More frequent use of live sports-betting features is associated with increased risk of gambling harm: Evidence from a case-control design.

Background: Many theories of gambling harm propose that some design features of interactive sports-betting platforms confer a risk of harm by enabling cyclical patterns of repeated gambling engagement. This exploratory study investigated whether such features were used more frequently by people at higher risk of gambling harm relative to a demographically matched lower-risk control group. Methods: This study used a case-control design to compare 85 people at higher risk of gambling harm (PGSI 5+) with an age- and gender-matched control group at lower risk of harm (n = 84, PGSI 0-4). We compared the frequency with which groups self-reported using in-play betting, cash-out, multi bets, proposition bets, social betting, and viewing live matches within a betting app. Results: The higher-risk group reported more frequent use of in-play betting and instant cash-out and were more likely to report streaming live sporting events within a betting app. Higher-risk participants were also more likely to make an immediate deposit to qualify for a marketing offer, and both groups reported being more likely to make risky bets when using bonus funds. We observed no group differences in the frequency of use of multi bets, proposition-bets, or social betting. Conclusions: Our findings were broadly consistent with the theory that design features of betting platforms that facilitate continuous engagement contribute to gambling harm. A notable finding was that in-app streaming of live events was more common among people at higher risk of harm, consistent with a novel prediction made by the motivating theory.