Purpose of Review <p>Online gambling regulation has become more permissive in many regions, particularly in Western countries, and stakeholders are concerned about young people (aged ≤ 25) and other vulnerable consumers experiencing harm. Some regions continue to maintain an online gambling ban, whilst others have adopted regulatory policies with a focus on consumer protection and harm minimization. Following a systematic search strategy, we reviewed empirical evaluations of international gambling policies to better understand their implementation and possible impact.</p> Recent Findings <p>Legalization leads to increased gambling participation and harm and has limited impact on reducing participation in illegal gambling. Bans on online gambling are difficult, if not impossible, to enforce. So-called ‘responsible gambling’ interventions have limited or no impact on behavior, even though they are widely touted by industry interests. Policies specifically impacting youths focus on preventing underage gambling access. However, young people manage to circumvent these restrictions. Insufficiently regulated gambling advertising is shown frequently to children, including through sports sponsorship.</p> Summary <p>We cannot recommend any gambling regulatory approach as being obviously better than its alternatives based on current evidence. Empirical evaluations of the gambling policies of many other countries have either never been conducted or never been reported in English. A policy that works in one country might not work as well in a different cultural context. More research is needed, and governments that have legalized gambling should impose a levy on gambling revenue to fund healthcare and independent scientific investigations to address and hopefully reduce harm.</p>