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New NCPG research shows most Americans gambled underage while healthcare screening for gambling remains virtually non-existent despite widespread public concern.
Mar 9, 2026 · 7 min read
A comprehensive national survey has revealed that nearly two-thirds of American adults participated in gambling activities before reaching legal age, while healthcare providers remain largely absent from identifying at-risk behaviors. The findings underscore growing concerns about youth exposure to gambling as digital platforms expand accessibility.
The research, conducted by The Harris Poll on behalf of the National Council on Problem Gambling (NCPG), surveyed 2,072 adults nationwide and found that 65% of adults aged 21 and older report gambling before their 21st birthday. Despite this widespread early exposure, only 15% of adults have ever been asked about their gambling behavior by a primary care provider.
The survey identified distinct patterns in early gambling participation, with lottery products leading the way. Among adults who gambled before age 21:
Generational differences emerged particularly around sports betting and online casino participation. Among 21-44 year olds, 33% placed sports bets before age 21, compared to just 11% of adults over 55. This disparity reflects the rapid expansion of digital gambling platforms in recent years.
"Youth are at significantly greater risk for developing gambling problems, and as gambling becomes increasingly normalized in media, sports, and online spaces, the risks grow. Prevention and education are essential to ensure young people, families, educators, and policymakers understand the potential harms and are protected from early exposure."
— Heather L. Maurer, MA, CAE, Executive Director of NCPG
| Gambling Activity | Percentage Before Age 21 |
|---|---|
| Lottery/scratch-off tickets | 40% |
| Home games for money | 37% |
| Sports betting | 23% |
| Online casino-style games | 21% |
| Fantasy sports | 16% |
65%
Adults who gambled before age 21
15%
Adults asked about gambling by healthcare providers
40%
Played lottery/scratch-offs before 21
37%
Participated in home games for money
33%
Adults 21-44 who bet on sports before 21
11%
Adults 55+ who bet on sports before 21
The research revealed substantial public awareness of gambling addiction as a serious health issue. 79% of Americans consider gambling addiction as serious as or more serious than alcohol or drug addiction, with 30% viewing it as more serious than other addictions.
This recognition extends to concerns about youth exposure. 66% of Americans express concern about underage exposure to gambling or gambling-like activities, including sports betting advertisements, online games with betting elements, and loot boxes. Concern reaches 71% among households with children under 18, compared to 62% among those without minors.
The survey was released during Problem Gambling Awareness Month in March 2026, coinciding with NCPG's recent success in securing federal research funding for gambling addiction studies, particularly focusing on impacts on veterans and service members.
Public Health Impact
79% of Americans consider gambling addiction as serious as or more serious than alcohol or drug addiction, with 30% viewing it as more serious than other addictions. This recognition is driving increased awareness of the need for prevention and early intervention programs.
When presented with descriptions of prediction markets, 30% of Americans characterized them as most similar to gambling – the most common response. This compared to 24% who viewed them as financial forecasting and 18% as investing.
The findings prompted the National Council on Problem Gambling's Board of Directors to issue a resolution calling for prediction markets to promote the organization's National Problem Gambling Helpline (1-800-MY-RESET) as a recovery resource.
"We need consistent consumer safeguards across emerging products like prediction markets, which are functionally gambling platforms. If they involve financial stakes, uncertain outcomes, and repeated participation, we must consider the public health implications and ensure appropriate, consistent protections are in place."
— Cole Wogoman, NCPG's Director of Government Relations and League Partnerships
Warning
With 30% of Americans viewing prediction markets as most similar to gambling, these platforms may face increased regulatory scrutiny and gambling-specific consumer protection requirements. Operators should prepare for potential compliance obligations similar to traditional gambling platforms.
The survey highlighted a significant disconnect between gambling participation rates and medical intervention. While routine screening for alcohol and tobacco use is standard in healthcare settings, gambling behavior assessment remains virtually absent from medical practice.
"This represents a significant missed opportunity for early identification and intervention. Gambling-related harm is often invisible until it becomes severe. Screening in healthcare settings can help normalize conversations and connect people to support earlier."
— Heather L. Maurer, MA, CAE, Executive Director of NCPG
The research methodology involved online surveys conducted February 19-23, 2026, among 2,072 adults ages 18 and older, with 1,975 participants aged 21 and older. The Harris Poll data carries a sampling precision of ±2.7 percentage points at a 95% confidence level.
The survey did not distinguish between states where certain gambling forms are legal at 18 versus those restricted to age 21, nor between participation with regulated versus unregulated operators.
Important
Gambling Disorder Screening Day is scheduled for March 10, 2026. Free self-assessments are available at NCPGambling.org/assessment.
Screening Opportunity
The absence of gambling behavior screening in healthcare settings represents a critical gap in early intervention. Unlike routine alcohol and tobacco screening, gambling-related harm often remains invisible until it becomes severe, making medical screening essential for early identification.
These findings present significant challenges for gambling operators and regulators as they navigate expanding market access while protecting vulnerable populations. The data suggests that current age verification systems may be insufficient to prevent underage participation, particularly in digital environments where verification can be circumvented.
The healthcare screening gap represents both a risk and an opportunity for the industry. While increased medical screening could identify problem gambling earlier, it also signals potential regulatory attention on gambling as a public health issue. Operators may need to anticipate enhanced compliance requirements around youth protection and problem gambling identification as public awareness grows.
The strong public perception linking prediction markets to gambling could influence regulatory approaches to these emerging platforms, potentially subjecting them to gambling-specific consumer protections and oversight.ght frameworks.
Industry Preparation
Gambling operators should anticipate enhanced compliance requirements around youth protection and problem gambling identification as public awareness grows. Current age verification systems may need strengthening, particularly in digital environments where verification can be circumvented.
According to the national survey, 65% of adults aged 21 and older report gambling before their 21st birthday. This widespread early exposure highlights the accessibility of gambling activities to minors despite age restrictions.
Only 15% of adults have ever been asked about their gambling behavior by a primary care provider. This represents a significant gap compared to routine screening for alcohol and tobacco use in healthcare settings.
Among adults who gambled before age 21, lottery or scratch-off tickets were most common at 40%, followed by home games with friends or family for money at 37%. Sports betting was particularly prevalent among younger generations at 33% for those aged 21-44.
79% of Americans consider gambling addiction as serious as or more serious than alcohol or drug addiction. 30% specifically view it as more serious than other addictions, indicating strong public recognition of gambling-related harm.
30% of Americans characterize prediction markets as most similar to gambling, the most common response in the survey. This perception has led to calls for prediction markets to provide problem gambling resources and implement consistent consumer safeguards.
According to National Council on Problem Gambling.
The National Council on Problem Gambling welcomes the first federal research funding for gambling addiction studies through a Defense Department program.
NCPG's board resolution calls for prediction market operators to prominently display problem gambling helpline information, comparing platform risks to sports betting.
The Responsible Gambling Council launches comprehensive parent resources to combat rising underage sports betting ahead of Super Bowl Sunday.
Betr expands into prediction markets through Polymarket partnership.
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