Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol

Lucija Banozic; Anne Matthews; Paula Flanagan

doi:10.12688/hrbopenres.14344.1

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Study Protocol

Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol

[version 1; peer review: 2 approved with reservations]

Lucija Banozic ¹, Anne Matthews¹, Paula Flanagan¹

PUBLISHED 20 Feb 2026

Author details Author details

¹ Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, Leinster, D09 V209, Ireland

Lucija Banozic
Roles: Conceptualization, Writing – Original Draft Preparation

Anne Matthews
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Paula Flanagan
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Gambling is increasingly getting recognised as a public health problem, with young adults (18-25) being identified as a particularly vulnerable group due to their ongoing neurodevelopment and increased exposure to spreading gambling environments. Individuals who adopt problematic gambling behaviours can either classify as problem gamblers or can in more severe cases meet the criteria for a clinical diagnosis for Gambling Disorder (GD). Different characteristics and traits, known as risk factors, can influence the development of these conditions. This review aims to evaluate the quantitative studies investigating risk factors contributing to problematic gambling behaviours in the young adult populations.

Methods

A systematic review guided by the Joanna Briggs Institute (JBI) methodology will be conducted. This review will consider quantitative and mixed-methods, where quantitative data can be extracted, evidence published from 1990 onwards on risk factors which are associated with gambling in the young adult population. Four databases will be searched as well as grey literature. Methodological quality will be assessed using the JBI critical appraisal tools based on the study designs of each study. Data extraction will be conducted using the JBI standardised extraction tools. The risk of bias will be assessed using the Quality in Prognostic Studies (QUIPS) tool to evaluate the risk-factor-outcome relationship.

Discussion

Gambling Disorder and Problem Gambling are a growing public health concern. The results of this review are anticipated to benefit researchers, clinicians and policymakers by providing a better understanding on key predictors of gambling-related harm in this population which would then aid in informing early intervention and prevention strategies.

Protocol registration number

PROSPERO 2026 CRD420261288057

Keywords

Gambling, risk factors, young adults, systematic review

Corresponding author: Lucija Banozic

Competing interests: No competing interests were disclosed.

Grant information: The work is supported by PhD Scholarship from School of Nursing, Psychotherapy and Community Health, Dublin City University.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2026 Banozic L et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Banozic L, Matthews A and Flanagan P. Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2026, 9:20 (https://doi.org/10.12688/hrbopenres.14344.1) First published: 20 Feb 2026, 9:20 (https://doi.org/10.12688/hrbopenres.14344.1) Latest published: 16 Apr 2026, 9:20 (https://doi.org/10.12688/hrbopenres.14344.2)

Introduction

For many people, gambling is a form of a leisure activity. However, persistent participation can lead to Problem Gambling (PG) and, in more severe cases, a clinically recognised behavioural addiction known as Gambling Disorder (GD) (Krotter et al., 2025). Gambling has increasingly become recognised as a public health issue (Tran et al., 2024). The recognition was first evident with the definition of excessive gambling in the International Classification of Diseases (ICD), followed by the development of the diagnostic criteria included in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) (Tran et al., 2024). PG refers to gambling behaviour that results in significant harm to the individual and their relationships (Scholes-Balog et al., 2014). Individuals experiencing PG may display symptoms associated with GD, but do not necessarily meet the full criteria for a clinical diagnosis (Afifi et al., 2016). The most widely used scale to measure PG is the Problem Gambling Severity Index (PGSI) which has been used in numerous epidemiological studies worldwide (Gavriel-Fried et al., 2024). GD is a psychiatric condition which is characterised by a maladaptive pattern of gambling behaviour that persists despite its negative influence on major areas of life functioning (Ferrara et al., 2018). GD is frequently associated with impulsive behaviour which can lead to harmful long-term consequences (Leppink et al., 2016).

Despite substantial variations in prevalence rates, the literature consistently demonstrates an elevated risk of PG among young adults relative to other populations (Duggan & Mohan, 2023). In the Irish context, a report by Mongan et al. (2022) revealed that in 2021, almost half (49%) of adults aged 15 and over engaged in some form of a gambling activity. Young adults aged 18–25 years are considered a particularly at-risk population, as this developmental stage is often described as “vulnerable” (Chambers & Potenza, 2003). This is a crucial stage in cognitive development which is associated with identity explorations, personal development and changes in different areas of life (Gavriel-Fried et al., 2024). During this development an individual is increasingly vulnerable to the onset of behavioural addictions, including gambling (Chambers & Potenza, 2003; Lambuth et al., 2026).

