公众对有害赌博的关注越来越多,但是尚未就减少风险和防止伤害的有效政策和干预措施达成共识。专注于政策和干预(即,措施),这项研究的目的是确定是否可以就认为可以成功实施的有效措施达成专家共识。我们的工作涉及预注册,三轮,独立的德尔福小组共识研究和实施评级练习。一套103项普遍和有针对性的措施,这些资源来自公共卫生利益相关者的几个关键资源和投入,分为七个领域:价格和税收;可用性;可访问性;营销,广告,促销,和赞助;环境和技术;信息和教育;以及治疗和支持。在三个回合中,一个由35名专家组成的独立小组分别完成了在线问卷,以对每个措施的已知或潜在有效性进行排名。如果至少70%的专家小组认为一项措施无效,就达成了共识,适度有效,或者非常有效。然后,每一项达成有效性共识的措施都在四个实施层面进行了评估:实用性,负担能力,副作用,和公平。使用求和阈值标准为英格兰选择最终的最佳度量集。专家组就103项措施中的83项(81%)达成共识。专家组判定两项措施无效。其余81项有效措施来自所有领域(营销中的15项措施中的14项,广告,促销,和赞助域被判定为有效,而信息和教育领域的十项措施中有五项被认为是有效的)。在评估工作中,评估了这81项措施实施成功的可能性.这项评估考虑了实用性,负担能力,产生意想不到的副作用的能力,以及减少社会中优势群体和弱势群体之间差异的能力。我们确定了40种通用和有针对性的措施来解决有害的赌博问题(价格和税收领域的三项措施;可用性领域的十项;可访问性领域的五项;市场营销的六项,广告,促销,和赞助域;八个来自环境和技术领域;三个来自信息和教育领域;五个来自治疗和支持领域)。在英格兰实施这些措施可以大大加强监管控制,同时提供新的资源。我们的工作发现为预防与赌博有关的危害的公共卫生方法提供了蓝图。
There is increasing public health concern about harmful
gambling, but no
consensus on effective policies and interventions to reduce risk and prevent harm has been reached. Focusing on policies and interventions (ie, measures), the aim of this study was to determine if expert
consensus could be reached on measures perceived to be effective that could be implemented successfully. Our work involved a pre-registered, three-round, independent Delphi panel consensus study and an implementation rating exercise. A starting set of 103 universal and targeted measures, which were sourced from several key resources and inputs from public health stakeholders, were grouped into seven domains: price and taxation; availability; accessibility; marketing, advertising, promotion, and sponsorship; environment and technology; information and education; and treatment and support. Across three rounds, an independent panel of 35 experts individually completed online questionnaires to rank each measure for known or potential effectiveness. A consensus was reached if at least 70% of the panel judged a measure to be either not effective, moderately effective, or highly effective. Then, each measure that reached a consensus for effectiveness was evaluated on four implementation dimensions: practicability, affordability, side-effects, and equity. A summative threshold criterion was used to select a final optimal set of measures for England. The panel reached
consensus on 83 (81%) of 103 measures. Two measures were judged as ineffective by the panel. The remaining 81 effective measures were drawn from all domains (14 of 15 measures in the the marketing, advertising, promotion, and sponsorship domain were judged as effective, whereas five of ten measures in the information and education domain were judged as effective). During the evaluation exercise, the 81 measures were assessed for likelihood of implementation success. This assessment considered the practicality, affordability, ability to generate unanticipated side-effects, and ability to decrease differences between advantaged and disadvantaged groups in society of each measure. We identified 40 universal and targeted measures to tackle harmful
gambling (three measures from the price and taxation domain; ten from the availability domain; five from the accessibility domain; six from the marketing, advertising, promotion, and sponsorship domain; eight from the environment and technology domain; three from the information and education domain; and five from the treatment and support domain). Implementation of these measures in England could substantially strengthen regulatory controls while providing new resources. The findings of our work offer a blueprint for a public health approach to preventing harms related to
gambling.