Muñoz-Miralles et al.

BMC Pediatrics (2016) 16:140

DOI 10.1186/s12887-016-0674-y

RESEARCH ARTICLE Open Access

The problematic use of Information and

Communication Technologies (ICT) in
adolescents by the cross sectional JOITIC
study
Raquel Muñoz-Miralles1,2,3*, Raquel Ortega-González4, M. Rosa López-Morón5, Carme Batalla-Martínez6,
Josep María Manresa1,2, Núria Montellà-Jordana1, Andrés Chamarro7, Xavier Carbonell8 and Pere Torán-Monserrat1

Abstract
Background: The emerging field of Information and Communications Technology (ICT) has brought about new
interaction styles. Its excessive use may lead to addictive behaviours.
The objective is to determine the prevalence of the problematic use of ICT such as Internet, mobile phones and
video games, among adolescents enrolled in mandatory Secondary Education (ESO in Spanish) and to examine
associated factors.
Methods: Cross sectional, multi-centric descriptive study. Population: 5538 students enrolled in years one to four of
ESO at 28 schools in the Vallès Occidental region (Barcelona, Spain). Data collection: self-administered socio-demographic
and ICT access questionnaire, and validated questionnaires on experiences related to the use of the Internet, mobile
phones and video games (CERI, CERM, CERV).
Results: Questionnaires were collected from 5,538 adolescents between the ages of 12 and 20 (77.3 % of the total
response), 48.6 % were females. Problematic use of the Internet was observed in 13.6 % of the surveyed individuals;
problematic use of mobile phones in 2.4 % and problematic use in video games in 6.2 %.
Problematic Internet use was associated with female students, tobacco consumption, a background of binge
drinking, the use of cannabis or other drugs, poor academic performance, poor family relationships and an
intensive use of the computer.
Factors associated with the problematic use of mobile phones were the consumption of other drugs and an
intensive use of these devices.
Frequent problems with video game use have been associated with male students, the consumption of other
drugs, poor academic performance, poor family relationships and an intensive use of these games.
Conclusions: This study offers information on the prevalence of addictive behaviours of the Internet, mobile phones
and video game use.
The problematic use of these ICT devices has been related to the consumption of drugs, poor academic performance
and poor family relationships.
This intensive use may constitute a risk marker for ICT addiction.
(Continued on next page)

* Correspondence: rmunozm.cc.ics@gencat.cat
1
Unitat de Suport a la Recerca Metropolitana Nord, Institut de Investigació
en Atenció Primària (IDIAP) Jordi Gol, Sabadell, Barcelona, Spain
2
Departament d’Infermeria, Universitat Autònoma de Barcelona, Bellaterra,
Barcelona, Spain
Full list of author information is available at the end of the article

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 2 of 11

(Continued from previous page)

Keywords: Internet, Addictive behaviour, Mobile phone, Video games, Adolescent
Abbreviations: CEIC, “Comitè d’Ètica en Investigació Clínica” (Clinical Research Ethics Committee); CERI, “Cuestionario de
Experiencias Relacionadas con Internet” (Questionnaire of experiences related to the Internet).; CERM, “Cuestionario de
Experiencias Relacionadas con el Móvil” (Questionnaire of experiences related to mobile phones).; CERV, “Cuestionario de
Experiencias Relacionadas con los Videojuegos” (Questionnaire of experiences related to video games).; ESO, “Educació
Secundària Obligatòria” (Compulsory Secondary School).; IAT, Internet addiction test; ICT, Information and communication
technologies; IDIAP Jordi Gol, “Institut d’Investigació en Atenció Primària Jordi Gol” (Primary Health Care Institute of
Research); IES, “Institut d’Educació Secundària” (Secondary High School); JOITIC, “JOves I Tecnologies de la Informació
i la Comunicació” (Youth and Information and Communication Technologies); OR (CI95 %), Odds ratio and 95 %
Confidence interval; OR, Odds ratio; PSiE, “Programa Salut i Escola” (Health and School program); SMS, Short message
service; SPSS, Statistical package for the social sciences

