When Do the Stakes Get Higher? Examining Factors Associated with At-Risk or Problem Gambling in a Large Sample of Italian Adult Recent Gamblers

Abstract Most gambling research focuses on problem gambling, often neglecting milder but more prevalent harmful patterns, whose prevention could prove highly cost-effective. This study analyzed factors associated with at-risk or problem gambling (Problem Gambling Severity Index ≥ 1) among 1060 recent gamblers in Italy (2022–2023). At-risk or problem gambling was reported by 17% of participants and decreased with age and education. It was more frequent among single individuals (almost twice the odds vs. married), those in the highest and lowest income groups (compared to the intermediate one), and current smokers (more than twice the odds vs. never smokers). Compared to land-based gambling, online and mixed-modality gambling was over four times more frequently associated with at-risk or problem gambling. Engaging in electronic gambling machines, virtual betting, and poker, but also in popular activities like lotteries and sports betting, was linked to at-risk or problem gambling. Gambling in at least three formats or weekly was associated with higher odds of at-risk or problem gambling. These findings suggest that to address a broader range of harmful gambling patterns, preventive strategies should focus on younger and less-educated gamblers, closely monitor online gambling, and track increasingly socially accepted formats. Since gambling in two or more formats or at least weekly may signal the presence of at least one gambling-related problematic behavior or negative consequence, detecting these patterns could support screening and early intervention efforts.