Gambling involves placing something of value on a random event with the intent of winning something else of value. It can be an enjoyable activity for some, especially those who enjoy the thrill of risk-taking and do not have problems with gambling. However, for others it can be harmful to their health and well-being, affect their relationships with friends and family and work performance, get them into trouble with the law and even lead to bankruptcy and homelessness. It is now recognised that pathological gambling is an addiction akin to alcohol and other drugs. It can cause dramatic alterations in the brain’s chemical signals and there are often genetic or psychological predispositions for people to develop problems.

In the USA gambling is a huge industry and generates revenues for the states, racetracks, horse owners, trainers and jockeys. There are also state and national lotteries. People can also gamble online.

Gambling has both negative and positive impacts on society and the economy. Negative impacts include costs and benefits which are categorized into three classes: financial, labor and health and well-being. These manifest on personal, interpersonal and community/societal levels (Fig 1). Personal level impacts induce effects on gamblers themselves and on their close relations; interpersonal level impacts involve those who are not necessarily gamblers, for example, their significant others and family; and societal/community level impact concern the wider community.

While skill may improve one’s chances of winning in some games, chance remains a random process. Hence, the chance of losing or winning does not increase or decrease. This is why it is important to differentiate between gambling and activities where skills are used (e.g., card games).