Between city and screen: a lived experience-led campaign on the commercial drivers of gambling harm

Background

Young adults are increasingly exposed to commercially driven health risks across physical and digital domains. Gambling is a clear example, with innovation in marketing and product design generating a public health crisis, with young adults particularly vulnerable. This study examines how young adults engage with a lived experience (LE)-led, city-based digital campaign within a wider gambling harm reduction strategy.

Methods

The “If Only I Knew” campaign was developed by the LE-led organisation Chapter One, commissioned by a city council public health team in Northern England, and independently evaluated. This study draws on qualitative interviews with 16 young adult university students and 6 senior stakeholders following implementation in early 2026, alongside contextual social media metrics from the campaign. Young adults were prompted to reflect on their perceptions and potential impact, with data analysed thematically.

Results

Young adults described gambling as embedded across urban and digital domains. They perceived the campaign positively in this hybrid risk environment, particularly its focus on harmful industry practices, which enhanced credibility and potential for impact, including stigma reduction. Engagement was influenced by relatability: LE narratives and familiar city spaces anchored messages in everyday life. However, tensions existed between reach and depth across social media. Participants emphasised the need to tailor to different audiences and to enhance relatability further by engaging the political determinants of harm.

Conclusions

Public health responses must address the hybrid nature of risk, where commercial determinants operate across physical and digital domains. LE-led digital campaigns that integrate place-based relevance may enhance reach alongside interventions across education, treatment and policy. Cities can thus act as catalysts for aligning digital and physical strategies to counter commercially driven health harms.

Key messages

• Relatable lived experience stories of commercially driven harm are engaging for young adults, particularly when grounded by place-based imagery and recognisable settings

• Digital health messaging innovations have a role in gambling harm reduction but must be complemented by physical campaigns, along with interventions across treatment and policy