Harm Reduction Journal最新文献

{"title":"Study protocol: seeking treatment for gambling - a 10-year retrospective clinical and register study of gambling patterns and physical and psychiatric comorbidity in patients with gambling disorder.","authors":"Anders Håkansson, Yassir Abdul Rahim, Molly Miles, Carolina Widinghoff","doi":"10.1186/s12954-026-01565-0","DOIUrl":"10.1186/s12954-026-01565-0","url":null,"abstract":"<p><strong>Background: </strong>Gambling disorder, the first non-substance-related addictive disorder to be recognized, can have a severe impact on health and psycho-social well-being, but treatment seeking is often low, and the documentation of clinical needs and medical comorbidities is sparser than for substance use disorders. The present study protocol describes a large clinical and register study which aims to describe physical and psychiatric comorbidities in patients seeking treatment at a regional gambling disorder treatment unit within addiction health care, and how comorbidity, routes of referral, and psychiatric medications are associated with problem gambling patterns, self-exclusion from gambling, gambling despite self-exclusion, gender, age, psycho-social living conditions, and over-indebtedness. In addition, the study aims to map out prior contacts of care in treatment-seeking patients, aiming to lay the ground for improved and earlier detection of gambling problems in diverse clinical settings.</p><p><strong>Methods: </strong>Health care documentation will be studied for all patients seeking treatment for gambling-related problems (estimated N around 1,200) for the entire 10-year period since the opening of a specialized treatment unit in the Skåne region, Sweden, in December, 2015, through November, 2025. In addition to data from health care records, treatment episode data will be run against a regional health care register describing all other primary care and specialized care contacts in the region, including out-patient and in-patient episodes and diagnoses, for both physical and mental health disorders.</p><p><strong>Discussion: </strong>The present project can describe - over time - the full range of socio-demographic conditions and comorbidities, not only regarding mental health but also physical disorders, in clinical patients with gambling disorder. Results can therefore guide efforts for detection of gambling problems in other types of social service or health care settings. User perspectives are ensured through the collaboration with a patient and peer support organization, and public implementation is ensured through continuous collaboration with political decision makers and coordinating leading stakeholders in social services and health care in the region and elsewhere.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, Clinical Trials identifier number NCT07488871, date of registration March 9, 2026.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV, mpox, and stigma in West Africa - a case for integrated person-centred syndemic management.","authors":"Alpha Umaru Bai-Sesay, Fasineh Shekuba Samura, Jusu Musa, Charles Steven Kanu, Yayah Sembu Conteh, Regiana Ama Nicol, Chizaram Anselm Onyeaghala","doi":"10.1186/s12954-026-01559-y","DOIUrl":"10.1186/s12954-026-01559-y","url":null,"abstract":"<p><p>Across West Africa, HIV, mpox, stigma, and health-system barriers may interact in ways that compound clinical and social harms and challenge disease-specific models of care. This commentary proposes a practical, tripartite harm-reduction framework for integrated, person-centred syndemic management, designed not only to reduce morbidity associated with HIV and mpox but also to reduce harms arising from stigma, criminalization, inadvertent disclosure, and discriminatory health services. We propose: [1] integrated clinical pathways that provide HIV, mpox, and mental health services through co-location or discreet referral options while preserving voluntary access, confidentiality, and patient choice; [2] person-centred surveillance using ethically governed, de-identified data linkage to reduce fragmentation while protecting privacy and autonomy; and [3] funded, community-led interventions that address stigma, discrimination, criminalization, and exclusion from care through peer navigation, targeted communication, and legal and policy advocacy. We argue that this operational shift, supported by pragmatic implementation research, provides a testable approach to reducing clinical, social, and health-system harms associated with the syndemic. We encourage national health ministries, regional bodies, and global health partners to support the co-design, resourcing, and rigorous evaluation of pilot programmes in appropriate settings. Through integrated action that treats the whole person within their social context, this framework provides a testable approach to informing more equitable and resilient health-system responses in West Africa.Clinical trial number: Not applicable.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Replicating motivational and cognitive-motivational typologies of doping attitudes among recreational fitness athletes: implications for harm reduction and risk communication.","authors":"René Paasch, Gunnar Mau","doi":"10.1186/s12954-026-01546-3","DOIUrl":"https://doi.org/10.1186/s12954-026-01546-3","url":null,"abstract":"<p><strong>Background: </strong>The non-medical use of image- and performance-enhancing drugs (IPEDs) in recreational fitness represents an important public health and harm-reduction challenge. While prevalence estimates provide useful benchmarks, they often obscure the motivational and cognitive-motivational heterogeneity underlying substance-use decisions and prevention needs in gym populations.