Background psychological dependence, modification of mood, toler-

The expansion of the Information and Communication ance and abstinence, and adverse effects such as unjusti-
Technologies (ICT) in our society has resulted in nu- fied absenteeism or academic failure. Some studies have
merous positive elements, including new means of com- noted that adolescents who are addicted to the Internet,
munication, working, learning and entertainment, across as in the case of drug addictions, present problems of
space and time. Internet browsing, the use of social aggression, anxiety, phobia, depression, sleep disorders
networks, video games and mobile phones have pro- and, in some cases, suffer from loneliness and social iso-
duced a radical lifestyle change, particularly amongst the lation [2, 3, 19, 20].
youngest, also known as digital natives [1], who use With mobile phones, these symptoms may also appear,
these devices heavily. It has also led to problems associ- although they tend to be less serious [3, 21, 22]. Similar
ated with an inappropriate or excessive use, including symptoms also have been found with video games, par-
work and school absenteeism, academic failure, deterior- ticularly on-line games [10, 23], which may substitute
ation of family or friendship relationships and even human contact with virtual relationships. Clearly there
health problems [2–4], particularly among adolescents. are many similarities between drug addiction and some
It seems that the use of these technologies normalizes manifestations of ICT use, which is why they both elicit
with age toward a more academic and less playful use, the frequent use of the term “addiction” but many litera-
and with fewer negative consequences. ture on this topic use a term other than “addiction” for
Information and Communication Technologies addic- high-engagement with certain behaviours that do not
tion has been highly argued over recent years, and the fulfil all the criteria of classical addiction, but exhibit
limits of appropriate use are still unclear. Various studies similar features. With this in mind, alternative terms for
have aimed to quantify the magnitude of the inappropri- “addiction” such as “problematic use” have been pro-
ate use of these technologies, with different results: 5 % posed [24–27].
for problems with Internet use [5, 6] 15,3 % [7], 9,4 % The objective of this study is to determine the prevalence
[8] or 34,7 % [9]; for problematic gaming between 2,7 % of the problematic use of ICT in adolescent students, and
[10] and 9,3 % [11], 20 % for dependence with mobile to describe its association with the consumption of toxic
phone [12]. Variability in the methods makes studies dif- substances, academic performance, family relationships
ficult to compare, as well the evolution of the definition and the intensity of ICT use.
of the disorder itself.
Among behavioural addictions, after the initial con- Methods
cern about Internet Addiction [13], technological addic- This is a descriptive, cross sectional and multi-centric
tions [14] have been an important focus of study. This study. The JOves I Tecnologies de la Informació i la
field has also received increased attention after the Comunicació (JOITIC) study protocol was approved by
DSM-5 considered Internet Gaming Disorder (IGD) in the Clinical Research Ethics Committee of IDIAP Jordi
section III, as a disorder that requires further study [15] Gol. The study population consisted of all of the
and some consensus seems to be gathered about the students at the mandatory Secondary Education (ESO)
diagnosis criteria [16] although it is not exempt from enrolled in 2010–11 year. Participating schools were
some criticism [17, 18]. The following essential diagnos- centres in which the “Programa Salut i Escola” (“Health
tic elements may also be present in the abuse of the new and School Program” or PSiE, for its initials in Catalan)
technologies, particularly in the case of the Internet: of the Catalonia government was being carried out. Of
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 3 of 11

