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Importance: The US Supreme Court decision Murphy v National Collegiate Athletic Association allowed states beyond Nevada to legalize sports betting, including online wagers. How sports betting has evolved and its association with gambling harms has not been studied.
Objective: To describe how US sports betting evolved after Murphy v National Collegiate Athletic Association and offer insights into the potential health effects of sportsbooks, which are platforms for wagering on sporting events.
Exposure: Enactment of (1) Murphy v National Collegiate Athletic Association nationally and (2) the opening of retail or online sportsbooks in states.
Design, setting, and participants: In this longitudinal study, aggregate US internet search trends for gambling addiction and wagers on sports were described before and after the emergence of legalized sportsbooks.
Main outcomes and measures: Internet searches per 10 million queries that mentioned gambling and addiction, addict, anonymous, or hotline (such as gambling addiction hotline) made to Google from January 1, 2016, through June 30, 2024.
Results: The number of states with operational sportsbooks increased from 1 during 2017 to 38 during 2024. Total sports wagers increased from $4.9 billion during 2017 to $121.1 billion during 2023, with 94% of wagers during 2023 being placed online. There were 23% (95% CI, 15%-30%) more searches nationally for gambling addiction help-seeking after Murphy v National Collegiate Athletic Association. Massachusetts (47%; 95% CI, 21%-79%), New Jersey (34%; 95% CI, 21%-45%), New York (37%; 95% CI, 26%-50%), and Pennsylvania (50%; 95% CI, 35%-66%) each had more searches than expected after the opening of any sportsbooks in their state. Additional analyses suggest the opening of online, vs retail, sportsbooks corresponded with a larger increase in searches.
Conclusions and relevance: The results of this time series study suggest that access to sportsbooks, sports wagers, and potential help-seeking for gambling addiction increased substantially and highlight the need to address the health implications of sportsbooks, including recognition and treatment of gambling problems and their broader societal implications.
Leddy, John J., Haider, Mohammad N., Ellis, Michael J., Mannix, Rebekah, Darling, Scott R., Freitas, Michael S., Suffoletto, Heidi N., Leiter, Jeff, Cordingley, Dean M., Willer, Barry
Sport-related concussion (SRC) is a significant public health problem without an effective treatment.
OBJECTIVE:
To assess the effectiveness of subsymptom threshold aerobic exercise vs a placebo-like stretching program prescribed to adolescents in the acute phase of recovery from SRC.
DESIGN, SETTING, AND PARTICIPANTS:
This multicenter prospective randomized clinical trialwas conducted at university concussion centers. Male and female adolescent athletes (age 13-18 years) presenting within 10 days of SRC were randomly assigned to aerobic exercise or a placebo-like stretching regimen.
INTERVENTIONS:
After systematic determination of treadmill exercise tolerance on the first visit, participants were randomly assigned to a progressive subsymptom threshold aerobicexercise or a progressive placebo-like stretching program (that would not substantially elevate heart rate). Both forms of exercise were performed approximately 20 minutes per day, and participants reported daily symptoms and compliance with exercise prescription via a website.
MAIN OUTCOMES AND MEASURES:
Days from injury to recovery; recovery was defined as being asymptomatic, having recovery confirmed through an assessment by a physician blinded to treatment group, and returning to normal exercise tolerance on treadmill testing. Participants were also classified as having normal (<30 days) or delayed (≥30 days) recovery.
RESULTS:
A total of 103 participants were included (aerobic exercise: n = 52; 24 female [46%]; stretching, n = 51; 24 female [47%]). Participants in the aerobic exercise group were seen a mean (SD) of 4.9 (2.2) days after the SRC, and those in the stretching group were seen a mean (SD) of 4.8 (2.4) days after the SRC. There were no differences in age, sex, previous concussions, time from injury, initial symptom severity score, or initial exercise treadmill test and physical examination results. Aerobic exercise participants recovered in a median of 13 (interquartile range [IQR], 10-18.5) days, whereas stretching participants recovered in 17 (IQR, 13-23) days (P = .009 by Mann-Whitney test). There was a nonsignificant lower incidence of delayed recovery in the aerobic exercise group (2 participants [4%] in the aerobic group vs 7 [14%] in the placebo group; P = .08).
CONCLUSIONS AND RELEVANCE:
This is, to our knowledge, the first RCT to show that individualized subsymptom threshold aerobic exercise treatment prescribed to adolescents with concussion symptoms during the first week after SRC speeds recovery and may reduce the incidence of delayed recovery.
