mental health

SPH Researchers to Study Health, Economic Effects of Sports Betting and Casino Gambling in Mass. with $2.5M Grant

A team of professors in the Department of Health Law, Policy & Management will gather timely insight on sports betting apps, problem gambling, and the community impact of casinos to inform health-protective changes to gambling regulations and programs in the commonwealth.

In a landmark ruling in May 2018, the Supreme Court effectively ended a federal ban on sports betting, paving the way for Massachusetts and at least 38 other states (plus Washington, DC and Puerto Rico) to legalize and regulate gambling on sports. Thanks to the rise of gambling apps—fueled by ubiquitous advertising on television, billboards, and social media—sports betting has taken off across the country, sparking concerns about how this proliferation in gambling may affect physical, mental, and financial well-being. 

With a new $2.5 million grant from the Massachusetts Gaming Commission, a group of School of Public Health researchers in the Department of Health Law, Policy & Management will capture a clear and comprehensive understanding of this growing issue through a three-year study on the social and economic effects of legalized sports and casino gambling in the state. Focusing on sports betting apps, problem gambling, and the community impact of casinos, the research team hopes the data they collect will inform changes to gambling regulations and programs.

Massachusetts legalized casino gambling in 2011 and retail and online sports betting in 2022. The state’s three casinos, in Everett, Springfield, and Plainville, generated $95.69 million in gaming revenue in September—the last month for which statistics are available—while online sports betting revenue totaled $52.34 million. As of March, the commonwealth had collected more than $2 billion in taxes and assessments from casinos and more than $339 million from sports betting since they were legalized.

But widening legalization of gaming “brings challenges that we don’t fully understand the scope of yet,” says Christopher Louis, associate chair and clinical professor of HLPM. He is principal investigator of the study, which also includes a team of five other associate professors of HLPM.

“Anytime you make a vice into something that creates new tax revenue for states, you have to study it to understand the unintended consequences,” including social and financial fallout from problem gambling, Louis says. “That’s the moment that we’re in now.” 

Widespread advertising

From FanDuel to DraftKings, the blizzard of ads for casinos and sports betting on TV, billboards, and social media is one of the study’s six areas of focus.

“Is it actually reaching the groups that we want, or is it spilling over into youth?” says Louis, an expert in evaluating large-scale programs. “You drive down I-93 and you see a DraftKings billboard. What does my 12-year-old recognize with that?”

Jennifer Ross and Matt Motta will lead the portion of the project to better understand the connection between advertising exposure across multiple mediums and its effect on problematic gambling behavior. 

“What we know about the content and effects of this advertising is limited,” Ross says. “Our findings will help us better understand the extent to which people in the commonwealth are exposed to advertising, the types of advertising, and where they are exposed, to ultimately inform potential policy interventions for regulating gambling advertising in the commonwealth that can protect vulnerable populations.”

The US’ unique gambling culture

Gambling thrived in the US long before these sports betting apps took off, with an estimated 1 in 7 people experiencing a gambling problem. Unlike other countries, the lack of a national gambling policy has led to a patchwork of regulations across states. Massachusetts bans sports betting on college teams and gambling with a credit card, and requires gambling companies to allow customers to set voluntary limits or ban themselves from sports betting and casinos for certain time periods. These voluntary limits aim to reduce gamblers’ chances of developing any of the range of health conditions already associated with problem gambling, including depression, anxiety, stress, and suicidal ideation.

“The gambling culture in the US is unique to some other countries in that, historically, regulation has primarily been handled at the state level,” Louis says. Proposed federal legislation such as the SAFE Bet Act aims to take a public health-centered approach to address problem gambling, but has yet to receive enough support to pass, he adds. The forthcoming work will help capture the latest trends in problem gambling that are only expected to increase with widespread access to sports betting.

“Taking a public health approach to gambling could help reduce addiction and problem gambling by focusing more on upstream determinants,” says Louis. “This would allow states to then work under that umbrella and implement more specific and evidence-based individualized player health-strategies that we know work, such as motivational interviewing and intervention-based tracking.”

Gambling among college students

Learning how college students are betting on sports and how it affects them is another key aim of the study, an effort led by Sarah Lipson, an expert in adolescent and young adult mental health.

The new study, Lipson says, is an important opportunity “to see how student gambling relates to all the outcomes that I’ve cared about throughout my career: mental health outcomes like depression and anxiety, social outcomes like loneliness and belonging, and academic outcomes like their performance in school and their likelihood to persist to graduation.” 

Lipson is a principal investigator for the Healthy Minds Network, which produces a respected national study of adolescent and young adult mental health that the gambling study will leverage. 

The 2024–25 Healthy Minds Study found 11.1 percent of college students nationally reported sports betting, says Lipson, and 22.1 percent of those said they struggled to set limits on how much they bet. According to Louis, while 21 is the minimum age for legal gambling in Massachusetts, underage sports betting via apps appears common.

“It’s a time of newfound independence,” Lipson says. “For many people, it’s the first time that they’re living away from home, that they’re the ones making decisions about all sorts of health behaviors, including their finances. And then we know that sports betting and gambling is just really pervasive and very accessible, and it’s hard to avoid. There’s this huge gap in research around the prevalence and how this behavior is affecting other parts of their lives.”

Six areas of focus

In total, the gambling study has six primary aims. In addition to the work led by Ross, Motta, and Lipson:

• Timothy Callaghan will conduct a survey of up to 6,000 Massachusetts residents—through the California-based national survey firm Verasight—to assess attitudes toward sports betting and casino gambling, actual gaming behavior, and the extent of problem gambling (which will provide much of the data for the study). 
• Justin White and Paul Shafer will gather timely data that focuses on gambling’s effects on employment and other economic measures among residents in the commonwealth.
• White will study the relationship between sports wagering and financial well-being and social needs for nongamblers, recreational gamblers, and problem gamblers alike.
• Shafer will investigate the impacts of casinos on county-level employment and wages and municipal government revenue and expenditures. 

“We plan to track how casinos and sports gambling are rippling through Massachusetts’ economy by pairing real-time economic surveillance with state-of-the-art evaluation to understand how gambling policies shape employment, wages, tax revenues, and household financial well-being,” says White, on his collaboration with Shafer.

Also involved in the project are an advisory board of experts from inside and outside BU. Project management will be provided by Boston-based Health Co-Lab, a service-disabled veteran-owned business, which will also create a public dashboard to disseminate the results in year three.

The gaming commission, which regulates the industry in the state, has an ongoing research agenda as required by its establishing legislation; more than 80 papers have been published since 2013 as a result, says Mark Vander Linden, director of research and responsible gaming for the commission.

“The expertise that BU brought, the talent pool, and the fresh ideas were quite impressive to us,” Vander Linden says. “The ability to tie into the Healthy Minds Study is an exceptional value to the gaming commission, which we believe will provide us with invaluable information about gambling in college-age students. They are a high-risk group, as we know, and we want a better understanding of this group and how we can be as effective as possible at mitigating harm.”

Vander Linden says the study needs to advance existing knowledge about the prevalence of problem gambling in Massachusetts and what groups are at risk, as the scene is changing rapidly, with the rise of sports betting apps and in-game betting, among other changes.

“Massachusetts has said we want to understand what are the trends, what’s happening, and how we need to adapt,” says Louis. “And I think that’s something that they should be given a lot of credit for.”