Gamble Game: A Pilot Mixed-Methods Study on Board Games for Adolescent Gambling Prevention in the School Setting

Adolescent gambling is an escalating public health concern, with potential ramifications for emotional and social development. Despite legal restrictions, the increasing normalization of gambling through widespread advertising and informal social settings is contributing to cognitive distortions and unrealistic expectations among young people. Recognizing the critical need for effective preventive strategies, researchers have explored innovative approaches, including the use of engaging, participatory methods in educational environments. A recent pilot study, published in Frontiers in Psychology, investigated the efficacy of "Game in Lab," a novel school-based intervention designed to equip adolescents with critical thinking skills and heightened awareness regarding the risks associated with gambling.

The Rise of Adolescent Gambling and the Need for Prevention

Adolescence is a developmental period inherently marked by increased risk-taking behaviors, and gambling is no exception. This behavior can lead to a cascade of negative consequences, impacting psychological well-being, academic performance, and interpersonal relationships. Epidemiological data from Italy, for instance, reveals a geographical disparity in adolescent gambling prevalence, with higher rates observed in regions characterized by greater income inequality. This suggests socioeconomic factors may play a role in vulnerability. Conversely, strong perceived support from parents and educators has been identified as a protective factor, underscoring the importance of the school environment in mitigating these risks.

From a psychological standpoint, adolescent gambling is often sustained by a complex interplay of cognitive distortions and related expectancies. These include misinterpretations of randomness, the illusion of control over outcomes, and a reliance on predictive beliefs. Positive expectations, such as the anticipation of pleasure, excitement, or financial gain, are strongly linked to increased gambling frequency and the severity of problematic behaviors. Conversely, negative expectancies, encompassing feelings of over-involvement and the emotional toll of gambling, are predictive of more severe gambling problems.

Despite legal prohibitions against minors engaging in gambling activities, the pervasive presence of gambling in society—through sophisticated advertising campaigns, accessible online platforms, and informal social contexts—contributes to its normalization. This constant exposure inadvertently reinforces the cognitive distortions and unrealistic expectations that can fuel problematic gambling behaviors in young individuals.

Schools as a Crucial Nexus for Prevention

Educational institutions are uniquely positioned to address this growing public health challenge. Schools offer systematic access to large adolescent populations, enabling the integration of evidence-based educational strategies and leveraging the inherent protective role of teachers and, by extension, families. Research has consistently demonstrated that brief, school-based programs focused on enhancing probabilistic reasoning and correcting cognitive biases can significantly reduce gambling-related cognitive distortions among youth.

These interventions typically involve structured modules delivered within regular school hours, aiming to impart knowledge about the independence of random events and the fallacies of predictive control. A key objective is to bridge the gap between theoretical understanding of probability in abstract tasks and its application to the "hot" contexts of gambling. This focus on promoting critical thinking and resilience against gambling behaviors highlights the transformative potential of educational initiatives within the school setting.

Beyond Traditional Lectures: The Power of Experiential Learning

While traditional didactic approaches have their place, the educational landscape is increasingly recognizing the efficacy of interactive methodologies for promoting health-related knowledge and behavior change in adolescents. Active learning strategies, which empower students to be engaged, responsible, and committed participants in their learning, are particularly valuable for fostering competency development.

Board games represent a prime example of such methodologies. They facilitate experiential and participatory learning, foster collaboration among peers, and require players to make decisions and confront their consequences. Emerging evidence consistently supports the educational value of board games across various domains. They have been shown to be effective in reducing stigma and promoting mental health awareness, enhancing executive functions and academic skills, and strengthening emotional competencies. A comprehensive systematic review indicated that board games in health education settings can yield substantial improvements in knowledge acquisition and moderate effects on behaviors and health outcomes.