Furthermore, the increasing availability of gambling services which have spread onto online platforms, have made gambling more accessible and convenient for young populations (Bickl et al., 2024; Hollén et al., 2020). If recreational gambling develops into a more serious, addictive, form of gambling, it can lead to a range of negative outcomes for young adults (Duggan & Mohan, 2023). Some of them include strain on finances, damage to mental and physical health, relationships, employment and education (Tran et al., 2024). Therefore, it is important to note the early appearance of risk behaviours as they can, if left untreated, result in severe disorders in later adulthood (Bozzato et al., 2020). This has been supported by the research that found that individuals who were classified as problem gamblers in early adulthood are more likely to remain problem gamblers with a more serious diagnosis in later adulthood (Emond et al., 2022; Kerr et al., 2021).

In order to inform policies about the issue of young adults adopting problematic gambling behaviours, it is important to understand which factors contribute to their development (Duggan & Mohan, 2023). Risk factors are conditions and traits which, if present, make an individual at a higher risk of developing a condition (Mrazek & Haggerty, 1994). As of now, a wide range of risk factors associated with problematic gambling behaviours have been identified in multiple primary studies and systematic reviews (Bickl et al., 2024). These risk factors can change throughout different life stages, and they can arise from the individual, their family, peers or environment. They can also be biological and psychosocial (Mrazek & Haggerty, 1994). Therefore, it is essential to have a thorough understanding of them and how they impact the development of PG and GD in different age groups (Calado et al., 2017).

A preliminary search identified two key systematic reviews on the topic of interest. Moreira et al. (2023) conducted a systematic review on risk factors associated with GD in the general population. This review categorised risk factors at a “personal” and “familiar” level. At the personal level, factors such as being young, single male or being married for less than five years, living alone, having poor education and financially struggling were all identified as factors which contributed to increased gambling behaviour (Moreira et al., 2023). At the familiar level, it has been identified that individuals that qualify as gamblers experience greater difficulties with family and social relationships than non-gamblers (Moreira et al., 2023). In addition, individuals who grew up with a single parent or parents with addiction problems were more likely to experience gambling problems (Moreira et al., 2023). While this systematic review covers a range of risk factors, the overall focus is on how they impact the general population which makes it difficult to extract the evidence on risk factors that specifically affect young adults.

A more focused review was conducted by Dowling et al. (2017) who published a systematic review and meta-analysis of longitudinal studies on early risk and protective factors of gambling that emerge in childhood, adolescence or young adulthood. This systematic review has identified thirteen individual risk factors, one relationship risk factors and one community risk factor which all influence the development of GD, as well as a range of protective factors (Dowling et al., 2017). This systematic review did present extensive evidence on the various risk factors, however, its focus on longitudinal studies excludes the evidence from the other relevant literature. It also remains challenging to isolate the specific factors associated specifically with young adults at the point of transition into high-risk gambling. Lastly, updating the literature beyond 2017 is necessary to incorporate new populations, methodologies and contemporary risk factors.

Therefore, the justification for conducting systematic review on this subject is to identify and synthesise a more comprehensive understanding of the risk factors associated with gambling in young adults by integrating the existing evidence from various studies. The review will have a primary focus on the desired population to broaden the spectrum from general or adolescent samples and the factors associated with the PG and GD.

Study aim and review question

A systematic review is proposed to evaluate the quantitative studies investigating risk factors contributing to problematic gambling behaviours in the young adult populations. The following questions aligned to the review question are:

What are the risk factors associated with PG and GD in young adults?
How do identified risk factors influence gambling-related harm in young adults?

The results of this review will be of value to researchers, healthcare professionals and policy makers as it may provide a better understanding of factors associated with the development of gambling-related problems in young adults.

Methods

Eligibility criteria

This protocol has been designed using a framework provided by The Joanna Briggs Institute (JBI) and will adhere to the PRISMA for systematic review protocols (PRISMA-P). The methodology has adapted the PEO framework (Population, Exposure, Outcome) as suggested by JBI (Moola et al., 2017). The PEO framework assisted in the identification of defining characteristics for the inclusion criteria for the systematic review.

