Gambling and screening for gambling problems in high school students before and after legal gambling age: associations with gender and gambling-related attitudes.

INTRODUCTION: Adolescence is a period associated with increased risk of gambling problems. Although strict age limits should apply in modern digital gambling platforms, gambling in minors remains a challenge. The present study aimed to study high school students' gambling both before and after the legal gambling age, and to study associations between gambling-related attitudes and screening positive for problem gambling. MATERIALS AND METHODS: The study is based on a digital survey which was distributed by teachers to high school students in Lund, Sweden, in April/May, 2025 (n = 528). Self-reported history of gambling was reported for each form of gambling, and problem gambling was screened for using the three-item NODS-CLiP and combined with demographic data and gambling attitudes. Risk factors for screening positive for problem gambling were studied in multivariate logistic regression analyses, including gender and age, measures of gambling-related attitudes, and each separate gambling form. RESULTS: A positive screen for problem gambling (NODS-CLiP >0) was seen in 16% at age 16, 15% at age 17, and 27% at age 18-19, in total among 31% of boys and 4% of girls. Gambling on online casino was reported by 41% if 18 + years and by 20% if below 18 years of age, and sports betting by 32 and 21% before and after 18 years of age, respectively. Screening positive for problem gambling was more common in case of parental acceptance of gambling, hiding gambling from parents, and liberal attitudes towards gambling policy, and in the multivariate analysis, problem gambling was significantly associated with online casino, sports betting, and gambling within videogames. CONCLUSION: In the present high school survey, gambling was very common, even before legal gambling age. Participants commonly screened positive for problem gambling, with a large risk increase in boys, and most strongly associated with online casino, sports betting, and gambling within videogames. Society-level policy interventions, as well as individual prevention targeting gambling attitudes, are called for.