11,320 students enrolled in the 39 centres of the metro- possible answers scored from 1 to 4 (1: never/almost
politan Barcelona region, 7,168 students between the never, 2: occasionally, 3 sometimes, 4: almost always). The
ages of 12 and 20 were eligible from the 28 centres that score result is the sum of responses for all items.
agreed to participate [28] (Fig. 1). The liaison nurse from The reliability analysis of three questionnaires ob-
the PSiE provided the materials (informed consent forms tained Cronbach’s alpha values of 0.77 for CERI, 0.80 for
and questionnaires) to the responsible parties of the cen- CERM and 0.91 for CERV.
tres. Students responded to anonymous questionnaires ”Problematic use” was defined depending upon whether
that were self-administered, regarding socio-demographic the score from the questionnaire was equal to or above 26
information and specific questionnaires on the ICT, for the CERI, 24 for the CERM or 39 for the CERV and
during school hours and in the presence of their tutor. use with “occasional problems” was based upon a score
Tutors were supposed to support the activity but no inter- between 18 and 25 for the CERI, 16–23 for the CERM or
vention had to be done, neither any access to the answers 26–38 for the CERV [30, 31].
or data.
The socio-demographic questionnaire [28] collected
information regarding the following variables: age, gender, Statistical analysis
school year, type of centre (public-charter), participation The categorical variables are described with absolute
in after-school activities, consumption of toxic substances and relative frequencies. The quantitative ones are des-
(tobacco, alcohol, cannabis and other drugs), family re- cribed by their mean and standard deviations.
lationships (referred by the student: «very bad» to «very In the contrasts for comparison of proportions, the Chi-
good»), poor academic performance (three or more square distribution or linear trend analysis was used.
subjects failed during the previous school year), parental Multivariable logistic regression was used for each of
control of the type of ICT (control of use: yes or not) and the examined technologies in order to explore what fac-
intensive use consisting of 3 or more hours daily of tors are related with their problematic use (dependent
computer use, over 5 h of video games per week and 10 variable). Subsequently, new analyses were repeated to
or more SMS messages daily [29]. relate low academic performance (dependent variable)
Patterns of use were identified via questionnaires that with the use of the ICT and other risk factors. All vari-
were specifically validated in accordance with technology: ables having a significance of p < 0.125 were considered
CERI (Questionnaire of experiences related to Inter- to be candidates for evaluation in the creation of a final
net use), CERM (Questionnaire of experiences related model for each technology, in which, after a manual
to mobile phones) [30] (Questionnaire of experiences re- process, only those having a significant OR or that
lated to video games) [31]. Questionnaires CERI and modified the beta coefficients by more than 10 % were
CERM contain 10 Likert items and 17 for CERV, with four maintained.

39 centers
11,320 students

Do not participate Participate

11 centers 28 centers
4,152 students 7,168 students

Do not agree Lost Valid

n=574(8.0%) n=1,056 (14.7%) n=5,538 (77.3%)

CERI CERM CERV

n=4,635 (83.7%) n=4,923 (88.9%) n=4,347 (78.5%)

CERI: Questionnaire of experiences related to the Internet; CERM: Questionnaire of experiences related to
mobile phones; CERV: Questionnaire of experiences related to video games.