Population: This review will consider studies that include young adults. For this review, a young adult is defined as an individual aged 18–25 years. Two different populations of young adults will be considered for inclusion:

1. Young adults who meet the criteria for PG based on a validated screening instrument (e.g., Problematic Gambling Severity Index Scale)
AND
2. Young adults who have a formal clinical diagnosis of GD diagnosed with a universally used clinical diagnostic tool (e.g., DSM-5 or ICD-10/11).

Studies primarily focused on the populations aged <18 and >25 years will be excluded. Studies reporting effectiveness of treatments and interventions for individuals diagnosed with GD where risk factors are not reported will be excluded.

Exposure: According to the JBI definition, a risk factor refers to an individual characteristic or exposure that is associated with an increased likelihood of an outcome occurring (Moola et al., 2017). Studies reporting on risk factors such as, but not limited to, psychological, social, individual, demographic, environmental and socio-economic, will be considered. Studies not defining and categorising risk factors and their association with the development of PG or GD will be excluded.

Outcome: The primary outcome which will be investigated is the development of PG/GD in the young adult population, the incidence of gambling behaviours, gambling frequency and/or any other gambling-related harm influenced by the identified risk factors. GD and PG will need to be assessed using validated tools. Studies reporting non-gambling outcomes, such as substance use, will be excluded.

Types of studies

This systematic review will consider primary quantitative studies and mixed-methods studies. However, primary mixed-methods studies will only be considered for inclusion if it is possible to extract quantitative data components concerning the young adult population. In instances where primary mixed-methods studies are presented in an integrated format and extraction cannot be undertaken, the studies will be excluded. Editorials, comments, literature reviews, conference abstracts, guidelines, recommendations, consensus papers and qualitative studies will be excluded. Studies not directly related to the review question, but that present valuable evidence on the relationship between risk factors and gambling will be included if they meet other inclusion criteria (Moola et al., 2017). Included studies will comprise of peer-reviewed, full texts published from 1990 to be consistent with the development of the first validated tool for the assessment of PG (Dowling et al., 2017). Grey literature will also be considered. The reference lists of included studies will be manually searched for additional relevant papers. There will be no limitation to the language in which the study has been originally published, but a version published in English will be sought.

Search strategy

A systematic search strategy will be developed with a professional subject librarian. The search terms and concepts will be identified by examining MeSH subject headings which will also help us to refine our search concepts. The databases which will be systematically searched are Scopus (Elsevier), Web of Science, PubMed and APA PsycInfo. In addition, the reference lists of all included studies will be manually searched for additional studies which may be included. Boolean operators and controlled vocabulary terms will be used as required for each database search. Grey literature, including government reports and Google Scholar, will be searched based on the key terms used for the database search.

Study selection

Following the search, all identified citations from each database searched will be imported into Zotero Citation Management System version 7/2025 where search results will be manually deduplicated. These will then be imported into Covidence Software for screening. Title and abstract screen will be conducted in Covidence independently by two reviewers where they will be assessed against the review’s eligibility criteria. All potentially relevant titles identified by either or both reviewers will be moved forward for a full-text review. The full texts of the selected studies will be assessed in detail by two independent reviewers using the eligibility criteria. Each full text study which is excluded will be documented and reported in the Appendix section of the systematic review (Moola et al., 2017). Any disagreements that arise between the reviewers will be settled through discussion or with the assistance of the third independent reviewer in the instances where the disagreements cannot be resolved. The complete results of the search will be reported in the final review and presented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram (Moola et al., 2017).

Assessment of methodological quality

The studies identified for inclusion will be appraised and evaluated for the methodological quality using the JBI critical appraisal tools which should be applied based on each study’s methodology (Moola et al., 2017). The assessment of methodological quality will be conducted independently by two reviewers. If the two reviewers disagree on the final critical appraisal, a third independent reviewer will be consulted. Data extraction and data synthesis will be conducted on all studies included in the final review despite the result of their methodological quality (Moola et al., 2017).

Data extraction

Two independent reviewers will extract all quantitative data using the JBI standardised data extraction tools which allow the extraction of the same types of data across the included studies (Moola et al., 2017). Any disagreements will be resolved through discussion until agreement is reached. In instances where agreement cannot be reached, a third independent reviewer will be consulted (Moola et al., 2017).

The following information will extracted: study characteristics including authors’ names and year the study was published in, study design, setting of the study, recruitment design, population’s characteristics including sample size and age range, follow-up or the duration of the study, items identified as risk factors, participants’ exposure vs non-exposure to the risk factors, primary outcome measures and risk of bias (Moola et al., 2017). Study authors will be contacted for any missing information or clarifications essential for data synthesis. Authors will be contacted by email a maximum of two times with the emails sent three weeks apart.

