From policy to practice: assessing the impact of electronic gambling machines regulations on harmful gambling behaviour

Background: Electronic gambling machines (EGMs) are among the most harmful forms of gambling. Their widespread availability has been linked to increased gambling activity and a rise in harmful gambling. However, it remains unclear whether restricting the availability and accessibility of EGMs is effective in reducing gambling harms at the population level. We investigate those issues by leveraging the natural experiment of the region of Piedmont in northwest Italy, which in 2018 set limits on the location and operating hours of EGMs. Methods: Data from the Gambling Adult Population Survey conducted in 2018 and 2022 were combined with information regarding the implementation of the policy in Piedmont municipalities and data on EGMs from the national monopoly holder. Our analysis uses a difference-in-difference design, which is appropriate given that only some municipalities in the region implemented the policy, each setting different operating time limits for EGMs. Sensitivity analyses were conducted to explore possible substitution effects towards bordering regions and online gambling. Results: Our findings reveal that policies aimed at reducing the operating hours of EGMs were effective in decreasing harmful gambling behaviour in the population, but only when a minimum daily operational suspension of 11 hours was implemented. No significant effect was observed from setting location limits, and no substitution effect was found. Conclusions: While restricting EGM availability can help mitigate harmful gambling, it requires coordinated efforts across different levels of government to ensure uniform policy implementation, along with individual-level policies, such as banning advertising, and consideration of diverse gambling products and online gambling.