Is Online Gambling RI’s Next Pediatric Public Health Threat?

In the eight years since Murphy v NCAA delivered a resounding victory for the digital gambling industry, have sufficient safeguards been implemented so as to adequately hinder underage access to and gambling via online platforms? And should the advertising for these platforms on streaming video services be more stringently regulated so as to approximate the norm expected of the Bally’s corporation when they purchase airtime from traditional television broadcast stations in local New England markets?

According to a February 2025 study published in the Journal of the American Medical Association’s Internal Medicine publication (vol 185, no 4, doi:10.1001/jamainternmed.2024.8193), sports-associated gambling addiction has increased significantly since the Supreme Court legalized internet sports betting. Sports betting wagers have increased dramatically from $4.9 billion in 2017 to $121.1 billion in 2023. In another article published by the UK’s Health Promotion International journal (2023 Mar 18;38(2):daac194. doi: 10.1093/heapro/daac194), the authors emphasize that the tactics utilized by the online gambling industry resemble earlier predatory advertising habits of the alcohol and tobacco companies.

Are we sitting on the precipice of a larger consumer safety and public health crisis that is being artificially induced by the various interests seeking profit from internet gambling and advertising that can illegally appeal to underage players?

My own interest in this matter came from personal experience. Recently I have been reviewing multiple seasons of an HBO program with family members. After watching more than ten episodes of the show, it becomes hard to ignore that an online gambling advertisement, in one form or another, was perhaps the most frequently broadcast item on the HBO Max streaming video platform. How is it legal for streaming video services to hold such low industrial standards of decency in terms of broadcast advertising? What particularly raised alarm was the cartoonish nature of the products being advertised; unlike typical sports book betting apps, these advertisements featured gambling apps with a user interface that would easily appeal to a child.

This could rapidly metastasize, like the opioid crisis in the past 25 years.

Or, with proper intervention, it could be proactively arrested, as occurred when the Rhode Island General Assembly adopted stricter vendor regulations governing the active ingredient in crystal methamphetamine known as pseudoephedrine, a chemical just coincidentally found in popular over-the-counter (OTC) antihistamine medications like Sudafed. While other states saw a massive uptick in crystal meth drug prosecutions and overdoses during the past two decades, Rhode Island emerged relatively unscathed from the meth epidemic. This was because, very early on, before it even registered as a local crime and health issue, the legislature, the pharmacies, and many traditional businesses like gas stations or groceries collaborated to proactively safeguard products on their shelves containing the pseudoephedrine chemical. In some cases, the vendors opted to cease sales of pseudoephedrine products altogether. In other instances, such as CVS/Caremark, these OTC products are now stored behind the counter and sold with safeguards resembling those used for alcohol or tobacco, including requisite presentation of legal identification. The identification card, furthermore, is scanned and recorded by the register attendant into an online electronic database accessible to all other local pharmacies as well as law enforcement. This in turn results in the creation of a ‘red flagging’ database function. If a single identification card is scanned so many times or more so as to purchase the substance, the database will release an automated alert to the proper authorities advising them of the occurrence, which in turn can be used by the police as reasonable cause to believe that someone seeks to construct an illegal meth lab.

This is a matter of mental health on a scale equivalent to any other addictive substance or service entering a mass consumer market, be it legal or otherwise. Internet gambling has grown into a new subgenre of video gaming and stands to see its market share of the overall online gaming industry expand exponentially as technology enables further development. For instance, as the major Silicon Valley firms continue pursuing immersive three-dimensional headset technology simulating real-time settings, what is to prevent them from eventually creating a fully-immersive 3-D casino setting that allows friends to play an intimate game of cards despite the physical expanse of thousands of miles? What used to sound like a scenario predicted by The Matrix is rapidly becoming a reality.

A brief word on technology and its impact on gamblers is warranted. We have a conclusive data set related to several phenomena that merit consideration.

First is the occurrence of various mental health habits that simply did not exist prior to the development of the smartphone and social media platforms. Psychologists today are documenting all varieties of ailments tied to the increase in screen-time and the content contained on those screens. Pediatric health literature reflects an increase in bullying and other forms of harassment stimulated by social media. Words like “doom-scrolling” are now discussed in the popular press as growing mental health concerns, diagnoses that simply did not exist prior to the invention of this technology.

Second is the growth in digital disinformation promoted by organizations like Alex Jones’s InfoWars, Breitbart, and other conservative/right wing media outlets lacking scruples about veracity of facts. Thousands of people unnecessarily died during the COVID-19 Pandemic because of disinformation about vaccines, a perfect real-time case study of how deeply medical skepticism reaches into our society. In the Black community, similar scrutiny, for altogether warranted reasons linked with legacies such as the Tuskegee human experimentation crimes, results in much higher rates of Black infants lacking adequate pediatric inoculations. Various forms of medical disinformation have currency in the public sphere, as is shown in the demonstrable lies proffered by so-called “Crisis Pregnancy Centers” operated by the Roman Catholic Church. All instances find free rein without hindrance on advertising platforms such as Facebook, or they do until the corporation is publicly shamed into breaking their relationship with an Advertising Client like Alex Jones.