Board games create an engaging and participatory learning environment that stimulates peer interaction and critical reflection. In the context of gambling, they offer a promising avenue for addressing cognitive distortions and gambling expectancies in an experiential manner. By combining playful activities with guided discussions, these games can enhance awareness of randomness, risk, and the importance of self-regulation. This integration of ludic dynamics with educational objectives equips adolescents with the tools to develop a more critical and conscious approach to gambling.

The "Game in Lab" Intervention: A Novel Approach

Despite the growing recognition of board games’ potential, few studies have systematically evaluated their use as structured preventive interventions specifically targeting adolescent gambling. Existing school-based programs have predominantly relied on traditional educational formats, with limited integration of experiential and interactive components. Furthermore, much of the available evidence is based solely on quantitative outcomes, often neglecting the crucial insights derived from students’ subjective experiences and how they internalize preventive messages.

To address these gaps, the "Game in Lab" project was developed. This cluster-randomized school-based intervention utilizes board games and guided debriefing sessions to cultivate probabilistic reasoning, critical reflection, and a deeper understanding of gambling-related cognitions and expectancies. The project employs a mixed-methods approach, integrating quantitative measures with qualitative focus groups. This comprehensive design aims to assess both the intervention’s effectiveness on cognitive outcomes and the perceived processes of change from the students’ perspectives, thereby contributing novel evidence to the field of adolescent gambling prevention.

Study Design and Methodology

The "Game in Lab" study employed a cluster-randomized controlled trial (RCT) design. This approach involved randomizing entire classes to either the intervention group, which received the "Game in Lab" training, or a control group, which did not. Data were collected at two key time points: pre-intervention (T0) and immediately post-intervention (T1). The study’s mixed-methods nature was further enhanced by conducting three focus groups with intervention participants to explore their subjective experiences and perceived changes.

Participants and Recruitment:
A total of 210 students from various Italian secondary schools were initially enrolled. The sample comprised students from humanities and science-oriented high schools, as well as technical institutes, reflecting a diverse educational background. Of the initial cohort, 183 students completed the baseline assessment, and 160 completed the post-intervention assessment. A subset of 129 students (61.4%) provided complete data at both T0 and T1, forming the core group for the main analyses. Attrition, primarily due to absences on data collection days or incomplete participation, was carefully examined. Baseline comparisons between completers and non-completers revealed no significant differences in gambling expectancies or cognitions, suggesting that attrition bias was minimal.

The study involved 12 classes, with each class serving as the unit of randomization. Six classes were assigned to the intervention group and six to the control group. Participation was voluntary and anonymous, with parental consent and student assent obtained prior to enrollment. The research protocol received approval from the Mercatorum Ethical Committee, ensuring compliance with ethical standards.

The "Game in Lab" Intervention:
The "Game in Lab" training was delivered over three weekly sessions, each lasting approximately 90 minutes. Facilitated by trained professionals, each session comprised two integral components: board game play and guided debriefing discussions.

The board game activities were carefully selected to foster reflection on chance, randomness, decision-making under uncertainty, and self-regulation. Games like Perudo, Las Vegas, Deep Sea Adventure, Cannot Stop, and Voyages were utilized. These games provided experiential opportunities for students to encounter scenarios requiring probabilistic reasoning and risk assessment. For instance, Perudo, a dice game involving bluffing and uncertainty, directly engaged students with concepts of randomness and strategic thinking. Deep Sea Adventure, a cooperative game with shared resources and escalating risks, highlighted the dynamics of shared risk and collective consequences.

Following each game session, guided debriefing discussions were facilitated. These discussions encouraged students to critically analyze their gameplay experiences. The facilitators explicitly linked game dynamics to gambling-related cognitions and expectancies, addressing common cognitive biases such as the illusion of control and the gambler’s fallacy. The debriefings were designed to be interactive and dialogical, promoting peer exchange and raising awareness of gambling risks in everyday life.

Data Collection and Measures:
Quantitative data were collected using validated self-report questionnaires at baseline (T0) and immediately after the intervention (T1). These measures included the Gambling Related Cognitions Scale (GRCS) and the Gambling Expectancy Questionnaire—Modified (GEQ-MOD), which assess cognitive distortions and gambling expectancies, respectively.

