Order of first-play in simulated versus monetary gambling.

The findings leave open the possibility of a catalyst pathway from youth engagement in loot boxes and games with gambling content to later monetary gambling, but causal psychosocial mechanisms remain unclear. However, a pathway from social casino and demonstration games to monetary gambling appears less likely, which may instead reflect containment or substitution effects. Simulated gambling disproportionately attracts youth who are vulnerable to gambling problems and harm, indicating the need for consumer protection measures.