The parking lot at the Super One Stop in Granite City, Illinois, is full. The convenience store just across the Mississippi River from Missouri sells liquor, cigarettes, and some groceries. But not all the cars belong to customers. It’s a Sunday morning in the middle of football season, and the people sitting in their vehicles are mostly looking down at their smartphones.

Nick Krumwiede is sure the people parked around him are betting on the day’s NFL games. That’s why he’s there. Krumwiede drove 15 minutes across the state line from his home in St. Louis to place three bets, including one on his beloved Chicago Bears.

Krumwiede could have driven to a casino in East St. Louis, Illinois, to bet on the games in person. But with apps like DraftKings and FanDuel on his smartphone, he doesn’t need to make the trip. He can place his bets in this parking lot.

“This is Sunday football, everybody,” Krumwiede said. “I guarantee you that’s what they’re doing.”

“You see them all sitting in there staring at their phones?” he said.

Public health experts say smartphone-based betting makes it easier for people to get into deep gambling trouble fast. But it takes effort to drive to a parking lot across state lines to bet on an NFL game. Soon, Missouri gamblers will be able to place those bets from their couches. Voters approved sports betting in Missouri in a November ballot initiative, and the state could start issuing sports betting licenses as soon as this summer.

The ballot measure requires the state to dedicate at least $5 million a year from its sports betting tax revenue to combat compulsive gambling. Supporters of the measure said that increase in resources could help the state address harms associated with gambling addiction. In other states, the introduction of online sports betting has been linked to increased calls to hotlines for problem gambling.

Estimates of the state’s revenue from sports betting range from $12.8 million to $20.5 million, according to a fiscal note for a previous bill to legalize sports betting.

Carolyn Hawley is a professor at Virginia Commonwealth University who researches problem-gambling addiction, treatment, and harm reduction. She has tracked Virginia’s experience since sports betting started there four years ago.

“ We don’t even have to leave our homes anymore,” she said. “We now have them on our smartphones. We can do it anytime, anyplace.”

In Virginia, some primary care providers have started asking their patients about their gambling habits, Hawley said. Doctors have shared reports of stress-related ailments, she said, especially in young men who had been betting on sports.

“They’re coming in with GI issues. They’re coming in with heart issues. They’re coming in with depression,” she said.

Sports bettors tend to be younger and male. In a recent poll of registered voters, Fairleigh Dickinson University found that a quarter of men under 30 bet on sports online. Problem gamblers make up 10% of that group, compared with 3% of the overall U.S. population.

After the legalization of sport betting in Virginia, Hawley observed a spike in calls to her state’s gambling helpline: 1,000% more between 2019 and 2023.

Hawley, who is also the president of the Virginia Council on Problem Gambling, said of those calls, 200% more people were looking for resources to quit gambling.  Other states have seen similar trends.

Dozens of states have legalized sports betting after a Supreme Court decision cleared the way in 2018, including every state that borders Missouri save one, Oklahoma.

Supporters who pushed for sports betting in Missouri say people already cross into other states to gamble. They argue that Missouri has missed out on valuable tax dollars that could, in part, help fund gambling treatment and prevention efforts in the state.

“The beautiful thing about being the 39th state to do something is you are able to take a look at what has worked and what hasn’t worked in other states,” said Jack Cardetti, spokesman for Winning for Missouri Education, a group made up of Missouri professional sports teams and sports betting companies that supported the ballot initiative.  “If we’re going to have an expansion of gaming here in the state of Missouri,” he said, “we also need to expand the resources.”

Missouri spent just $100,000 on problem gambling in 2023 and zero dollars the year before that. The state is still developing a plan to spend the money earmarked from the ballot initiative.

In Illinois at the Super One Stop, store owner Himang Patel said he doesn’t mind sports bettors using his parking lot to gamble on their phones. Some people sit up to an hour, and Patel said that can be an opportunity to sell a pack of cigarettes or bag of chips. He guessed that the extra foot traffic will die off when sports betting becomes legal in Missouri.

Krumwiede said he’s looking forward to not having to make the drive across the state line, but he’s also mindful that easier access could come with risks. He knows gambling can be addictive.

“Sometimes I have bad days where I go out and put out a hundred bucks and I lose almost all of it,” he said. “It’s kind of like a sinking feeling. You don’t talk about it.”

Krumwiede tries to set rules for himself so he doesn’t lose too much money at any one time.

He said he is looking forward to not having to make the drive to Illinois after sports betting starts in Missouri. But he’s worried, too. He said there were periods in the past when he lost too much money.

“It’s a little scary, but I’m just going to have to make new rules,” Krumwiede said.

He has a few more months to figure it out.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.