</p><p><strong>Objective: </strong>This study re-examined a previously published typology and evaluated its reproducibility of doping attitudes and prevention needs among German recreational fitness athletes using selected constructs from the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM), complemented by qualitative illustration.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted with 624 recreational athletes (64.1% male, 34.5% female, 1.4% diverse; Mage = 37.1, SD = 10.0). After data cleaning, the analytical sample comprised 550 participants. Four TPB/HBM-related scales with acceptable internal consistency (α = .78-.86) served as clustering variables. Ward's method followed by k-means clustering (k = 7, seed = 42) informed the retention of a seven-cluster solution (overall silhouette = .22; bootstrap-based reproducibility with B = 200 indicated moderate stability). Associations with lifetime use of anabolic-androgenic steroids (AAS), testosterone replacement therapy (TRT), and growth hormone (GH) were examined descriptively. Fifty-two open-ended responses to illustrate cluster-specific motivational and cognitive-motivational patterns.</p><p><strong>Results: </strong>Seven distinct motivational and cognitive-motivational profiles were identified, with descriptively distinct profile patterns across TPB/HBM-related dimensions. Small but statistically significant associations were observed for AAS and TRT, whereas GH use did not differ significantly across profiles. Qualitative accounts illustrated contrasts between value-based abstainers, ambivalent risk-takers, performance-oriented rationalisers, and low-engagement groups.</p><p><strong>Conclusions: </strong>The replication provides preliminary support for a seven-profile typology of IPED-related orientations in recreational fitness, indicating heterogeneous motivational patterns and prevention needs rather than a single risk continuum. Given the moderate stability observed in the bootstrap analyses, the typology should be interpreted cautiously at the individual level but may provide an exploratory framework for harm-reduction-oriented communication and prevention approaches in gym populations.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contraceptive and condom use among women from key populations in Myanmar.","authors":"Maxim Kan, Carl Fredrik Sjöland, Khine Wut Yee Kyaw, Ruby Killingsworth, Sai Phyo Zarni, Martin Kåberg, Aung Yu Naing, Anna Mia Ekström","doi":"10.1186/s12954-026-01520-z","DOIUrl":"10.1186/s12954-026-01520-z","url":null,"abstract":"<p><strong>Background: </strong>Contraceptive and condom use remain low among women in marginalized communities, including those who sell sex, use or inject drugs, or are sexual partners of people who use or inject drugs (key populations). This study examines how selling sex and drug use relate to contraceptive and condom use with different partner types in Myanmar, alongside structural risk contexts.</p><p><strong>Methods: </strong>We analyzed a cross-sectional survey among women from key populations (women who sell sex, use drugs, or are sexual partners of men who use drugs) recruited through community-based organizations across four sites in Northern and Eastern Myanmar. The analysis focused on women of reproductive age (15-49 years). Participants completed standardized questionnaires assessing contraceptive use in the past 12 months and condom use with partner types in the past 3 months. Descriptive and bivariate analyses were conducted, and multivariable Poisson regression models estimated adjusted prevalence ratios (aPRs) for contraceptive and condom use in relation to selling sex, drug use, and selected covariates.</p><p><strong>Results: </strong>In multivariable analyses among 336 women, those reporting drug use only (aPR 0.68, 95% CI 0.48-0.95) had lower contraceptive uptake compared with women with no personal experience of selling sex or drug use. Women who had never used drugs were more likely to use contraception than opioid users (aPR 0.64, 95% CI 0.43-0.95) or stimulant users (aPR 0.72, 95% CI 0.57-0.92). Work-provided housing was associated with higher contraceptive use (aPR 1.43, 95% CI 1.01-2.05). This association was strongest among individuals selling sex, for whom such housing may represent brothel environments that facilitate access to contraceptives. Experience of selling sex was associated with higher condom use with casual partners, whereas drug use only or neither experience was associated with lower condom use with casual partners, highlighting prevention gaps outside sex-work-focused outreach.</p><p><strong>Conclusion: </strong>Among women from key populations in Myanmar, contraceptive and condom use were determined by structural factors and risk contexts. Drug use was associated with lower contraceptive uptake, while experience of selling sex and work-provided housing were linked to higher use, likely reflecting differential access to outreach-based services. Scaling up reproductive health and HIV-prevention services within harm reduction and outreach, while addressing housing insecurity, is essential to improve outcomes in these populations.