Fig. 1 Flowchart of participating subjects

Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 4 of 11

Data analysis was carried out using the SPSS version those that made reference to adult control (44.7 vs 37.8 %).
18.0 statistical package. There was no relevant association observed with the
Given the large volume of participants, any small dif- remaining variables.
ference may be significant. Therefore, although the sig- The problematic use of mobile phones was associated
nificance level used in all of the contrasts was p ≤ 0.001, with drug use (14.3 vs 2.2 %) and the intensive use of
the size of the observed associations has been considered this device (25.5 vs 1.9 %) (Table 3). Occasional prob-
to be relevant when the differences between groups were lems were associated with the female gender (21.0 vs
over 5 %. 12.4 %), the use of tobacco (30.2 vs 14.5 %), alcohol
(26.8 vs 14.1 %), cannabis (26.6 vs 15.3 %), poor aca-
demic performance (25.5 vs 14.3 %), poor family rela-
Results tionships (26.3 vs 15.5 %), intensive mobile phone use
Five hundred seventy four (8.0 %) parents and/or students (>10 SMS/day) (48.0 vs 16.2 %), the use of Chats (34.5
did not agree to participate and 1,056 (14.7 %) answers vs 15.3 %), games (25.9 vs 15.6 %) and the sending SMS
got lost (students did not attend to the chosen class hour (21.6 vs 10.7 %). No relevant association was observed
to administrate the questionnaire or did not answer it). with the drug use and phone calls.
5,538 valid answers were collected (77.3 % responders of In the analysis of video games, problematic use were
the initially included) from students between the ages of observed in regards to the male gender (10.6 vs 1.4 %),
12 and 20, 48.6 % of whom were females. The percentage poor academic performance (10.4 vs 5.1 %), poor family
of no responses in each of the socio-demographic ques- relationships (13.8 vs 5.3 %), the consumption of other
tionnaires was less than 1%, except in academic perform- drugs (16.0 vs 5.9 %) and the intense use of video games
ance (3.13 %). The number of questionnaires that were (>5 h/week) (26.1 vs 3.2 %). No relevant association was
correctly completed differed based on questionnaire type observed with the remaining variables (Table 4).
(Fig. 1). The presence of occasional or frequent problems in
Based upon the cut off points established for the ques- students in the first cycle (1st and 2nd year) as com-
tionnaires, problematic Internet use was observed in pared to the 2nd cycle (3rd and 4th year of ESO) in-
13.6 % of the students; problematic mobile phone use creased for Internet use by 53.5 vs 64.1 % (p < 0.001) and
was seen in 2.4 %; and problematic video game use was for mobile phone use, by 17.0 vs 21.5 % (p < 0.001), but de-
found in 6.2 % (Table 1). creased for video game use from 35.1 vs 30.7 % (p < 0.001).
In the analysis by technologies, problematic Internet In the multivariate analysis, the problematic use of
use is found to be more frequent in females (17.0 %) as the Internet was associated with the female gender
compared to males (10.6 %), with increases from the (OR = 1.49), tobacco consumption (OR = 1.55), binge
1st to 3rd years of ESO, and decreases in the 4th year drinking (OR = 1.35), poor family relationships (OR = 2.05)
(Table 2). Tobacco use (27.1 vs 11.4 %), a history of and intensive use (>3 h/day) (OR = 5.77) (Table 5). Prob-
binge drinking (23.4 vs 11.0 %), the use of cannabis lematic use of mobile phones is associated with tobacco
(23.6 vs 11.9 %) or other drugs (31.3 vs 13.2 %) was also consumption (OR = 2.16), with poor family relation-
related to higher rates of addiction, as were poor aca- ships (OR = 2.33) and intensive use (sending >10 SMS
demic performance (18.6 vs 12.3 %), poor family rela- messages/day) (OR = 12.39). As for video game use,
tionships (28.8 vs 11.7 %) and intensive computer use males had a higher risk of problematic use (OR = 4.63),
(>3 h/day) (35.8 vs 7.5 %). as did students with poor family relationships (OR = 2.82),
Increased problematic use was also found in those in- those engaging in intensive use (>5 h/day) (OR = 6.90) and
volved in Chats (18.9 vs 8.2 %), social networks (15.1 vs those who play alone (OR = 1.66).
5.3 %), non-academic use (17.0 vs 10.6 %) and those Upon creating new models of logistic regression using
making purchases (19.1 vs 13.2 %). poor academic performance as the dependent variable,
A healthier use was found amongst those students who we find that female gender, good family relationships
participated in after-school activities (42.8 vs 36.8 %) and and participation in after-school activities are protective
factors, while the consumption of toxic substances is a
Table 1 Pattern of use of ICT risk factor (Table 6).
No problems Occasional problems Problematic use Students with occasional or frequent problems with
CERI 1917 (41.4 %) 2084 (45.0 %) 632 (13.6 %) Internet use present the greatest risk for poor aca-
CERM 3977 (80.9 %) 822 (16.7 %) 119 (2.4 %) demic performance, although this exceeds our signifi-
cance level (p > 0,001). For mobile phones, only those
CERV 2908 (66.9 %) 1167 (26.9 %) 269 (6.2 %)
with occasional problems and for video games, only
ICT information and communication technologies, CERI questionnaire of
experiences related to the internet, CERM questionnaire of experiences related
those having frequent problems posed this increased
to mobile phones, CERV questionnaire of experiences related to video games risk (Table 6).
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 5 of 11

