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Background While it is a generally accepted fact that many gambling screening tools are not fit for purpose when employed as part of a public health framework, the evidence supporting this claim is sporadic. The aim of this review is to identify and evaluate the gambling screening tools currently in use and examine their utility as part of a public health approach to harm reduction, providing a holistic snapshot of the field. Methods A range of index tests measuring aspects of problem gambling were examined, including the South Oaks Gambling Screen (SOGS) and the Problem Gambling Severity Index (PGSI), among others. This review also examined a range of reference standards including the Diagnostic Interview for Gambling Severity (DIGS) and screening tools such as the SOGS. Results The present review supports the belief held by many within the gambling research community that there is a need for a paradigm shift in the way gambling harm is conceptualised and measured, to facilitate early identification and harm prevention. Discussion This review has identified a number of meaningful deficits regarding the overall quality of the psychometric testing employed when validating gambling screening tools. Primary among these was the lack of a consistent and reliable reference standard within many of the studies. Currently there are very few screening tools discussed in the literature that show good utility in the domain of public health, due to the focus on symptoms rather than risk factors. As such, these tools are generally ill-suited for identifying preclinical or low-risk gamblers.

Tilting is a poker-related phenomenon that involves cognitive and emotional dysregulation in response to unfavourable gambling outcomes. Tilting is characterised by an increase in irrational, impulsive and strategically weak betting decisions. This study aimed to adapt and investigate the concept of tilting amongst sport bettors in order to provide preliminary insight regarding previously unexplored instances of maladaptive sports betting. The sample consisted of 225 sports bettors who completed an online questionnaire that investigated their reported tilting episodes, awareness of tilting, impulsivity, perceived skill, gambling severity, gambling frequency, and product preferences. Cluster analyses revealed three distinct groups of sports bettors based on their reported tilting episodes and their awareness of this phenomenon. The first group were labelled ‘Conscious tilters’ due to being cognizant of their own tilting occurrence which was significantly higher than the other two groups. These ‘Conscious tilters’ had the highest mean problem gambling severity that was indicative of the ‘problem gambler’ categorisation. The second group were labelled ‘Unconscious tilters’ due to their underestimation of their own tilting occurrence and were categorised as ‘moderate risk gamblers’. The third group were labelled ‘Non-tilters’ due to a relatively accurate perception of their low to non-existent tilting occurrence and were categorised as ‘low-risk gamblers’. Additionally, there were significant differences between these groups in relation to reported gambling frequency, impulsivity, and product preferences. There is evidence of various classifications of ‘tilters’ within sports betting. Specific sports betting product features may also facilitate tilting and therefore require further research in this context. It is important for this research area to develop in order to mitigate harms associated with the rapidly changing sport betting environment.

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