and often co-occur [35], where both internal and external [e.g., environmental] factors may contribute to the engagement in problematic behaviors [36], and where the balance between risk and protective factors determines whether or not the individual will engage in problematic behaviors. In contrast to theories focusing on how engagement in one risk behavior may displace other activities, the PBT suggests that as one type of problematic behavior increases, the likelihood of the occurrence of other problem behaviors also increases. Co-existence of these behaviors may also be explained by common underlying risk factors, supporting the notion of a problem behavior syndrome [32, 37]. Sociodemographic characteristics of adolescents who gamble include older age and male gender, with older adolescent boys tending to gamble more often and bet higher amounts of money [38].

Although the PBT suggests that one risk behavior may elevate the likelihood of others, most studies have not compared a full range of potentially co-occurring problem behaviors in the same analysis, particularly as new emerging risk behaviors related to digital technology use and electronic delivery of drugs have become more prevalent. The present investigation seeks to address gaps in the existing research and uses recently collected data to examine the associations between past-year gambling and other health risk behaviors, including substance use, tobacco and electronic vapor product use, sexual behaviors, risky use of digital technologies, and risk activities on school property. To do so, we interrogated data from the year prior to the COVID-19 pandemic. Specifically, in the current study, we sought to provide insight into adolescent gambling and risk behaviors in a contemporary, representative sample of Connecticut high-school students participating in the 2019 Youth Risk Behavior Survey [YRBS].

In this exploratory study, we had two specific aims: [1] provide an up-to-date, pre-pandemic estimate of the prevalence of past-year gambling among Connecticut high-school students; and [2] identify sociodemographic characteristics associated with gambling and assess trauma exposure, other risk behaviors, suicidality, homelessness, health status, academics, and social support associated with gambling. Based on the PBT, we hypothesized that adolescents who reported past-year gambling would have low academic grades and be more likely to engage in problem behaviors, including alcohol and drug use, tobacco, vaping, risky sex practices, and aggressive behaviors [e.g., physical fights and carrying weapons on school territory]. We hypothesized that adolescents who experienced low levels of parental support would be more likely to engage in problem behaviors as more social support may help develop better coping mechanisms and emotional regulation skills. Finally, we hypothesized that gambling participation would be prevalent particularly among older adolescent males and associate with trauma exposure and suicidality.

Materials and methods

Results

Descriptive statistics

Data were available for 2,015 individuals. Respondents who had missing data on the gambling question (n = 208; 10%) were excluded from analyses. Thus, the total analytic sample consisted of 1,807 individuals, of whom 891 (49.7%) were males. Approximately one-quarter [n = 453; 25.4%] reported gambling one or more times during the past 12 months. Slightly more than one-third of the sample (n = 733, 34.3%) was 15 years old or younger. Almost half of the sample included 16- and 17-year-old students (n = 855; 45.7%), with the remainder of the sample (n = 213; 11.8%) being aged 18 years and older. Slightly more than half of the sample (n = 902; 57.7%) was White; 11.6% (n = 159) was Black; 5.1% (n = 121) was Hispanic; 3.7% (n = 84) was Asian; and 21.9% was multiracial or other race (n = 525).

The gambling patterns among persons who reported having gambled in the past 12 months are presented in Fig 1, Table 1.

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Fig 1. Self-reported gambling frequency among adolescents over the past 12 months.

This bar graph shows the self-reported number of times adolescents have gambled over the past 12 months. The majority (57%) reported gambling 1–2 times, followed by 22.7% gambling 3–9 times. Smaller percentages engaged in gambling 10–19 times (7.5%), 20–39 times (4.3%), and 40+ times (8.4%).

https://doi.org/10.1371/journal.pone.0290589.g001

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Table 1. Self-reported gambling frequency among adolescents over the past 12 months.

https://doi.org/10.1371/journal.pone.0290589.t001

Bivariate and multivariate analyses. Table 2 displays the sociodemographic characteristics of adolescents with and without gambling. Adolescents who reported past-year gambling were more likely to be older and male.

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Table 2. Socio-demographic characteristics of the sample stratified by gambling status [N = 1,807].

https://doi.org/10.1371/journal.pone.0290589.t002

Table 3 presents suicidality, traumatic experiences, substance use, and other risk behaviors stratified by gambling status and adjusted for age and sex [S1 Table in S1 File for unadjusted findings].

