Awareness and utilization of health interventions can be influenced by sociodemographic factors. These factors play a role in information processing, particularly regarding health messaging. The aim of this study is to analyze how different sociodemographic factors and gambling behaviors are associated with awareness of a (Swedish) gambling self-exclusion register. The study used data from the Swedish longitudinal gambling study (Swelogs) and analyzed n = 6720 participants from a stratified random sample of the Swedish population aged 18–84 years. Logistic regressions were conducted to analyze associations between sociodemographic characteristics, gambling behavior and awareness. Males with middle (OR = 1.70, 95% CI = 1.32–2.19) and high income (OR = 1.58, 95% CI = 1.19–2.09) and females with high (OR = 1.35, 95% CI = 1.03–1.76) and middle-level education (OR = 1.35, CI = 1.04–1.76), had higher awareness of Spelpaus.se. Online gamblers with problematic gambling behavior were three times (OR = 3.69, 95% CI = 2.15–6.37) more likely to be aware than non-gamblers. Online gamblers born in Sweden were twice (OR = 1.95, 95% CI = 1.19–3.19) as likely to be aware compared to those born outside of Europe. Males with high level of awareness had higher PGSI scores compared to women. Education could increase awareness of potential health risks and opportunities for intervention, particularly among women. Future interventions should be tailored to cater to the specific needs of individuals with lower levels of awareness, to facilitate enhancing their awareness and ultimately promoting a more equitable utilization of self-exclusion measures.

On January 1st, 2019, a license-based system allowing online commercial companies to operate and advertise in the Swedish market was introduced. According to the Gambling Act, advertising should be ‘moderate’. Legislative changes are windows of opportunities where stakeholder interpretation and adaption may result in new agenda-setting based on conflicting interests. This article examines how stakeholder groups initially perceived and interpreted this key concept of moderation. Data from semi-structured interviews, seminars and press conferences, as well as policy documents and statements, were analyzed using a framework method approach. Contrary to what is stated in the legislation, stakeholders defined ‘moderation’ in terms of both content and volume. Although industry and media representatives requested further guidance for interpreting ‘moderation’, they favored self-regulation and allowing market consolidation. There was a notable ambivalence within and between stakeholder groups concerning balancing freedom of expression, market protection, consumer protection and public health. In conclusion, legislation is a blunt steering instrument when key concepts are largely left to stakeholders, with opposing interests, to interpret. Our study shows the incremental and interactive character of policy-making, where new legislation resulted in new policy responses. Case law and market consolidation take time and regulatory interventions need to take this into account. 

Background

Mental health conditions often go untreated, which can lead to long-term poor emotional, social physical health and behavioural outcomes, and in some cases, suicide. Mental health-related stigma is frequently noted as a barrier to help seeking, however no previous systematic review has considered evidence from the Caribbean specifically. This systematic review aimed to address two research questions: (1) What is the impact of mental health stigma on help-seeking in the Caribbean? (2) What factors underlie the relationship between stigma and help-seeking in the Caribbean?

Methods

A systematic search was conducted across six electronic databases (Medline, Embase, Global Health, PsychInfo, Scopus and LILACS). The search included articles published up to May 2022. Experts in the field were consulted to provide publication recommendations and references of included studies were checked. Data synthesis comprised of three components: a narrative synthesis of quantitative findings, a thematic analysis of qualitative findings, and a meta-synthesis combining these results.

Results

The review included nine articles (reflecting eight studies) totaling 1256 participants. A conceptual model was derived from the meta-synthesis, identifying three themes in relation to mental health stigma and help-seeking in the Caribbean: (i) Making sense of mental health conditions’; (ii) Anticipated/Experienced stigma-related experiences and (iii) Individual characteristics.

Conclusion

This review provides insights into the relationship between mental health stigma and help-seeking in the Caribbean based upon the current research evidence. This can be applied in the design of culturally appropriate future research, and to support policy and practice towards stigma reduction, and improved mental care help-seeking in the Caribbean.

Spielersperren können als präventive Schutzmaßnahme oder schadensbegrenzende Intervention bei problematischem und pathologischem Glücksspielen eingesetzt werden. Dennoch fallen die Nutzungszahlen in Deutschland äußerst gering aus. Neben Interessenskonflikten, Angst vor Stigmatisierung und anderen negative Einflussfaktoren trägt die Abwesenheit einer fördernden gesetzlichen Regulation in Deutschland hierzu bei.