Table 2 Bivariate analysis of individuals with problematic internet Table 2 Bivariate analysis of individuals with problematic internet
use and related factors use and related factors (Continued)
CERI (n = 4635) Other drugs <0.001
No Occasional Problematic use p Yes 28 49 35
problems problems (25.0 %) (43.8 %) (31.3 %)
Gender <0.001
No 1876 2018 590
Females 826 988 371 (41.8 %) (45.0 %) (13.2 %)
(37.8 %) (45.2 %) (17.0 %)
Intensive computer use <0.001
Males 1075 1078 255
≤ 3 h/day 1741 1567 267
(44.6 %) (44.8 %) (10.6 %)
(48.7 %) (43.8 %) (7.5 %)
Type of center <0.001
> 3 h/day 156 499 366
Public 1278 1461 478 (15.3 %) (49.0 %) (35.8 %)
(39.7 %) (45.4 %) (14.9 %)
Adult control <0.001
Charter 639 623 156
Yes 1075 1049 280
(45.1 %) (43.9 %) (11.0 %)
(44.7 %) (43.7 %) (11.6 %)
Year <0.001
No 809 988 343
1st 653 508 152 (37.8 %) (46.2 %) (16.0 %)
(49.7 %) (38.7 %) (11.6 %)
Email 0.710
2nd 467 484 147
Yes 1274 1433 426
(42.5 %) (44.1 %) (13.4 %)
(40.7 %) (45.7 %) (13.6 %)
3rd 392 598 202
No 581 628 201
(32.9 %) (50.2 %) (16.9 %)
(41.2 %) (44.5 %) (14.3 %)
4th 405 493 133
Chat <0.001
(39.3 %) (47.8 %) (12.9 %)
Yes 754 1175 449
After-school activities <0.001
(31.7 %) (49.4 %) (18.9 %)
Yes 1493 1557 439
No 1101 886 178
(42.8 %) (44.6 %) (12.6 %)
(50.9 %) (40.9 %) (8.2 %)
No 416 523 192
Online games 0.384
(36.8 %) (46.2 %) (17.0 %)
Yes 618 729 212
Poor academic performance <0.001
(39.6 %) (46.8 %) (13.6 %)
Yes 293 428 165
No 1237 1332 415
(33.1 %) (48.3 %) (18.6 %)
(41.5 % (44.6 %) (13.9 %)
No 1574 1596 444
Social networks <0.001
(43.6 %) (44.2 %) (12.3 %)
Yes 1465 1882 595
Family relationship <0.001
(37.2 %) (47.7 %) (15.1 %)
Good/very good 1791 1815 480
No 390 179 32
(43.8 %) (44.4 %) (11.7 %)
(64.9 %) (29.8 %) (5.3 %)
Poor/indifferent 112 247 145
Scholastic information <0.001
(22.2 %) (49.0 %) (28.8 %)
Yes 1054 968 239
Cigarettes <0.001
(46.6 %) (42.8 %) (10.6 %)
Yes 176 300 177
No 801 1093 388
(26.9 %) (45.8 %) (27.1 %)
(35.1 %) (47.9 %) (17.0 %)
No 1741 1784 455
Purchases <0.001
(43.7 %) (44.8 %) (11.4 %)
Yes 146 210 84
Binge drinking at least once <0.001
(33.2 %) (47.7 %) (19.1 %)
Yes 257 498 230
No 1709 1851 543
(26.1 %) (50.6 %) (23.4 %)
(41.7 %) (45.1 %) (13.2 %)
No 1651 1571 398 CERI questionnaire of experiences related to the internet
(45.6 %) (43.4 %) (11.0 %)
Cannabis <0.001 Discussion
Yes 175 320 153 We have obtained information about the prevalence of
(27.0 %) (49.4 %) (23.6 %) problematic use of mobile, Internet and video games on
No 1728 1747 470 adolescents and examined risk factors. Selection of the
(43.8 %) (44.3 %) (11.9 %)
participating study population and the high response
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 6 of 11