Risk of bias assessment

The risk of bias will be assessed using the Quality in Prognostic Studies (QUIPS) tool. While the JBI highly recommends the use of JBI tools for the review, the exemptions can be made where the appropriate justification for the use of different tools is given (Moola et al., 2017). The JBI tool is designed to assess the quality of a wide range of study designs and it, therefore, includes multiple separate tools which are adapted depending on the study design (Moola et al., 2017). In comparison, QUIPS is a single tool that is more suitable as it is specifically created for assessment of risk of bias in the prognostic factor studies where the bias is evaluated in the risk factor-outcome relationship (Hayden et al., 2013).

Data synthesis

The data synthesis strategy will be focused on the pooling of quantitative data based on risk-factor-outcome associations through the use of Odds Ratios (ORs) and Relative Risks (RRs). It will begin with an assessment of clinical and methodological homogeneity across study populations, definitions of risk factors and outcome measures which, in this case, is gambling severity (Moola et al., 2017).

Considering that the inclusion criteria includes participants aged 18–25 years who either have a formal clinical diagnosis of GD or meet the criteria for PG, subgroup analysis will be conducted if appropriate. Subgroup analysis will allow us to examine whether risk-factor-outcome associations differ in severity or consistency across GD compared to PG groups. This will, therefore, strengthen the applicability of the findings from this systematic review. Subgroup analyses will only be possible if at least two methodologically comparable studies are identified within each subgroup.

It is anticipated that a full meta-analysis will not be feasible due to various factors including heterogeneity in research designs and variabilities in study and reporting methods. Therefore, a comprehensive narrative synthesis will be primarily utilised. The characteristics of the study will be narratively summarised in the tables of the report according to risk factors to investigate the consistency of correlations. Extracted data will be presented in the tables as frequencies and percentages, means and standard deviations, or medians and interquartile ranges, as appropriate. Risk factors will be categorised based on their concept (i.e. demographics, social, psychological) to facilitate narrative synthesis. If two or more homogenous studies reporting effect sizes of the same outcome measure are identified, the available information will be synthesised using a random or fixed effects model and a meta-analysis will be conducted where appropriate (Moola et al., 2017).

Study status

This Systematic review protocol has been developed and registered on PROSPERO (CRD420261288057). The review is currently undergoing the systematic search which will be followed by screening, data extraction and data synthesis as outlined above.

Discussion

GD and PG among the young adult population is a growing public health concern (Gavriel-Fried et al., 2024). However, the risk factors associated with it remain insufficiently synthesised. Young adults are particularly vulnerable due to their ongoing neurodevelopment, heightened impulsivity and exposure to expanding gambling environments (Lambuth et al., 2026). Although existing evidence has identified various potential risk factors, the evidence is dispersed across different study designs, populations and methodologies, limiting the generalisability of evidence for prevention and early intervention.

This systematic review, guided by the JBI methodology, aims to address these gaps by providing a comprehensive and methodologically inclusive review of quantitative evidence on risk factors associated with GD and PG among young adults aged 18–25 years. The review will incorporate different study designs while risk factors will be categorised across different areas. As such, the review is expected to provide an up-to-date overview of available evidence focused specifically on young adults. Subgroup analysis, if conducted, will further enhance the understanding as it will explore differences between clinically diagnosed gamblers and problem gamblers.

It is expected that the findings of this systematic review will benefit researchers, clinicians and policymakers by providing a clarification on key risk factors of gambling-related harm and inform prevention and intervention strategies (Moola et al., 2017).

Dissemination

The completed review will be submitted for a publication in a peer-reviewed journal. It will be openly accessible and will be shared at relevant academic and professional conferences.

Data availability

Underlying data

No data are associated with this article.

Extended data

Reporting guidelines

Zenodo: “PRISMA-P checklist for a systematic review”. https://doi.org/10.5281/zenodo.18327348 (Banozic et al., 2026b)

Search strategy

Zenodo: “Example of a search strategy for “Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol”. https://doi.org/10.5281/zenodo.18374648 (Banozic et al., 2026a)

Data are available under the terms of the Creative Commons Attribution 4.0 International License (CC-By 4.0).

Acknowledgements

The authors would like to acknowledge Emma Stapleton, Subject Librarian for the School of Nursing, Psychotherapy and Community Health, Dublin City University for her assistance in the development of the search strategy.