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Table 3. Traumatic experiences, suicidal and other risk behaviors stratified by gambling status [N = 1,807].

https://doi.org/10.1371/journal.pone.0290589.t003

Adolescents who reported past-year gambling experienced more trauma, including electronic bullying, forced sex, having felt unsafe at school, and homelessness. The gambling group was more likely to report alcohol and binge drinking, marijuana and synthetic marijuana use, and use of over-the-counter medication to get high. The gambling group was more likely to report having played video games or using a computer for other than school purposes three or more hours per day, using alcohol and/or marijuana (current and lifetime), engaging in binge drinking, and misusing over-the-counter medication to get high. They were also more likely to report having used tobacco (cigarettes and cigars) and electronic vapor products, been offered drugs at school, engaged in risky sexual behaviors (sex with multiple partners and sex while drunk), and involvement in aggressive behaviors (e.g., carrying a weapon on school property, having been in a physical fight on school property). Adolescents from the gambling group reported they were more than twice as likely to have attempted suicide.

Table 4 presents subjective health, academic performance, and social support measures adjusted for age and sex [S2 Table S1 File for unadjusted findings].

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Table 4. Perceived health status, academics and support variables stratified by gambling status [N = 1,807].

https://doi.org/10.1371/journal.pone.0290589.t004

The gambling group reported poorer school performance and less family support.

Discussion

This study examined 2019 data regarding gambling behaviors and their correlates among high-school students in Connecticut. Approximately one-quarter [25.4%] reported past-year gambling. This estimate appears higher than that previously found [18.6%] among Connecticut adolescents surveyed in 2017 [39]. These differences may reflect, in part, the use of slightly different wording in the question to assess gambling involvement in the past year in these two samples. However, other possibilities [e.g., the increasing popularity and social acceptability of sports gambling, especially following the introduction of daily fantasy sports in Connecticut in 2017 and their promotion through frequent advertisements] warrant consideration. The observed gambling prevalence estimate is lower than estimates based on national telephone-based surveys [44.3% to 68%] and in the low range of what was has been reported among students in school-based surveys [24.4% to 86%] and convenience samples [22.5% to 47.4%], although changes over time in the prevalence of adolescent gambling during the early part of the second decade of this millennium should also be considered [41, 42]. While half of the adolescents who gambled last year reported doing it only 1 or 2 times, 12.7% of gambling adolescents reported gambling 20 or more times, with 8.4% reporting more than 40 times.

Past-year gambling was higher among male adolescents, consistent with previous findings [20, 43, 44]. Boys generally gamble more and are more likely to experience gambling problems compared to girls [45]. Additionally, men with gambling problems often report beginning their gambling activities in their teens, while women typically start gambling later in life [46]. Understanding gender-related differences can inform effective educational strategies for families and school administrators and counselors, helping them to shape preventive efforts with sex-informed considerations. In support of our hypothesis, and consistent with the PBT, adolescents who gambled in the past year reported more frequent engagement in other problem behaviors including alcohol, tobacco, and marijuana use, similar to prior observations [22, 41, 47]. Such gambling/substance-use relationships were found to extend to use of electronic vaping devices, a newer substance-related concern among youth [48]. Further, gambling in adolescents was associated with other risk behaviors including unsafe driving (using cell phone/e-mailing/ texting while driving) and frequent use of computers or cell phones and risky sexual behavior. Gambling was also associated with aggressive behaviors including illegal activities on school grounds and getting into physical fights, as in prior studies of Connecticut high-school students [22]. The association between problem-gambling severity and weapon-carrying is also consistent with previous studies of Connecticut high-school students [22, 39].

Consistent with some prior findings, adolescents reporting past-year gambling, relative to those reporting no gambling, were more likely to report lifetime suicide attempts. One recent study associated gambling and suicide attempts, with the likelihood of suicide attempts increasing with increasing problem-gambling severity in both young women and men [49]. A history of suicide attempts was found to be independently associated with multiple risk-taking behaviors such as gambling, alcohol, nicotine and other drug use, and aggressive behavior [50]. Other studies have also associated health risk behaviors with suicidal ideation and attempts among adolescents, and recognition of these health risk behaviors may be one means of identifying those who may be at increased risk of suicidality [51].