Table 3 Bivariate analysis of the individuals with problematic Table 3 Bivariate analysis of the individuals with problematic
use of mobile phones and related factors use of mobile phones and related factors (Continued)
CERM (n = 4923) Other drugs <0.001
No Occasional Problematic use p Yes 64 26 15
problems problems (61.0 %) (24.8 %) (14.3 %)
Gender <0.001
No 3884 790 103
Females 1820 501 62 (81.3 %) (16.5 %) (2.2 %)
(76.4 %) (21.0 %) (2.6 %)
Intensive mobile phone use <0.001
Males 2126 309 54
≤ 10 SMS/day 3916 773 93
(85.3 %) (12.4 %) (2.2 %)
(81.9 %) (16.2 %) (1.9 %)
Type of center <0.001
> 10 SMS/day 26 47 25
Public 2711 592 99 (26.5 %) (48.0 %) (25.5 %)
(79.7 %) (17.4 %) (2.9 %)
Calls 0.030
Charter 1266 230 20
Yes 3441 781 103
(83.5 %) (15.2 %) (1.3 %)
(79.6 %) (18.1 %) (2.4 %)
Year 0.001
No 71 22 6
1st 1173 207 43 (71.7 %) (22.2 %) (6.1 %)
(82.4 %) (14.5 %) (3.0 %)
Chats <0.001
2nd 972 170 20
Yes 390 228 43
(83.6 %) (14.6 %) (1.7 %)
(59.0 %) (34.5 %) (6.5 %)
3rd 974 241 31
No 3122 575 66
(78.2 %) (19.3 %) (2.5 %)
(83.0 %) (15.3 %) (1.8 %)
4th 857 204 25
Games <0.001
(78.9 %) (18.8 %) (2.3 %)
Yes 777 284 34
After-school activities 0.003
(71.0 %) (25.9 %) (3.1 %)
Yes 3032 580 91
No 2735 519 75
(81.9 %) (15.7 %) (2.5 %)
(82.2 %) (15.6 %) (2.3 %)
No 932 239 27
SMS <0.001
(77.8 %) (19.9 %) (2.3 %)
Yes 2301 654 74
Poor academic performance <0.001
(76.0 %) (21.6 %) (2.4 %)
Yes 664 239 33
No 1211 149 35
(70.9 %) (25.5 %) (3.5 %)
(86.8 %) (10.7 %) (2.5 %)
No 3214 551 79 CERM questionnaire of experiences related to mobile phones
(83.6 %) (14.3 %) (2.1 %)
Family relationship <0.001 percentage provide a realistic view of the degree of ICT
Good/very good 3578 674 83 problematic use in adolescents.
(82.5 %) (15.5 %) (1.9 %) Internet addiction in adolescents is a topic of great so-
Poor/indifferent 360 140 33 cial and familiar concern. In our study, 13.6 % of the
(67.5 %) (26.3 %) (6.2 %)
surveyed individuals present problematic behaviour that
Cigarettes <0.001 is associated with this technology. This prevalence is
Yes 439 208 41 similar to that which was reported by Yen in females
(63.8 %) (30.2 %) (6.0 %) [32], although in males it is much higher. In 2010, Car-
No 3538 614 78 bonell et al. did not find differences and our study has
(83.6 %) (14.5 %) (1.8 %)
revealed a greater frequency of problems in the females
Binge drinking at least once <0.001 [33]. Most likely, this trend is related to the type of use
Yes 703 276 50 which in a very short time, has evolved to the increased
(68.3 %) (26.8 %) (4.9 %) use of social networks, which tend to be used more fre-
No 3246 545 69 quently by females [34–36]. However, other studies have
(84.1 %) (14.1 %) (1.8 %)
indicated that female adolescent or university-aged stu-
Cannabis <0.001 dents are more aware of the risk, which should serve as
Yes 456 179 39 a protective factor [29, 37].
(67.9 %) (26.6 %) (5.8 %) The number of hours invested in Internet, video-
No 3486 642 82 games or mobile phone activities is not a definitive cri-
(82.8 %) (15.3 %) (1.9 %)
terion in the diagnosis of technological addictions. In
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 7 of 11