Faculty Opinions recommended

References

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Banozic L, Matthews A, Flanagan P: Example of a search strategy for “Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol”. Zenodo. 2026a. http://www.doi.org/10.5281/zenodo.18374648
Banozic L, Matthews A, Flanagan P: PRISMA-P checklist for a systematic review. Zenodo. 2026b. http://www.doi.org/10.5281/zenodo.18327348
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Version 2

VERSION 2 PUBLISHED 20 Feb 2026

Author details Author details

¹ Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, Leinster, D09 V209, Ireland

Lucija Banozic
Roles: Conceptualization, Writing – Original Draft Preparation

Anne Matthews
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Paula Flanagan
Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The work is supported by PhD Scholarship from School of Nursing, Psychotherapy and Community Health, Dublin City University.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (2)

version 2

Revised

Published: 16 Apr 2026, 9:20

https://doi.org/10.12688/hrbopenres.14344.2

version 1

Published: 20 Feb 2026, 9:20

https://doi.org/10.12688/hrbopenres.14344.1

© 2026 Banozic L et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Banozic L, Matthews A and Flanagan P. Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2026, 9:20 (https://doi.org/10.12688/hrbopenres.14344.1)

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Open Peer Review

Version 1

VERSION 1

PUBLISHED 20 Feb 2026

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Reviewer Report 26 Mar 2026

Elvira Bolat, Bournemouth University, Poole, UK

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15796.r53914

This manuscript presents a systematic review protocol aiming to synthesise quantitative evidence on risk factors associated with problem gambling (PG) and gambling disorder (GD) among young adults aged 18–25 years. The protocol follows Joanna Briggs Institute (JBI) guidance and PRISMA-P standards, outlining inclusion criteria, search strategy, study selection, quality appraisal, and planned synthesis methods. The review seeks to address a gap in the literature by focusing specifically on young adults, a group identified as particularly vulnerable due to developmental, psychological, and environmental factors.
The study is timely and relevant, given the growing recognition of gambling as a public health issue and the expansion of online gambling environments. The protocol is generally well-structured and demonstrates familiarity with systematic review methodology.

Major comments, which must be addressed:

1. The current eligibility criteria imply that included participants must already have PG/GD, which risks shifting the review focus from risk factors for development to correlates of existing conditions. This creates a conceptual inconsistency between the stated aim (risk factors) and the inclusion criteria (existing PG/GD populations). Please revise inclusion criteria to explicitly allow studies examining predictors/exposures in relation to future or concurrent outcomes. Clarify whether the review targets etiological (predictive) risk factors or? This is essential to ensure the review is scientifically coherent and aligned with its stated aim.

2. The protocol currently includes PG/GD, gambling frequency/participation, “any gambling-related harm”. These represent conceptually distinct outcomes and should not be treated interchangeably. Please Introduce a clear outcome hierarchy primary outcome: PG/GD (clinically validated); secondary outcome: gambling-related harm; exploratory outcome: participation/frequency (or consider removing). Without this clarification, the synthesis risks becoming methodologically inconsistent and difficult to interpret.

3. The manuscript uses language such as “influence” and “impact,” which may imply causality. However, included studies are likely to vary (cross-sectional, cohort, case-control), and not all designs support causal inference; cross-sectional studies only support associational claims. Please replace causal language with neutral terminology (e.g., “association,” “relationship”). Explicitly state which study designs are included; how different designs will be treated analytically; how predictive vs. correlational evidence will be distinguished.

4. While the protocol mentions potential meta-analysis and narrative synthesis, the approach lacks clarity. Key gaps are
no clear criteria for when meta-analysis will be conducted and limited detail on handling heterogeneity; no framework for assessing certainty of evidence. Specify:
- Criteria for conducting meta-analysis (e.g., number of studies, homogeneity thresholds)
- Planned statistical approach (e.g., random vs fixed effects justification)
- Introduce a framework for evidence certainty (e.g., GRADE or equivalent)
- Provide more structure for narrative synthesis (e.g., thematic grouping, strength of evidence).

5. The age-band is central to the review but lacks operational clarity. How will studies with broader age ranges be handled? Will subgroup extraction be required? Clearly define inclusion rules for studies with mixed age samples (e.g., inclusion if subgroup data available). Specify how age-specific data will be extracted and analysed

Minor comments:
- Clarify treatment of grey literature (search limits, inclusion criteria, quality appraisal);
- Improve consistency in terminology (PG vs GD vs gambling harm);
- Minor language refinements (e.g., avoid repetition and tighten phrasing in Introduction and Discussion);
- Consider briefly justifying the 1990 cut-off more explicitly in relation to measurement tools.