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Cannabis Green Wave\" versus \"Nicotine Freeze\": the regulatory paradox of cannabis liberalization and nicotine prohibition.","authors":"Konstantinos Farsalinos","doi":"10.1186/s12954-026-01517-8","DOIUrl":"10.1186/s12954-026-01517-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The contemporary landscape of psychoactive substance regulation is characterized by a striking policy paradox. On one hand there is the gradual liberalization and mainstreaming of the cannabis market (the \"Green Wave\"), propelled by principles such as human rights, harm reduction, criminal justice reform, social equity, and economic efficiency. This coincides with a neo-prohibitionist tightening of regulations against non-combustible, harm reduction nicotine products (the \"Nicotine Freeze\"). This manuscript interrogates the toxicological, sociological, and bioethical inconsistencies driving this divergence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analysis: &lt;/strong&gt;Decoupling the active compounds (THC and nicotine) from their traditional combustible delivery systems reveals a stark regulatory asymmetry. Toxicologically, while the primary harms of both substances appear to stem from combustion, state policies heavily restrict lower-risk, non-combustible nicotine alternatives while facilitating access to smokeable and edible cannabis. Neurocognitively, nicotine functions as a non-intoxicating stimulant with potential cognitive benefits, whereas cannabis, particularly sustained and heavy use, carries risks of cognitive impairment and psychosis. Furthermore, a glaring double standard exists regarding youth protection: the \"gateway theory\" and flavor bans are aggressively weaponized to prohibit nicotine alternatives, while cannabis products become progressively more palatable and include potentially youth-appealing flavored products with minimal precautionary resistance. Therefore, from a toxicological and public health perspective, these regulatory double standards indicate that the current treatment of nicotine versus cannabis repeats historical prohibition paradigms, which, despite toxicological arguments, were driven primarily by political ideology and prejudice rather than objective evidence. Sociologically, the strict prohibition of nicotine products ignores the \"Iron Law of Prohibition,\" inadvertently fostering unregulated black markets-a historical lesson policymakers readily accept regarding cannabis. Bioethically, cannabis legalization is championed under the banner of \"cognitive liberty\" and adult autonomy, whereas nicotine regulation has regressed into \"hard paternalism,\" infantilizing consumers and denying smokers' access to life-saving substitutes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Current regulatory frameworks are no longer neutral; they enforce a moral hierarchy that protects the pursuit of cannabis while punishing the management of functional nicotine dependence. The foundational arguments that characterize the current trend of cannabis legalization are systematically ignored in the case of harm reduction nicotine products. To optimize public health outcomes, regulators must resolve this paradox by abandoning selective paternalism and applying a consistent, risk-proportionate harm-reduction paradigm to all psychoactive substanc","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: What we need, not what we're given: recommendations for action from young sex workers who use drugs.","authors":"Marie Schneider, Josephine Achieng, Rebeca Calzada Olvera, Brett Koenig, Jenn McDermid","doi":"10.1186/s12954-026-01516-9","DOIUrl":"10.1186/s12954-026-01516-9","url":null,"abstract":"","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Reducing the harms of cannabis use in youth post-legalization: insights from Ontario youth, parents, and service providers.","authors":"Toula Kourgiantakis, Angie Hamilton, Christine Tait, A Kumsal Tekirdag Kosar, Carrie K Y Lau, Sandra McNeil, Eunjung Lee, Shelley Craig, Abby L Goldstein","doi":"10.1186/s12954-026-01515-w","DOIUrl":"10.1186/s12954-026-01515-w","url":null,"abstract":"","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging evidence gaps: the role of real-world data in tobacco harm reduction.","authors":"Arielle Selya, Gem Le, Venera Tomaselli, Riccardo Polosa","doi":"10.1186/s12954-026-01511-0","DOIUrl":"10.1186/s12954-026-01511-0","url":null,"abstract":"<p><p>The importance of real-world evidence (RWE) is becoming increasingly recognized in the fields. of medicine and healthcare delivery as a complement to evidence from randomized controlled. trials (RCTs). Incorporating RWE - which informs on a treatment's uptake, effectiveness, risks, and benefits under realistic (vs. carefully controlled) conditions among diverse and heterogeneous populations-can specifically benefit efforts to reduce combustible tobacco use, the primary cause of preventable premature death globally. RCTs have shown a variety of quit methods (e.g., nicotine replacement therapy, varenicline, and electronic nicotine delivery systems (ENDS)) to be effective for smoking cessation, but these treatments have varying uptake and success in real-world settings. A likely reason why RCT evidence does not necessarily generalize to real-world settings is that the populations eligible for RCTs do not represent the majority of adults who smoke (e.g., with respect to motivation to quit), underscoring the need for complementary RWE. Accordingly, non-combustible nicotine products (NCNPs) including ENDS that can serve as alternative consumer products and do not require a priori intentions to quit smoking seem to have higher uptake, and therefore greater reach, than traditional medical or pharmaceutical methods. RWE can also advance our limited current understanding of how consumers use reduced-risk products, which could in turn improve generalizability of RCTs in the future, as well as inform clinical communications and regulatory strategies. Since RWE has limitations such as confounding and selection bias, it should be used as a complement, not a replacement for, traditional RCT evidence.