A Pennsylvania college student must wait until they are 21 to place a wager at a state-licensed sports book. But prediction-market platform Kalshi allows people to open accounts at 18 years old, offering a way for young people banned from sports betting to put money on the outcome of a game.
For clinicians treating gambling problems, the difference in how those products are described can matter as much as the difference in age requirements.
Dr. Cynthia Grant, a licensed clinical social worker and vice president of clinical at Birches Health, said she has worked with people who committed to stopping their sports betting or online gaming, then switched to prediction markets because they understood those products as something different.
"We don't treat platforms, we treat people," Grant said.
Her concern comes as Pennsylvania expands gambling-related support services and researchers document substantial online participation.
But the evidence has an important limit: Statewide findings cannot establish how widespread gambling problems are among Philadelphia college students.
What Pennsylvania's assessment shows — and what it does not
The 2025 Pennsylvania Interactive Gaming Assessment conducted by Penn State estimates that 17% to 30% of Pennsylvania adults gambled online during the previous year.
The report also found the highest problem-gambling rates among people who gambled both online and offline, rather than exclusively in one setting. Participation itself is not the same as a gambling disorder.
Grouping all online participants together can conceal differences between someone using one product and someone participating in several forms of gambling, said Gillian Russell, an assistant research professor at Penn State as part of the Prevention Research Center and a co-author of the assessment.
A person might bet on sports by phone, visit casinos, buy lottery tickets and play poker, she said. The pattern of participation matters, not simply whether someone uses the internet.
For adults ages 18 to 24, she said, obtaining sufficient data remains difficult.
"One thing we know about younger people is they don't like to answer the phone," Russell said. "So, we're definitely lacking some data there."
Student status introduces another complication. Someone who works and attends school may identify primarily as employed when a survey asks for a single category, she said.
That does not fully capture differences between undergraduate and graduate students, commuters and campus residents, or people returning to school later in life.
Those limitations leave researchers unable to use the assessment to establish a reliable prevalence estimate specifically for Philadelphia college students.
Why young men are drawing attention
Separate research shows concern among younger adults nationally.
A 2024 Fairleigh Dickinson University poll found that 10% of men ages 18 to 30 scored in the problem-gambling range, compared with about 3% of registered voters overall.
The national survey used the nine-question Problem Gambling Severity Index, which asks about experiences such as borrowing money to gamble and financial or emotional consequences.
The results reflect respondents' reported experiences and screening scores, not clinical diagnoses or Pennsylvania-specific estimates.
The poll also found that 45% of men 30 and younger reported at least one problem-gambling behavior. Reporting one behavior is not equivalent to meeting the screener's threshold for problem gambling.
Grant said college can bring independence, access to money, academic pressure and a desire to fit into new social groups. Gambling may become a way to socialize or cope with stress, she said.
"You don't have to go anywhere for it," Grant said. "You can just sit in your dorm room and be on your phone."
Russell cautioned against treating every campus the same. She described differences between commuter settings such as Penn State Abington and residential campuses, where students may spend much of their time around peers who have also recently moved away from home.
Peer groups can encourage risky behavior, she said, but they can also provide alternative activities and support.
Prediction markets complicate recognition of risk
Pennsylvania's licensed sports books require participants to be at least 21, above prediction market Kalshi's minimum age at 18.
Kalshi describes its event contracts as financial derivatives. Users buy and sell contracts tied to whether an event occurs, with prices changing as people trade.
Grant said clinicians may see similar problems regardless of whether a person describes the activity as betting or trading: repeatedly checking results, trying to recover losses and struggling to stop despite consequences.
She said the language of investing or forecasting can lead someone to believe that knowledge will protect them from loss.
Russell said researchers need to ask about specific activities rather than rely on whether respondents consider themselves gamblers. A broad question about gambling can miss behaviors people do not recognize under that label.
She said the distinction also affects help-seeking.
Someone might seek support for anxiety, relationship conflict or other consequences without identifying gambling as part of the problem.
Kalshi offers voluntary self-exclusion options that let people restrict access to its markets. Its website also warns that users can lose the money they spend entering transactions, including fees.
Kalshi did not respond to a request for comment on clinicians' concerns about gambling-related risks, its minimum participation age of 18 or protections for younger users.
More patients do not automatically mean a higher statewide addiction rate
Grant said Birches' new Pennsylvania patients increased more than 125% between the second and third quarters of 2026.
That increase comes as Birches announced a contract with the Pennsylvania Department of Drug and Alcohol Programs in April, expanding access to state-supported treatment. Grant said that partnership is now the company's largest source of new Pennsylvania patients.
She also described a reported 200% year-over-year increase in patients nationally mentioning prediction markets during assessments.
Recognizing problems before a financial crisis
Warning signs can emerge before someone accumulates substantial debt, Grant said, including disrupted sleep, irritability, hiding activity, repeatedly checking apps, using money needed for essentials, or unsuccessful efforts to cut back.
The central concern is loss of control and consequences, she said, rather than a particular dollar amount.
"The time to intervene is not once someone has already lost thousands of dollars or spent their tuition money," Grant said. "It's really when they're starting to lose control over how much time and money that they're spending."
She recommends families describe specific changes they have noticed and approach the conversation calmly, without shaming or labeling the person.
Russell said consequences can also show up in school performance, work and relationships. Focusing only on money risks overlooks those effects.
Bringing prevention and help closer to students
At Abington, Russell said prevention work includes bringing a provider onto campus for activities such as tie-dye demonstrations.
The exercise illustrates uncertainty — a student may expect the fabric to unfold into a particular pattern, just as a sports fan expects a familiar team to perform a certain way.
The result can still differ.
Russell said she has also helped promote text and online chat options for gambling support, including through information printed on water bottles distributed on campus.
The goal is to make help visible in forms students may be more comfortable using.
She described collegiate recovery programs as another potential source of community, alternative activities and connections to care.
Pennsylvania announced expanded gambling-related case management Aug. 27, which offers help navigating needs such as transportation, child care, housing, employment and financial literacy.
Pennsylvanians can call 1-800-GAMBLER for free, confidential assistance and referrals. Chat and text options are also available through the Council on Compulsive Gambling of Pennsylvania.
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