Strengths of the manuscript
- Clear public health relevance and strong justification for topic.
- Appropriate use of established frameworks (JBI, PRISMA-P).
- Transparent and structured methodology
Inclusion of risk of bias assessment (QUIPS) is appropriate for prognostic studies.
- Registration on PROSPERO enhances transparency and credibility.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Gambling and marketing

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 16 Apr 2026

Lucija Banozic, Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, D09 V209, Ireland

16 Apr 2026

Author Response

Dear Dr. Bolat,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. ... Continue reading Dear Dr. Bolat,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have revised the inclusion criteria to allow studies examining predictors and exposures related to both future or concurrent PG/GD, and have provided further clarification on how the age-band rule will be applied. We have refined the outcomes by establishing a clear hierarchy of primary and secondary outcomes. We now explicitly specify the type of studies that will be included and have replaced causal language with neutral terminology. The protocol now also clearly outlines how the data synthesis will be conducted, including meta-analysis, narrative synthesis, statistical approach and assessment of evidence certainty.

We have also addressed the minor comments and clarified the treatment of grey literature and the rationale for the1990 cut-off, as well as improved the terminology and language in Introduction and Discussion.
Dear Dr. Bolat,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have revised the inclusion criteria to allow studies examining predictors and exposures related to both future or concurrent PG/GD, and have provided further clarification on how the age-band rule will be applied. We have refined the outcomes by establishing a clear hierarchy of primary and secondary outcomes. We now explicitly specify the type of studies that will be included and have replaced causal language with neutral terminology. The protocol now also clearly outlines how the data synthesis will be conducted, including meta-analysis, narrative synthesis, statistical approach and assessment of evidence certainty.

We have also addressed the minor comments and clarified the treatment of grey literature and the rationale for the1990 cut-off, as well as improved the terminology and language in Introduction and Discussion.
Competing Interests: No competing interests were disclosed. Close
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Author Response 16 Apr 2026

Lucija Banozic, Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, D09 V209, Ireland

16 Apr 2026

Author Response

Dear Dr. Bolat,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. ... Continue reading Dear Dr. Bolat,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have revised the inclusion criteria to allow studies examining predictors and exposures related to both future or concurrent PG/GD, and have provided further clarification on how the age-band rule will be applied. We have refined the outcomes by establishing a clear hierarchy of primary and secondary outcomes. We now explicitly specify the type of studies that will be included and have replaced causal language with neutral terminology. The protocol now also clearly outlines how the data synthesis will be conducted, including meta-analysis, narrative synthesis, statistical approach and assessment of evidence certainty.

We have also addressed the minor comments and clarified the treatment of grey literature and the rationale for the1990 cut-off, as well as improved the terminology and language in Introduction and Discussion.
Dear Dr. Bolat,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have revised the inclusion criteria to allow studies examining predictors and exposures related to both future or concurrent PG/GD, and have provided further clarification on how the age-band rule will be applied. We have refined the outcomes by establishing a clear hierarchy of primary and secondary outcomes. We now explicitly specify the type of studies that will be included and have replaced causal language with neutral terminology. The protocol now also clearly outlines how the data synthesis will be conducted, including meta-analysis, narrative synthesis, statistical approach and assessment of evidence certainty.

We have also addressed the minor comments and clarified the treatment of grey literature and the rationale for the1990 cut-off, as well as improved the terminology and language in Introduction and Discussion.
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 17 Mar 2026

Matthew Browne, CQ University, Bundaberg, Australia

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15796.r54059

This is a pre-registered systematic review protocol that plans to gather and assess quantitative evidence on risk factors linked to problem gambling and gambling disorder in young adults. The goal is to identify the main predictors of gambling-related harm in this age group; the findings are intended to inform prevention and early intervention.

It's a well written and correctly structured submission that is mostly suitable for registration. That said, there are a few issues that should be addressed in order to tighten up the proposal, so that it better matches the pretty strict delineations required for a systematic review.