This dimension of their identity, as advertising clients pursuing commerce on a platform selling such services in a fashion akin to a traditional advertising agency, namely Facebook, should impose a mandate of corporate responsibility regarding consumer protections that are currently abrogated by the company’s conduct. Statistics show that the majority of web browsing time today is spent on social media, with the people using Facebook or X/Twitter as their most frequent tool for referral to third party websites and content like journalism and news reporting. The major corporate news broadcasters, including both Fox News and CNN, all advertise on these platforms.

As an advertising agency, Facebook’s corporate conduct has been abhorrent in terms of protections expected to be upheld regarding content youths can be exposed to. Facebook has millions of accounts for young people people across America. It is therefore a normative expectation that an advertising agency abide by existing regulatory norms regarding predatory marketing, promotion of unhealthy habits like smoking or gambling, pornography, or material inciting violence, in part, so as to shield their underage account holders from deleterious content causing harm to this most vulnerable class of consumers. In total frankness, it is hard to determine the difference between the conduct of these various web advertisers and the Winston cigarette company when they collaborated with Hanna-Barbera to generate a tobacco ad starring Fred Flintstone.

Third is the fundamental question of technology and its impact upon our neuro-psychology. The medical profession is confronting symptoms and phenomena that did not occur before the smartphone was invented. How does the screen negatively impact the formation of young brains and emotional cortices? We know that the Meta Corporation conducted and then spiked an internal investigation that showed Instagram had caused female youth users to develop a disproportionate level of body image-related health disorders. These technologies, in other words, are presenting us with questions that cut to the heart of government’s role in consumer protection. Is it safe to allow a youth unregulated access to a digital communications device that requires underwriting by a credit card? Or is it time for a regulatory oversight and audit looking into deeper questions presented by such phenomena? Is it time to acknowledge that smartphones grant all users access to restricted content in a manner suggesting it is inappropriate to make such a device accessible to a youth? Should youths be limited in terms of cellular telecommunications access to older technologies like flip phones until phone manufacturers create a device demonstrating adequate compliance with existing consumer youth protections? Is it incumbent upon the regulatory authorities to compel the smartphone manufacturers to produce a “youth-safe” device that grants parents/guardians greater oversight and control over the content seen by their youths?

The various fiscal interests underwriting these new gaming platforms, from the financiers underwriting the internet casino treasury to the individual gambling app developers to advertisers and finally the broadcasters that host these advertising segments intentionally appealing to underage audiences, are positioned to profit mightily. These gains will accrue from the financial hardship and anguish wrought by juvenile gambling addiction unless proactive legislative intervention is taken so as to create precautionary measures that prevent illegal underage gambling via these internet platforms.

As just a personal experiment, I used my own iPhone to download and activate an account with the casino and slots machine game Cashman Casino Slots Games in a matter of two minutes. There were no safeguards required for admission to the online game in spite of legal norms that require presentation of a state identification card for access to tobacco or alcohol products, not to mention entrance to a physical casino. All I did was click a button labelled “Log In with Facebook” to streamline the on-boarding process and gain admission to the platform.

The Supreme Court ruled that states could regulate these newly-authorized and created online gambling venues. Justice Alito wrote in the majority decision for Murphy “Congress can regulate sports gambling directly, but if it elects not to do so, each state is free to act on its own. Our job is to interpret the law Congress has enacted and decide whether it is consistent with the Constitution.” The habits of the Court in terms of “Originalism” and, more obviously, states rights, dictate the possibility of a novel victory for progressives. Could the Court’s restraint upon federal legislation entitle the General Assembly to greater leeway with regards to regulatory oversight and consumer protections? Could a bill, properly worded so as to balance proactive consumer protection alongside adequate regulatory oversight and enforcement regarding illegal underage gambling, effectively sail through the Legislature and onto the Governor’s desk as we head into the Democratic Primary? There is little to be lost in terms of a popularity contest with the gambling industry in Rhode Island politics because the casinos have been little more than a nuisance requiring semi-regular bailouts from the state government and/or private investors, such as the current operator Bally’s. Gaming was one of many attempts to reorient the Ocean State’s economy towards a more resilient service sector mimicking Las Vegas or Orlando. But this, along with many other projects, failed to revive the economy for numerous reasons too complex to describe herein.