Table 4 Bivariate analysis of individuals with problematic use of Table 4 Bivariate analysis of individuals with problematic use of
video games and related factors video games and related factors (Continued)
CERV (n = 4347) Other drugs <0.001
No Occasional Problematic use p Yes 51 28 15
problems problems (54.3 %) (29.8 %) (16.0 %)
Gender <0.001
No 2840 1131 251
Females 1857 206 29 (67.3 %) (26.8 %) (5.9 %)
(88.8 %) (9.8 %) (1.4 %)
Intensive video game use <0.001
Males 1028 948 235
≤ 5 h/week 2750 873 119
(46.5 %) (42.9 %) (10.6 %)
(73.5 %) (23.3 %) (3.2 %)
Type of center 0.001
> 5 h/week 122 288 145
Public 1991 784 213 (22.0 %) (51.9 %) (26.1 %)
(66.6 %) (26.2 %) (7.1 %)
Adult control of video game time <0.001
Charter 917 383 56
Yes 1095 660 116
(67.6 %) (28.2 %) (4.1 %)
(58.5 %) (35.3 %) (6.2 %)
Year 0.001
No 1729 493 151
1st 802 370 76 (72.9 %) (20.8 %) (6.4 %)
(64.3 %) (29.6 %) (6.1 %)
Adult control of video game type 0.025
2nd 689 300 61
Yes 940 428 78
(65.6 %) (28.6 %) (5.8 %)
(65.1 %) (29.5 %) (5.4 %)
3rd 761 283 88
No 1887 734 191
(67.2 %) (25.0 %) (7.8 %)
(67.1 %) (26.1 %) (6.8 %)
4th 656 213 44
Plays alone <0.001
(71.9 %) (23.3 %) (4.8 %)
Yes 1121 672 165
After-school activities 0.017
(57.3 %) (34.3 %) (8.4 %)
Yes 2178 921 200
No 1621 470 103
(66.0 %) (27.9 %) (6.1 %)
(73.9 %) (21.4 %) (4.7 %)
No 719 241 69 CERV Questionnaire of experiences related to video games
(69.9 %) (23.4 %) (6.7 %)
Poor academic performance <0.001 fact, researchers distinguish between high engagement
Yes 483 231 83 and problematic use [38, 39] and suggest that some
(60.6 %) (29.0 %) (10.4 %) past studies may have overestimated the prevalence of
No 2350 914 176 addiction type problems of ICT users. Therefore the
(68.3 %) (26.6 %) (5.1 %)
questionnaires like CERI and CERM are based on the
Family relationship <0.001 negative consequences rather than in the time invested
Good/very good 2614 1031 204 in ICT [30]. However, we have found a strong relation-
(67.9 %) (26.8 %) (5.3 %) ship between intensive use and problematic use as hap-
Poor/indifferent 265 130 63 pens in other studies with video gamers [40] and
(57.9 %) (28.4 %) (13.8 %)
Internet users [41] while the type of use disappears as
Cigarettes <0.001 an additional risk factor upon adjustments made via
Yes 424 114 41 multivariate analysis. These results seem to indicate
(73.2 %) (19.7 %) (7.1 %) that for the youngest users, the number of hours of use
No 2484 1053 228 is actually a risk factor. Poor family relationships appear
(66.0 %) (28.0 %) (6.1 %)
as the second most important risk factor. Here, the role
Binge drinking at least once <0.001 of the family as a regulator of use, may be fundamental
Yes 617 198 73 for preventing Internet addiction [32, 42].
(69.5 %) (22.3 %) (8.2 %) Drug use and impulsivity have been related with
No 2276 963 195 problematic Internet behaviour [43]. In our case, we
(66.3 %) (28.0 %) (5.7 %)
have found associations with tobacco use and a history
Cannabis 0.095 of binge drinking. As for mobile phones, an increased
Yes 391 146 47 risk in problematic use has been found only in those
(67.0 %) (25.0 %) (8.0 %) that display intensive use of mobile phones or who con-
No 2497 1016 220 sume other drugs. These results are consistent with
(66.9 %) (27.2 %) (5.9 %)
findings from prior studies [6, 44]. Intensive use or the
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 8 of 11

