There is increasing public health concern about harmful gambling, but no consensus on effective policies and interventions to reduce risk and prevent harm has been reached. Focusing on policies and interventions (ie, measures), the aim of this study was to determine if expert consensus could be reached on measures perceived to be effective that could be implemented successfully. Our work involved a pre-registered, three-round, independent Delphi panel consensus study and an implementation rating exercise. A starting set of 103 universal and targeted measures, which were sourced from several key resources and inputs from public health stakeholders, were grouped into seven domains: price and taxation; availability; accessibility; marketing, advertising, promotion, and sponsorship; environment and technology; information and education; and treatment and support. Across three rounds, an independent panel of 35 experts individually completed online questionnaires to rank each measure for known or potential effectiveness. A consensus was reached if at least 70% of the panel judged a measure to be either not effective, moderately effective, or highly effective. Then, each measure that reached a consensus for effectiveness was evaluated on four implementation dimensions: practicability, affordability, side-effects, and equity. A summative threshold criterion was used to select a final optimal set of measures for England. The panel reached consensus on 83 (81%) of 103 measures. Two measures were judged as ineffective by the panel. The remaining 81 effective measures were drawn from all domains (14 of 15 measures in the the marketing, advertising, promotion, and sponsorship domain were judged as effective, whereas five of ten measures in the information and education domain were judged as effective). During the evaluation exercise, the 81 measures were assessed for likelihood of implementation success. This assessment considered the practicality, affordability, ability to generate unanticipated side-effects, and ability to decrease differences between advantaged and disadvantaged groups in society of each measure. We identified 40 universal and targeted measures to tackle harmful gambling (three measures from the price and taxation domain; ten from the availability domain; five from the accessibility domain; six from the marketing, advertising, promotion, and sponsorship domain; eight from the environment and technology domain; three from the information and education domain; and five from the treatment and support domain). Implementation of these measures in England could substantially strengthen regulatory controls while providing new resources. The findings of our work offer a blueprint for a public health approach to preventing harms related to gambling.

公众对有害赌博的担忧日益增加，但尚未就降低风险和预防伤害的有效政策和干预措施达成共识。本研究侧重于政策和干预措施（即措施），旨在确定是否可以就被认为有效的措施达成专家共识，这些措施可以成功实施。我们的工作涉及预先注册的三轮独立德尔福小组共识研究和实施评级活动。一组 103 项通用和有针对性的措施的起始集来自公共卫生利益相关者的几个关键资源和投入，分为七个领域：价格和税收；可用性; 可访问性；营销、广告、促销和赞助；环境和技术；信息和教育；以及治疗和支持。在三轮中，一个由 35 名专家组成的独立小组分别完成了在线问卷调查，以对每个措施的已知或潜在有效性进行排名。如果至少 70% 的专家组认为某项措施无效、中等有效或高度有效，则达成共识。然后，在四个实施维度上对达成共识的每项措施进行评估：实用性、可负担性、副作用和公平性。总结性阈值标准用于为英格兰选择一组最终的最佳测量值。专家组就 103 项措施中的 83 项（81%）达成共识。有两项措施被专家组判定为无效。其余 81 项有效措施来自所有领域（15 项措施中的 14 项在营销、广告、促销、和赞助领域被判定为有效，而信息和教育领域的十项措施中有五项被判定为有效）。在评估过程中，评估了 81 项措施实施成功的可能性。该评估考虑了每项措施的实用性、可负担性、产生意想不到的副作用的能力以及减少社会中有利和不利群体之间差异的能力。我们确定了 40 项针对有害赌博的通用和有针对性的措施（三项来自价格和税收领域；十项来自可用性领域；五项来自可访问领域；六项来自营销、广告、促销和赞助领域；八项来自环境和技术领域；三个来自信息和教育领域；和五个来自治疗和支持领域）。在英格兰实施这些措施可以在提供新资源的同时大大加强监管控制。我们的工作结果为预防与赌博相关的危害的公共卫生方法提供了蓝图。