There is nothing hindering the Rhode Island General Assembly from therefore intervening so as to establish benchmarks for consumer protection that the gambling interests should be compelled to comply with. I have observed that these interests have begun exploiting local television advertising opportunities on under-regulated video streaming platforms like YouTube or HBO Max in a manner that frankly reminds me of the old Joe Camel cigarette campaign, which likewise was targeted towards youths who were being encouraged to use a dangerous product at a future date before they had adequate comprehension of the health risks.

The undeniably crude and juvenile approach of the advertisements that I have seen makes it hard to deny that there is a targeted aspect to it all. The internet should not provide an under-regulated sector of the economy with the opportunity to engage with altogether unscrupulous and dangerous advertising and marketing practices that harm underage consumers on these various platforms. The risks associated with these products are significant, including but not limited to the possibility of a youth incurring monetary debts outside supervision or knowledge of a parent or guardian who would later be compelled to fulfill these obligations.

As a practical set of policy solutions, the General Assembly should collaborate with the various State gaming authorities to create a set of “bare-minimum” expectations for web-based platforms hosting games of chance. This should include providing a photographic identification document scan for age validation, something already mandated by multiple web platforms and apps such as Facebook, PayPal, ride-share apps like Uber, and Zipcar.

Why do these popular phone apps require the user scan their State ID or Passport in order to engage in everyday commerce with their respective companies but these digital Casinos are not held to the same standard of expectation?

Why is it possible for a middle school student to gain unhindered access to the Cashman Casino app in a manner that potentially risks exposing the primary phone account holder, the parent/guardian, to betting debt obligations unwittingly created by the youth on these platforms?

Why did I have to go through more hoops and legal document presentations to create an Advertising Account on Facebook than I did when I created a Gambler’s account on an iPhone app that was capable of accruing real money debts?

I hope I am not the only one who grasps the harms this lack of regulatory oversight present to youth consumers that should not, under any circumstances, be encouraged via television advertising to engage in the initial symptoms of problem gambling syndrome. The advertiser encouragement of addictive behavior via youth-targeted broadcasting is a long and storied history that included class action tort law rulings against the tobacco industry for ads targeting youth consumers. This is the benchmark to strive for in terms of regulatory oversight.

The nuances of the advertising campaign have to be specifically understood in order to adequately address whatever protests that parties may raise under First Amendment protections for advertisements.

The games are designed and presented as free initially. I logged onto the app and was given an initial award of 1,000,000 “points” for use in the various games on the platform. While the game programmers might argue that this should delimit their liability, do not be deceived; these introductory “points” simply operate in the same way as if the casino had handed the player a one-time-only bucket of free chips to use for playing on the gaming floor of their physical casino. Furthermore, it is undeniable that the players are encouraged by ads to purchase more “points”/chips from the casino when their personal treasury runs low. They can also cash out their “points”/chips for monetary prizes, thereby fulfilling a reasonable definition of an advertisement for gambling on a broadcasting platform. It therefore stands to reason that this under-regulated sphere of advertising requires state intervention according to the portfolios of gaming regulators.

The most horrific scenario possible to stem from this set of circumstances would be the growth of a local juvenile problem gambling addiction. The social expenses in terms of Medicaid expenditure for behavioral health services, ruined households, and even the assignment of immense gambling debts to unsuspecting parents resulting in personal bankruptcy are tremendous. The predatory nature of the entire online gambling industry, from top to bottom, requires a significant amount of state intervention under pre-existing and readily-available statutes of regulation governing both gambling and local-level advertising that govern acceptable content produced by the Bally’s corporation for broadcast.

This is not an argument to erode the ability of age-legal gamblers to access games of chance. Instead, it is a plea to proactively update the existing regulatory apparatus to better reflect 21st century technological advances and innovations that enable novel methods of placing bets in a way encouraging an illegal activity, underaged gambling in Rhode Island. Foregrounding emphasis on crime prevention should provide meaningful inspiration to the various gaming interests that stand to profit from the internet gambling industry, which would continue to steam ahead forcefully and profitably with or without such regulation. In this sense, it is worthwhile to emphasize, in closing, that I suspect illegal activity involving minors could possibly have already occurred and that there already exists a cohort of youth gamblers in Rhode Island who might develop habits of problem gambling. Consider this passage from a journal published by the American Academy of Pediatrics (Pediatrics (2026) 157 (3): e2025073040.):

“Teens are thought to be at a higher risk of gambling disorders because of their high online engagement in the midst of ongoing brain development, with teens possessing weaker impulse inhibition and more propensity for pleasure-seeking and risk-taking behaviors rather than thoughts about future consequences. In the United States, clinicians have voiced concerns about the number of teens reporting that they have a sports betting app on their phone.”

It is therefore worthwhile to consider this as a measure of proactive public health protection.

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