Americans are betting on sports at unprecedented levels. Since the Supreme Court’s 2018 decision allowing states to legalize sports gambling, online sportsbooks have spread rapidly. Most states now allow some form of sports betting and billions of dollars are wagered each year — much of it through mobile apps.
The growth of this industry has largely been covered as a business, tech, or sports story. But a growing body of research suggests journalists should also think about it as a public health issue.
A national survey released in March by the National Council on Problem Gambling and The Harris Poll found that nearly two‑thirds (65%) of U.S. adults reported participating in at least one form of gambling before age 21, even though 21 is the legal minimum in most states. The same survey found that 66% of adults are concerned about underage exposure to gambling or gambling-like activities, and 79% say gambling addiction is as serious as or more serious than alcohol or drug addiction.
Younger adults were especially likely to report gambling before age 21, with about one‑third of those aged 21–44 saying they’d placed a sports bet before that age. These patterns raise red flags for prevention and long‑term harms.
More accessible than ever before
Public health experts point to several characteristics of modern sports betting that raise concerns. One is how the products are designed. Unlike traditional gambling environments, online betting platforms allow people to place wagers instantly, repeatedly, and from anywhere. Features such as live “in-play” betting during games and complex parlays encourage frequent bets and can quickly multiply losses.
The shift to smartphones has also removed many of the natural barriers that once slowed gambling. With a few taps, users can deposit money, place a bet, and bet again seconds later. Apps often send push notifications or promotional offers encouraging continued play.
That combination — easy access, fast betting cycles, and constant promotion — is one reason researchers are paying closer attention to potential health effects.
During major sporting events such as the Super Bowl, viewers are routinely exposed to multiple sportsbook commercials, including ads from companies such as DraftKings and FanDuel.
Partnerships between betting companies and the National Football League mean gambling odds, promotions, and branded segments often appear throughout game broadcasts, sports podcasts, and social media feeds, making betting part of the everyday sports viewing experience.
Those marketing practices are also increasingly the subject of lawsuits and regulatory scrutiny. Several legal complaints allege that sportsbooks use aggressive promotions, “risk-free” bets, and personalized incentives that can encourage heavy or compulsive gambling.
Online sports betting shares characteristics with other products that public health researchers track because of their potential harms, according to a recent editorial in JAMA Health Forum. The editorial’s authors suggest the issue should be examined at both the level of individual gamblers and across entire populations.
Studies have linked problem gambling with depression, anxiety, substance use and financial stress. Researchers are also beginning to detect population-level signals tied to the expansion of sports betting markets, such as increases in online searches related to gambling addiction.
The public health framing also raises important health equity questions.
Research on gambling harms has long shown that the consequences are not evenly distributed. Lower-income households, younger men and some communities of color often experience higher rates of gambling-related financial harm. At the same time, advertising and promotions for sportsbooks frequently appear in digital spaces, sports broadcasts and neighborhoods where residents may already face economic pressures.
States collect tax revenue from betting, but the financial and mental health impacts may fall more heavily on vulnerable populations.
Story ideas
Consider using a solutions lens to address gambling harms. As an AHCJ International Fellow, New England Public Media Karen Blum reported on Norway’s tightly regulated gambling environment, where loss limits, mandatory breaks, and public health‑oriented policy aim to reduce addiction and harm. That story sheds light on policy approaches far different from the largely commercial model in the U.S., and offers a contrast that can help audiences — and policymakers — think about alternatives.
Instead of focusing only on industry growth or state tax revenue, reporters could ask:
- Are clinicians screening patients for gambling-related harms?
- How many people are seeking treatment for gambling disorder?
- Are states directing betting revenue toward prevention and treatment programs?
- Which communities are most affected?