Traumatic experiences were more prevalent in the gambling group and included bullying, physical violence, forced sex, and homelessness. These findings resonate with earlier findings involving adolescents [1]. Youth with gambling problems typically report having experienced more negative life events relative to those who do not gamble [52–54]. Adolescents with past-year gambling also reported low social support. Specifically, they have reported less family support and love from their parents. Social support may influence relationships between gambling and other risk-taking behaviors [55]. Specifically, social support from parents, teachers, and friends may decrease the likelihood of involvement in risky behaviors including gambling [54–58]. Supportive social environments may promote emotional well-being, buffer stress [59], and promote coping, mitigating associations between stress and anxiety [60]. Social support may also contribute to higher self-esteem and resilience [61], while low social support has been associated with greater problem-gambling severity, mental health problems and perceived stress [62].

Several strengths and limitations of the study are noteworthy. The YRBS is a large epidemiological study involving self-report measures. Self-reported data are subject to biases, such as reliability on memory, social desirability, and honesty of responses. Given the illegal nature of several variables (e.g., gambling among participants younger than 18 years, illicit substance use), it is also possible that participants may have not reported engagement in certain behaviors, leading to overly conservative prevalence estimates. Alternatively, over-reporting of risk behaviors (e.g., for bravado]) may also have occurred. We have classified gambling groups based on the single question, “During the past 12 months, how many times have you gambled on a sports team, gambled when playing cards or a dice game, played one of your state’s lottery games, gambled on the Internet, or bet on a game of personal skill such as pool or a video game?” This classification does not allow for identifying gambling groups based on types of gambling or problem-gambling severity, or for assessing related impacts. Additional studies using more dynamic classifications are needed. Second, the cross-sectional design precludes analyses or statements about potential directionality or causality. Third, although this is a representative sample, the survey was conducted in select school districts in one state, and the extent to which our findings generalize to populations outside the state of Connecticut is unclear. Fourth, many questions assessing non-gambling domains were not validated scales. While this may have reduced subject burden, additional studies using empirically validated measures are needed. Fifth, the categories of variables could have been defined differently (for example, suicide attempts may have been considered as traumatic, but was grouped with other suicidality measures). Sixth, the consent procedures used may influenced findings. Seventh, COVID-19 pandemic and related stress and combative measures (spatial distancing, closures of schools) may have influenced gambling, other risk behaviors and mental health [63, 64]. Thus, additional studies during and following the pandemic are needed.

Conclusion

Adolescents who have engaged in past-year gambling often participate in other risk-taking behaviors, including newer ones that include electronic delivery of substances and use of digital technologies. Links between risk-taking behaviors and gambling increase evidence from earlier research showing associations between sexual risk-taking [65], substance use and violence [39, 66], binge drinking, and gambling [67]. An association between gambling and health risk-taking also supports the notion that participation in one risky behavior may increase participation in others, consistent with the PBT model [68]. Given that some of these behaviors occur on school grounds, school administrators and teachers should be aware of them and their implications for adolescent health [69]. Early life stressors, adverse childhood experiences and trauma warrant screening and assessment. Adequate social support may function as a protective factor against gambling and problem gambling as it enhances healthy coping mechanisms. Hence, strengthening adolescents’ social support from school personnel and parents may be beneficial. Social support may be a crucial component of intervention strategies for adolescent gambling and its correlates. Strong familial relationships and open communication between adolescents and parents, may reduce the likelihood of involvement in risky behaviors overall and in gambling in particular. Adolescent gambling should be considered an important public health issue because it clusters with other unhealthy behaviors, which may increase the risk of negative health outcomes over time. Prevention and intervention efforts should not solely focus on gambling but should also take into consideration other simultaneous risk-taking behaviors. Prevention strategies that aim to increase social support, especially from parents, may be helpful in reducing adolescent gambling and related concerns.

Overall, results suggest that gambling is a relatively common activity among adolescents. Given that adolescents may be increasingly exposed to various gambling opportunities, especially online, it is important to identify individuals at risk, monitor the consequences of gambling, and refer individuals for help when needed. This may be particularly relevant in Connecticut and other states in which online gambling and sports gambling have been recently legalized.

Supporting information