To complement the quantitative findings and gain deeper insights into students’ perspectives, three focus groups were conducted with a purposively selected sample of 25 intervention participants. These discussions, guided by a semi-structured script, explored students’ perceptions of the training, its impact on their cognitions, and their attitudes toward gambling. Each focus group lasted approximately 75 minutes and was audio-recorded and transcribed verbatim. Thematic saturation was achieved, indicating that the collected qualitative data provided a comprehensive representation of participants’ experiences.

Data Analysis:
Quantitative data were analyzed using Jamovi statistical software. Primary analyses employed ANCOVA with cluster adjustment, incorporating a random intercept for class to account for the nested structure of the data. This approach allowed for the assessment of intervention effects while controlling for baseline scores and the non-independence of observations within classes. Descriptive statistics were calculated for sociodemographic variables and questionnaire scores.

Qualitative data were analyzed using reflexive thematic analysis. Transcripts were systematically coded to identify recurrent patterns, which were then organized into broader themes reflecting students’ critical thinking, emotional regulation, and awareness of gambling risks. The research team engaged in discussions to ensure consistency and reflexivity in interpretation. Findings from both quantitative and qualitative analyses were integrated through a triangulation approach to provide a holistic understanding of the intervention’s impact.

Findings: Mixed Quantitative Results and Rich Qualitative Insights

The pilot study yielded a complex picture, with quantitative data presenting mixed results while qualitative findings offered substantial insights into the intervention’s impact.

Quantitative Outcomes:
A total of 129 students provided complete data for analysis. Descriptive statistics indicated that both the intervention and control groups showed reductions in gambling-related expectancies and cognitions from baseline to post-intervention. However, cluster-adjusted ANCOVA models, which rigorously accounted for the study’s design, did not confirm statistically significant additional effects for the intervention group. Specifically, for gambling expectancies (GEQ-MOD), the intervention group maintained slightly higher post-test scores compared to the control group, although the effect size was moderate.

Interestingly, for gambling-related cognitions (GRCS), the cluster-adjusted ANCOVA revealed a significant effect of the training, but in an unexpected direction. Students in the intervention group reported higher post-test scores compared to the control group. This finding, while statistically significant, suggests that the intervention may have heightened students’ awareness and recognition of gambling-related cognitions, rather than immediately reducing them. The negligible intraclass correlation coefficients for both outcomes indicated minimal clustering at the classroom level, suggesting that classroom variance did not significantly influence the estimates.

Qualitative Insights:
The thematic analysis of the focus groups provided a nuanced understanding of the intervention’s impact, revealing three overarching themes: critical thinking, emotional regulation, and awareness of risk.

• Critical Thinking: Students reported an increased ability to critically assess the role of luck versus strategy in gambling. They articulated a better understanding of probability, recognizing that random events have independent outcomes and that repetitive play does not necessarily increase chances of winning. Comparisons with traditional board games highlighted a newfound appreciation for the distinction between skill-based games and games of chance.

• Emotional Regulation: Participants described experiencing a range of emotions during gameplay, including adrenaline, frustration, and euphoria. The training appeared to foster a greater awareness of these emotional responses and a perceived ability to manage them more effectively. Some students also highlighted experiences of solidarity and collaboration, noting how playing as a group fostered mutual encouragement and a sense of team spirit.

• Awareness of Risk: The intervention enhanced students’ understanding of gambling-related risks. They recognized the speed at which losses can occur and the importance of acknowledging personal limits. The concept of the "illusion of control" was frequently mentioned, with students realizing how easily they could be drawn into believing they could influence outcomes. A significant shift in perspective was observed, with many participants acknowledging that gambling risks are not confined to older individuals but are relevant to their own age group.

