Commentary on Dobbie et al.: Preventing adolescent gambling‐related harm—Is a universal approach sufficient?

Although a school‐based universal gambling prevention program can be feasibly and reliably implemented, its ultimate public health impact may depend on its integration with targeted interventions capable of producing sustained behavioural changes among at‐risk adolescents.

Dobbie and colleagues' [1] pilot cluster randomised controlled trial represents a significant contribution to the development of gambling‐related harm prevention programs for adolescents. Pilot cluster randomised controlled trials are designed to establish feasibility and inform progression toward larger phase III trials, while also providing preliminary indicators of intervention efficacy. Such trials remain rare in the domain of universal prevention strategies for addiction, and particularly for gambling‐related harms. Although researchers have long emphasized adolescence as a critical developmental window for gambling prevention, with schools identified as the optimal delivery context [2, 3, 4, 5], the empirical base has been slow to develop. Of the four previous pilot cluster randomised controlled trials reporting outcomes on gambling‐related knowledge and behaviours beyond 6 months [6, 7, 8, 9], most were constrained by small sample sizes, class‐level rather than school‐level randomisation and incomplete reporting of feasibility and acceptability criteria as articulated in CONSORT guidelines [10]. As a result, prior evidence offered limited guidance regarding scalability, methodological robustness and real‐world implementation of school‐based gambling prevention interventions. Against this backdrop, the present study meaningfully advances the field by explicitly addressing progression criteria for a definitive trial.

A central strength of Dobbie et al.’s [1] study lies in its clear demonstration of feasibility across multiple domains, including recruitment, retention, implementation with fidelity within a school setting and rates of attrition below 30%. This is particularly salient given growing evidence that adolescents are increasingly exposed to gambling opportunities through online platforms, gaming‐related monetization features and normalization of gambling via advertising and social media [11, 12]. The study also aligns gambling prevention research with broader youth substance use prevention efforts, where school‐based universal interventions for tobacco, alcohol and cannabis have demonstrated feasibility and potential public health value [13]. Importantly, the authors' engagement with key stakeholders, schools, educators and students, enhances the ecological validity of the intervention and supports its potential scalability. Although stakeholder involvement inevitably introduces constraints related to curriculum time, institutional priorities and variability in delivery, the trial demonstrates that these challenges can be navigated without compromising core study procedures.

Notwithstanding these strengths, the study raises important questions about the optimal prevention strategy for gambling‐related harms in youth. Gambling behaviours and related harms are influenced by a complex constellation of individual, social and environmental factors, making it difficult to disentangle intervention‐specific effects from broader developmental or contextual influences. Moreover, universal educational and peer‐led interventions, although potentially effective at increasing knowledge and shaping attitudes, often show more modest effects on sustained behavioural change [3, 5]. This is consistent with universal interventions for substance use behaviours that have indicated weak effects [13]. This limitation invites comparison with more targeted approaches, such as personality‐focused interventions. For example, Conrod and colleagues [14] demonstrated that a selective, personality‐targeted school‐based program produced durable reductions in substance use disorder outcomes over 5 years. Such findings raise the question of whether universal gambling interventions should be complemented, or potentially replaced, by targeted strategies for youth who are at an elevated risk.

Dobbie et al.’s [1] trial does not resolve questions regarding the relative merits of universal versus targeted prevention, but rather opens an important dialogue about how these approaches may function in complementary ways. By demonstrating the feasibility and acceptability of a universal, school‐based intervention, the study highlights the potential role of universal programming in establishing shared awareness and harm literacy at an early age, while also drawing attention to the limits of such approaches for addressing individual differences in risk. This, in turn, underscores the need to consider how targeted interventions might be layered onto universal delivery models to more effectively address heterogeneous developmental pathways to gambling‐related harm. Pilot trials that prioritize feasibility and progression criteria, therefore, contribute not by prescribing an optimal prevention model, but by informing how integrated, stepped approaches might be meaningfully tested in future research.

In conclusion, Dobbie and colleagues' [1] pilot cluster randomised controlled trial makes a timely and important contribution by demonstrating that universal, school‐based gambling prevention interventions can be feasibly and acceptably implemented in real‐world settings. Its emphasis on feasibility, stakeholder engagement and progression criteria address longstanding gaps in the literature and highlights how rigorous pilot trials can advance the field.

AUTHOR CONTRIBUTIONS

Jérémie Richard: Conceptualization; writing—original draft.

DECLARATION OF INTERESTS

None.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.