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reshaping addiction harm reduction program in Iran: The Ministry of Health's journey from reactive measures to strategic optimization.","authors":"Hamid Reza Fathi, Hadi Zarafshan, Hamid Sharifi, Ahmad Hajebi, Seyed Ebrahim Ghoddousi, Ghobad Moradi, Mohammadreza Shalbafan","doi":"10.1186/s12954-026-01510-1","DOIUrl":"https://doi.org/10.1186/s12954-026-01510-1","url":null,"abstract":"<p><p>Iran's national harm reduction program, scaled up during a period of substantial decline in HIV prevalence among people who inject drugs, later faced growing operational challenges as client numbers declined at many service sites. This Comment describes the evidence-based restructuring undertaken by the Ministry of Health and Medical Education (MoHME) after approximately two decades of implementation. National studies on population size estimation, geospatial distribution of injecting drug use, and service quality assessment informed a major reconfiguration of the harm reduction network. Underutilized facilities were consolidated, while outreach teams and mobile clinics were repositioned toward underserved areas and emerging drug-use hotspots. The restructuring aimed to improve resource utilization, maintain national coverage, and better align services with changing patterns of drug use and emerging hotspots. Iran's experience highlights the importance of continuous evaluation and adaptation of mature harm reduction programs in response to epidemiological transitions, evolving substance-use patterns, and emerging evidence. The lessons from this process may be relevant for other countries seeking to optimize publicly funded harm reduction services while preserving access for vulnerable populations.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational interventions for erroneous gambling beliefs among Norwegian online casino players: a large-scale real-world study of behavioural impact.","authors":"Nadia Arshad, Nathan Lakew, Per Carlbring, Ståle Pallesen, Tony Leino, David Forsström, Philip Lindner, Jakob Jonsson","doi":"10.1186/s12954-026-01508-9","DOIUrl":"10.1186/s12954-026-01508-9","url":null,"abstract":"<p><strong>Background: </strong>Erroneous beliefs about gambling contribute to the development and maintenance of problem gambling and represent an important public health concern. Norsk Tipping (NT), the state-owned gambling operator in Norway, initiated the Spillepuls project to develop and evaluate preventive interventions for its online customers. This study evaluated an educational intervention that addressed gambling-specific misconceptions among users of NT's online casino platform. The intervention compared different formats (video versus quiz), delivery modes (voluntary versus mandatory), and timing (pregame versus during play), against a non-intervention control group. The outcome measures comprised gambling behaviour and use of responsible gambling (RG) measures.</p><p><strong>Method: </strong>The data were collected by NT as part of their routine operations. The experiment took place between May 2022 and January 2023. During this period, NT randomly assigned 18,981 new online casino customers to one of three conditions (Video, Quiz, or Control) on their third day of play. Customers allocated to the Video and Quiz conditions were subsequently randomized to one of three delivery modes: voluntary before gameplay, mandatory before gameplay, or mandatory during gameplay.</p><p><strong>Results: </strong>No significant differences in gambling behaviour or uptake of RG measures were observed between the intervention groups and the control group. However, comparisons across the six intervention conditions revealed clear differences in engagement. Mandatory pregame delivery produced the highest completion rates, with a small but significant difference between the video and quiz formats (99.8% vs. 98.2%; χ²(1, N = 5403) = 10.9, p < .01). In contrast, the voluntary pregame video achieved the lowest completion rate (7.1%; χ²(1, N = 5435) = 283.4, p < .001). Participants rated the video interventions as more relevant and useful than the quizzes in both the mandatory and voluntary conditions, whereas the quiz format was perceived as less intrusive.</p><p><strong>Conclusion: </strong>Mandatory interventions achieved substantially higher completion rates, whereas voluntary video and quiz interventions were perceived as more relevant and useful by participants. Although mandatory pregame delivery was associated with lower values for selected monetary gambling indicators than voluntary pregame delivery, none of the intervention conditions differed from the control group in gambling behaviour or uptake of RG measures. These findings indicate the need for further research to identify more effective approaches for promoting RG.</p>","PeriodicalId":12922,"journal":{"name":"Harm Reduction Journal","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}