Discussion: Navigating Mixed Results and Unpacking Mechanisms

The findings from this pilot study offer a complex but valuable perspective on the potential of board games in adolescent gambling prevention. The mixed quantitative results, coupled with the rich qualitative data, underscore the need for a nuanced interpretation.

Interpreting the Quantitative Findings:
The absence of statistically significant reductions in gambling expectancies and the unexpected increase in gambling cognitions in the intervention group warrant careful consideration. Several factors may contribute to these observations. Firstly, the intervention might have induced a "measurement reactivity" effect. By engaging students in activities that explicitly address gambling-related mechanisms, the training may have heightened their awareness, leading them to more readily identify and report such cognitions and expectancies at post-test. This does not necessarily imply an increase in problematic tendencies but rather a more sophisticated understanding of the constructs being measured.

Secondly, methodological limitations, such as the relatively small sample size and the cluster-randomized design, may have impacted statistical power. While baseline scores were controlled, initial group differences, even if not statistically significant, could have influenced post-test estimates. The limited number of clusters, despite negligible intraclass correlations, might have reduced the ability to detect subtle intervention effects.

Furthermore, the immediate post-intervention assessment might have been too soon to capture the full impact of the experiential learning. Processes such as critical reflection, emotional regulation, and risk awareness may require time and real-world application to consolidate and translate into measurable changes in declarative cognitions. Previous research on adolescent gambling prevention has shown that cognitive and attitudinal effects can emerge or stabilize several months post-intervention, suggesting the importance of longitudinal follow-up assessments.

The reliance on self-report measures also presents a limitation. These instruments primarily capture declarative cognitions, which may not fully encompass the depth of reflective processes triggered by experiential learning. Integrating behavioral indicators or ecological momentary assessments could offer a more comprehensive understanding of the intervention’s impact.

The Power of Qualitative Insights:
Despite the mixed quantitative outcomes, the qualitative findings provide compelling evidence of the intervention’s ability to stimulate crucial preventive mechanisms. The themes of enhanced critical thinking, improved emotional regulation, and increased risk awareness align with established theories of experiential learning and participatory health education. Board games, in this context, serve as a safe and engaging platform for adolescents to confront gambling-like emotions and deconstruct misconceptions through guided dialogue.

The intervention appears to activate processes that foster reflection-on-action, a key pathway for cognitive and emotional change. By allowing students to experience the dynamics of chance and risk in a controlled environment, the "Game in Lab" program facilitates a deeper understanding of the psychological mechanisms underlying gambling behavior.

Methodological Considerations and Future Directions:
The study’s mixed-methods approach was a strength, allowing for the triangulation of quantitative patterns with qualitative narratives. However, several limitations are acknowledged. The modest sample size and attrition rate may have reduced statistical power. The exclusive reliance on self-report measures, potential for social desirability bias, and the immediate post-intervention assessment are important considerations. Additionally, contextual differences across school types and potential facilitator-related effects were not explicitly modeled, introducing potential sources of variability.

Future research should aim to replicate these findings in larger, more diverse samples and employ multi-wave designs that include longitudinal follow-up assessments. The integration of behavioral or implicit measures of gambling cognition could provide a more comprehensive evaluation of the intervention’s efficacy. Furthermore, exploring the role of teachers as co-facilitators could enhance the ecological validity and sustainability of such programs.

Conclusion: A Promising Foundation for Future Prevention Efforts

This pilot study demonstrates the feasibility and engagement potential of using board games as a school-based tool for adolescent gambling prevention. While the immediate quantitative outcomes did not reveal statistically robust reductions in gambling cognitions, the qualitative results offer significant promise. The intervention successfully stimulated critical thinking, fostered emotional awareness, and enhanced adolescents’ recognition of gambling-related risks. These findings lay a foundational understanding for the development of more impactful and engaging preventive strategies. Further research, particularly larger-scale studies with longitudinal follow-ups, is crucial to fully elucidate the preventive potential of this innovative approach and its capacity to foster lasting positive change among young people.