Background Gambling-related harm represents a significant health challenge, poorly addressed compared with other addictive behaviours. Young people, including students, are known to be influenced by gambling advertising and at particular risk of harm, but there is little research evidence on their daily exposure to gambling advertising outside the home.

Methods In collaboration with Sheffield City Council, nine medical students undertook an observational, ethnographic study. They recorded all instances of gambling advertising on four pedestrian routes commonly walked by university students. Final data collection methods were selected after a pilot study on an initial route.

Route Details - The routes for data collection were identified through purposive sampling to incorporate a diversity of student journeys. Length was between 1 km-3.5 km. Three groups of three medical students each separately assessed all routes.

Data Collection - A short pre-piloted questionnaire was used to record: route taken; product advertised; media of the advertisement; students’ response/feelings towards the advertisement; and personal reflections. Strava on smart-phones was adapted so spatial locations (what3words) within the route were recorded, alongside photographs of each advertisement, and textual data.

Data Analysis - Stepwise thematic analysis (Braun/Clarke) was used to analyse qualitative data. After familiarisation with the data, common concepts were found and coded. From these, common themes were identified.

Results The commonest advertisements were for National Lottery, scratch cards, betting shops, slot machines and Health Lottery. Others included digital posters for online betting companies, alcohol packaging advertisements, National Lottery funded events, and local business lotteries.

Advertising density along routes varied from 0.6 to 1.0 advertisements per minute walked, with some evidence of a relationship between gambling exposure and deprivation.

Main themes were Normalisation of Gambling; Links to Sports/Alcohol; Impulsivity; Youth Targeting; Government Endorsement; Bright Colours; Impulsive Purchase.

Overall, National Lottery advertising was ubiquitous in shops, seen as attractive to students and young people, and likely to lead to ‘impulsive participation’. Links between alcohol and social or sporting events encouraged the uptake of a gambling element. Betting shops were seen as less attractive to young people than other settings.

The data collected were used in presentations for the local authority and for a regional gambling harms strategy group and have potential to be replicated in other UK cities.

Conclusion Walking routes in a UK city had a high density of gambling advertising and marketing. This research supports a need to reduce out-of-home exposure to gambling advertising and marketing generally, and particularly for young people.