Effects of the nursing practice environment, slow nursing, and living a calling on geriatric nursing stress among general hospital nurses in South Korea: a cross-sectional descriptive study.

Public health researchers are increasingly recognizing gambling as a significant public health concern (). Scholars have begun expressing concern about the rapid expansion of legalized gambling avenues across the United States ([U.S.]; e.g., sports betting, online casinos), as these are associated with adverse health consequences, including gambling disorder (GD) (, ). GD is an addictive disorder characterized by a persistent pattern of gambling that leads to distress and impairment, whereas problem gambling (PG) is a broader term for harmful gambling behaviors that do not necessarily meet the diagnostic threshold for GD. Although some policies exist to address gambling problems, they generally lack a structural public health framework, and tend to focus disproportionately on individual pathology (). Other scholars have questioned industry involvement in gambling policy and research, warning that their presence may normalize gambling, minimize harm, and exploit vulnerable populations (). In the U.S., the 12-month prevalence of GD is estimated at 0.2–0.3% (), though rates vary widely across different populations. Recent research efforts have identified a multitude of populations at risk for PG, including men, youth, disadvantaged socioeconomic groups, individuals with marginalized identities, individuals with co-occurring mental health conditions, and individuals with a family history of gambling problems (). Research shows that U.S. military populations (i.e., service members and veterans) are uniquely vulnerable to PG and experience disproportionately more gambling-related consequences (). Research suggests a higher prevalence of PG among veterans in both the U.S. and United Kingdom (UK) compared to civilians (, ), with some evidence indicating that female veterans may be particularly vulnerable (, ). Service members and veterans with PG face high rates of psychiatric comorbidity, including substance use disorders, mood disorders, personality disorders, and posttraumatic stress disorder (, , , ). Additionally, PG may be a unique risk factor for suicide in veterans worldwide, as GD appears to predict suicidality, and veterans with GD often report having attempted suicide at some point in their life (). Despite these disparities, little is known about how structural and organizational elements affect military communities. Military personnel and veterans face unique internal and structural barriers to engaging in mental health treatment, such as inaccessibility (), financial and transportation difficulties (), and inadequate provision of care (, ). Qualitative studies have highlighted that treatment-related stigma and the normalization of gambling remain central barriers to help-seeking among service members and veterans (, ). For example, a study of UK Armed Forces personnel identified secrecy surrounding gambling, fear of reputational damage, and reluctance to disclose concerns as major barriers to early identification and help-seeking (). Participants also reported dissatisfaction with available treatments and emphasized the importance of informal, peer, and anonymous support. Suggested solutions included early screening, educational courses, and mandatory training. However, the study was limited by its focus on mostly participants with low or recovered PG symptoms, raising concerns about representativeness and its ability to capture the perspectives of those actively struggling with GD.