1. the current wording makes it sound as though included participants must already have PG/GD, which would make the review about characteristics/correlates of existing problem gamblers, not risk factors for developing PG/GD or harm. The authors should consider inclusion criteria that allow studies where predictors/exposures are examined in relation to later or concurrent PG/GD/harm outcomes

2. The protocol currently mixes several distinct outcomes: PG/GD, gambling frequency/ participation, and 'any other gambling-related harm'. This is pretty broad and conceptually diffuse. There should be a clearer hierarchy or separation of outcomes - one approach could be with PG/GD as primary, harm as secondary, and participation/frequency as exploratory. Harm and PG/GD could potentially be dealt with together, but participation/frequency would have to be separate (or removed altogether).

3. Remove or soften any language implying causal 'influence' unless the design of the included studies justifies it. Cross-sectional, cohort, case-control, mixed-methods etc studies do not all support the same strength of inference. Should explicitly state which designs are eligible whether cross-sectional studies will be treated as correlational rather than predictive, and how the review will distinguish correlates from prognostic/predictive risk factors.

4. How will the evidence be synthesised? Will any quantitative meta-analytic synthesis be done? If so, details will need to be provided. If the synthesis will be qualitative, a clearer narrative synthesis framework and some plan for judging overall certainty/confidence in the evidence (even among cross-sectional studies, we'd expect the quality of evidence to vary wildly) should be specified.

5.the 18–25 age-band rule and operational details around how searches bounded language/grey literature should be explicit. The age-band rule is probably the most crucial here, since that affects study admissibility directly.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Gambling studies, statistical modelling.

CITE

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Author Response 16 Apr 2026

Lucija Banozic, Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, D09 V209, Ireland

16 Apr 2026

Author Response

Dear Professor Browne,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. ... Continue reading Dear Professor Browne,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have clarified the wording of the inclusion criteria to allow studies where predictors/exposures are examined in relation to later or existing PG/GD. We have refined and structured the outcomes into a clear hierarchy, with PG/GD as the primary outcome, and gambling-related behaviours, including gambling frequency and gambling participation, as the secondary outcome. We have clarified the inclusion of both longitudinal and cross-sectional/case-control evidence and how cross-sectional evidence will be treated as correlational rather than predictive. We have expanded the description of the synthesis approach. Where feasible, a meta-analysis will be conducted, otherwise, a structured narrative synthesis will be undertaken. explained how meta-analysis will be conducted and if not feasible, narrative synthesis will take place. We have also further clarified the 18-25 age range inclusion and clarified procedures for grey literature searched.
Dear Professor Browne,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have clarified the wording of the inclusion criteria to allow studies where predictors/exposures are examined in relation to later or existing PG/GD. We have refined and structured the outcomes into a clear hierarchy, with PG/GD as the primary outcome, and gambling-related behaviours, including gambling frequency and gambling participation, as the secondary outcome. We have clarified the inclusion of both longitudinal and cross-sectional/case-control evidence and how cross-sectional evidence will be treated as correlational rather than predictive. We have expanded the description of the synthesis approach. Where feasible, a meta-analysis will be conducted, otherwise, a structured narrative synthesis will be undertaken. explained how meta-analysis will be conducted and if not feasible, narrative synthesis will take place. We have also further clarified the 18-25 age range inclusion and clarified procedures for grey literature searched.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 16 Apr 2026

Lucija Banozic, Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, D09 V209, Ireland

16 Apr 2026

Author Response

Dear Professor Browne,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. ... Continue reading Dear Professor Browne,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have clarified the wording of the inclusion criteria to allow studies where predictors/exposures are examined in relation to later or existing PG/GD. We have refined and structured the outcomes into a clear hierarchy, with PG/GD as the primary outcome, and gambling-related behaviours, including gambling frequency and gambling participation, as the secondary outcome. We have clarified the inclusion of both longitudinal and cross-sectional/case-control evidence and how cross-sectional evidence will be treated as correlational rather than predictive. We have expanded the description of the synthesis approach. Where feasible, a meta-analysis will be conducted, otherwise, a structured narrative synthesis will be undertaken. explained how meta-analysis will be conducted and if not feasible, narrative synthesis will take place. We have also further clarified the 18-25 age range inclusion and clarified procedures for grey literature searched.
Dear Professor Browne,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have clarified the wording of the inclusion criteria to allow studies where predictors/exposures are examined in relation to later or existing PG/GD. We have refined and structured the outcomes into a clear hierarchy, with PG/GD as the primary outcome, and gambling-related behaviours, including gambling frequency and gambling participation, as the secondary outcome. We have clarified the inclusion of both longitudinal and cross-sectional/case-control evidence and how cross-sectional evidence will be treated as correlational rather than predictive. We have expanded the description of the synthesis approach. Where feasible, a meta-analysis will be conducted, otherwise, a structured narrative synthesis will be undertaken. explained how meta-analysis will be conducted and if not feasible, narrative synthesis will take place. We have also further clarified the 18-25 age range inclusion and clarified procedures for grey literature searched.
Competing Interests: No competing interests were disclosed. Close
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Version 2

