Gaming and gambling behaviours among Italian adolescents: a cross-sectional study

As the boundaries between gaming and gambling increasingly blur, emerging evidence suggests that gaming might act as a gateway to gambling. In this context, we examined the prevalence of these behaviours and their relationship with each other in a nationally representative sample of Italian adolescents. In this cross-sectional study, we used data from 11 965 students aged 15–19 years (mean age 16·9 years, SD 1·4; 50·6% male, 49·4% female) who participated in the 2023 ESPAD Italia cross-sectional survey between April 15 and May 31, 2023. Anonymous in-class questionnaires were administered to students on paper or online. Participants reported their sex (current legal), year of birth, geographical area, and perceived socioeconomic status. Information on gaming was derived from self-reported measures, including the Screening Test for Problematic Gaming (STPG). Gambling data included self-reported participation and patterns of engagement (assessed using the South Oaks Gambling Screen–Revised for Adolescents; SOGS-RA). Post-stratification weighting based on geographical area, age, and sex was applied in accordance with the target population's distribution. We estimated adjusted odds ratios (aORs) and 95% CIs for gambling participation, any-risk gambling (SOGS-RA ≥2), and problem gambling (SOGS-RA ≥4) in relation to gaming behaviours using logistic regression models, adjusting for age, sex, geographical area, and perceived economic status. Recent (past 12 months) gaming was reported by 67·2% (n=6621) of participants (85·2% of male participants [n=4181]; 49·2% of female participants [n=2440]). Among them, 33·0% (n=1937) had spent money on in-game purchases in online games, and 24·0% (n=1511) scored high on the STPG. Lifetime gambling was reported by 58·7% (n=5955) of participants (65·8% of male participants [n=3311]; 51·6% of female participants [n=2644]; 57·2% [n=3653] of minor participants [younger than 18 years]), while recent (past 12 months) gambling was reported by 53·0% (n=5422; 60·0% of male participants [n=3055]; 45·9% of female participants [n=2367]; 51·5% of minor participants [n=3310]). Among recent gamblers, 20·4% [n=798] met criteria for any-risk gambling. Recent gaming was associated with lifetime gambling (aOR 1·74, 95% CI 1·57–1·93), recent gambling (1·65, 1·49–1·83), and any-risk gambling (1·33, 1·08–1·62). With increasing in-game spending and loot box engagement, these associations seemed to strengthen. An average monthly spending of more than €50 on in-game purchases (1·64, 1·10–2·44) and more than €5 on loot boxes (4·76, 2·55–8·88) over the past 12 months was associated with problem gambling. Like gaming, gambling is widespread among Italian adolescents, including minors. Findings indicate a convergence between these behaviours and suggest that gaming monetisation systems might engage psychological vulnerabilities similar to those involved in gambling, or even—although causal inferences cannot be drawn due to the limitations of the cross-sectional design—promote gambling participation and escalation.