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Abstract

Background: Gambling-related harms are increasing among young adults, yet limited research has examined how rural cultural identity shapes gambling engagement and associated harms. Appalachia is a predominantly rural region with distinct cultural values, limited behavioral health access, and increasing exposure to legalized and informal gambling opportunities.

Purpose: This study examined whether Appalachian self-identification and affective states are associated with gambling engagement and gambling-related harm among college students residing in central Appalachia.

Methods: Participants were 395 undergraduate students recruited from a central Appalachian public university who completed an online survey assessing Appalachian self-identification, gambling engagement, gambling-related symptom severity (Problem Gambling Severity Index), and positive and negative affect. Analyses included ANOVA, moderation models, and logistic regression to examine identity, affect, and gambling outcomes.

Results: Appalachian identity was not associated with differences in gambling engagement or symptom severity and did not moderate associations between affect and gambling-related harm. Gambling engagement strongly predicted symptom severity, and negative affect consistently predicted both engagement and harm. Appalachian identity predicted gambling participation only when controlling for symptom severity, suggesting a conditional and indirect association.

Conclusion: Findings suggest that Appalachian identity alone does not function as a standalone risk factor for gambling-related harm among college students. However, emotional distress and gambling engagement remain salient predictors of harm. Appalachian health systems and campus-based services should prioritize affective screening and culturally responsive prevention efforts as gambling accessibility expands in rural regions.

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