VERSION 2 PUBLISHED 20 Feb 2026

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	1	2
Version 2 (revision) 16 Apr 26	read
Version 1 20 Feb 26	read	read

Matthew Browne, CQ University, Bundaberg, Australia
Elvira Bolat, Bournemouth University, Poole, UK

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4 Views

08 May 2026 | for Version 2

Matthew Browne, CQ University, Bundaberg, Australia

4 Views Cite this report Responses(0)

Approved

The authors have responded in detail to all of the issues I have raised, and they've tightened up the protocol significantly. I have no issues with approving this now and wish them all the best with their project.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Gambling studies, statistical modelling.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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9 Views

26 Mar 2026 | for Version 1

Elvira Bolat, Bournemouth University, Poole, UK

9 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Gambling and marketing

Respond to this report

Responses (1)

Author Response

16 Apr 2026

Lucija Banozic, Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, D09 V209, Ireland

Dear Dr. Bolat,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have revised the inclusion criteria to allow studies examining predictors and exposures related to both future or concurrent PG/GD, and have provided further clarification on how the age-band rule will be applied. We have refined the outcomes by establishing a clear hierarchy of primary and secondary outcomes. We now explicitly specify the type of studies that will be included and have replaced causal language with neutral terminology. The protocol now also clearly outlines how the data synthesis will be conducted, including meta-analysis, narrative synthesis, statistical approach and assessment of evidence certainty.

We have also addressed the minor comments and clarified the treatment of grey literature and the rationale for the1990 cut-off, as well as improved the terminology and language in Introduction and Discussion.

View more View less

Competing Interests

No competing interests were disclosed.

Back to all reports

Reviewer Report

19 Views

17 Mar 2026 | for Version 1

Matthew Browne, CQ University, Bundaberg, Australia

19 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Gambling studies, statistical modelling.

Respond to this report

Responses (1)

Author Response

16 Apr 2026

Lucija Banozic, Dublin City University School of Nursing Psychotherapy and Community Health, Dublin, D09 V209, Ireland

Dear Professor Browne,
Thank you for your invaluable feedback on the protocol for our systematic review. We are appreciative of the time and effort afforded by you to this process. We are appreciative of your time and effort. Your expertise and constructive review have greatly contributed to the improvement of this protocol.

We have clarified the wording of the inclusion criteria to allow studies where predictors/exposures are examined in relation to later or existing PG/GD. We have refined and structured the outcomes into a clear hierarchy, with PG/GD as the primary outcome, and gambling-related behaviours, including gambling frequency and gambling participation, as the secondary outcome. We have clarified the inclusion of both longitudinal and cross-sectional/case-control evidence and how cross-sectional evidence will be treated as correlational rather than predictive. We have expanded the description of the synthesis approach. Where feasible, a meta-analysis will be conducted, otherwise, a structured narrative synthesis will be undertaken. explained how meta-analysis will be conducted and if not feasible, narrative synthesis will take place. We have also further clarified the 18-25 age range inclusion and clarified procedures for grey literature searched.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol

Abstract

Background

Methods

Discussion

Protocol registration number

Keywords

Introduction

Study aim and review question

Methods

Eligibility criteria

Types of studies

Search strategy

Study selection

Assessment of methodological quality

Data extraction

Risk of bias assessment

Data synthesis

Study status

Discussion

Dissemination

Data availability

Underlying data

Extended data

Acknowledgements

References

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Are you a HRB-funded researcher?

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Risk Factors Associated with Gambling in Young Adults: A Systematic Review Protocol

Abstract

Background

Methods

Discussion

Protocol registration number

Keywords

Introduction

Study aim and review question

Methods

Eligibility criteria

Types of studies

Search strategy

Study selection

Assessment of methodological quality

Data extraction

Risk of bias assessment

Data synthesis

Study status

Discussion

Dissemination

Data availability

Underlying data

Extended data

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

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Open Peer Review

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Reviewer Reports

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