The introduction of casinos to Massachusetts has significantly increased overall economic activity and employment in the state, particularly in regions proximate to the casinos. The casino tax on gross gaming revenue provides hundreds of millions in tax revenue that benefits state and local governments. While the economic gains outweigh losses, there are notable outflows of casino profits out of state and negative impacts on other industries. Casinos have not increased the prevalence of problem gambling, likely attributable to the ready availability of casino gambling in neighboring states. However, much of the additional economic activity comes from spending from people at risk of or experiencing gambling problems, who are estimated to account for 90% of casino revenue in 2021/2022. While the actual population prevalence of problem and at-risk gambling did not increase, the revenue drawn from this vulnerable segment of the population likely has increased. There have been fairly minimal negative social impacts of casino introduction, with the exception of issues such as slight increases in certain types of crime, traffic accidents, impaired driving, and shifts in public perception regarding gambling availability.