History has demonstrated that new threats to the health of our communities are continually emerging, often from unexpected sources. I was first made aware of this new danger to the public’s health while having dinner with some young health policy colleagues in Washington, DC. Our casual conversation veered into a serious problem these two women had noticed among their male friends. They had been swept up in a serious and disruptive fixation that threatened their financial security and undermined their personal relationships: sports betting. Prior to this conversation, I had no awareness of what a serious challenge this had become. We have all witnessed the rapid rise of sports better apps on our phones along with the rapid growth of sports betting revenue in recent years. In 2018 the U.S. Supreme Court nullified the Professional and Amateur Sports Protection Act, a law that placed strict restrictions on sports gambling. Since that time a majority of states (30) have succumbed to industry pressure and now permit widespread sports betting from the palm of your hand. Gambling can be a highly addictive activity even when not technically pathological. Furthermore, it can be detrimental to the wellbeing of young adults who are trying to establish a firm financial foundation.

Sports betting has become extremely common in young adults, especially males. An astounding 58% of 18–22-year-old participants in a 2023 survey have engaged in sports betting.1 Young men are especially at risk for problem gambling behaviors, with 45% 18-30 years of age demonstrating at least one problematic gambling behavior.2 Sports gambling among young adults is not a uniquely American problem. A shocking 17% of male British college students have resorted to student loans to cover gambling debts.3

Prior to 2018, only one state had a legal sports book operation. By 2024, that number had increased to 38. Total sports wagers have skyrocketed, increasing from $4.9 billion during 2017 to $121.1 billion in 2023. A recent publication in JAMA Internal Medicine documented a 23% increase in internet searches for gambling addiction that was tightly associated with the explosion of sports betting, especially those placed electronically.4 It is important to acknowledge that profits generated by sports betting companies are derived from people that might better invest those dollars elsewhere.

Problem gambling is a serious health issue that can undermine financial security and lead to serious mental health issues. We are charging headlong into a massive expansion of online gambling that now includes prediction markets. These allow bets to be placed on a diverse range of future events, from the outcomes of political elections or what Bad Bunny would wear during his Super Bowl performance. There are clear analogies to other public health challenges, such as the persistence of tobacco abuse or the deadly prescription opioid crisis. Mississippi has not yet passed legislation that would allow sports gambling apps. There is clearly industry pressure to add Mississippi to the list, and several bills have been submitted in recent years. In anticipation of ongoing legislative efforts, we must recognize the massive expansion of online gambling as an emerging public health issue of great urgency, one which public health agencies, policy makers, and the medical community should place under great scrutiny.