Table 5 Exploratory models of multivariate logistic regression Table 6 Exploratory models of multivariate logistic regression
to associate potential risk factors with the presence of regular related with poor academic performance (dependent variable)
problems in the use of the Internet, mobile phones and Internet Coefficient OR (CI 95 %) p
video games
Female −0.682 0.51 – 0.43–0.60) <0.001
Internet Coefficient OR (CI 95 %) p
Good relationship with family −0.567 0.57 – 0.45–0.71) <0.001
Males 0.397 1.49 (1.26–1.79) <0.001
Binge drinking 0.398 1.49 1.20–1.85) <0.001
Smoking 0.435 1.55 (1.20–1.99) 0.001
Cannabis 0.485 1.62 (1.27–2.09) <0.001
Binge drinking 0.303 1.35 (1.08–1.71) 0.010
Smoking 0.820 2.27 (1.78–2.90) <0.001
Poor relationship with family 0.718 2.05 (1.61–2.62) <0.001 After-school activities
Computer time (>3 h) 1.752 5.77 (4.8–6.96) <0.001 1 day −0.760 0.47 (0.33–0.66) <0.001
Constant −2.943 2 days −0.702 0.50 (0.40–0.62) <0.001
Mobile phone Coefficient OR (CI 95 %) p 3 days −0.833 0.44 (0.36–0.53) <0.001
Smoking 0.771 2.16 (1.41–3.33) <0.001 Problematic use of Internet
Poor relationship with family 0.847 2.33 (1.49–3.66) <0.001 Occasional problems 0.219 1.25 (1.04–1.49) 0.016
SMS (>10) 2.516 12.39 (7.32–20.97) <0.001 Frequent problems 0.299 1.348 (1.053–1.727) 0.018
Constant −4.225 Constant −0.554 0.58 <0.001
Video games Coefficient OR (CI 95 %) p Mobile phones Coefficient OR (CI 95 %) p
Male −1.533 0.22 (0.14–0.33) <0.001 Female −0.787 0.46 (0.39–0.54) <0.001
Poor relationship with family 1.036 2.82 (1.98–4.01) <0.001 Good relationship with family −0.690 0.50 (0.40–0.63) <0.001
Time with video games 1.932 6.902 (5.21–9.14) <0.001 Binge drinking 0.370 1.45 (1.17–1.79) 0.001
(>5 h)
Cannabis 0.374 1.45 (1.13–1.87) 0.003
Plays alone 0.508 1.66 (1.25–2.20) 0.001
Smoking 0.843 2.32 (1.83–3.00) <0.001
Constant −4.810
After-school activities
OR (CI 95 %): Odds Ratio and 95 % Confidence Intervals
1 day −0.733 0.48 (0.34–0.67) <0.001
2 days −0.658 0.52 (0.42–0.65) <0.001
3 days −0.876 0.416 (0.34–0.50) <0.001
consumption of other drugs has also been associated Problematic use of mobile phone
with the problematic use of video games, as occurs with
Occasional problems 0.611 1.843 (1.52–2.24) <0.001
the male gender, poor academic performance and poor
Frequent problems 0.273 1.314 (0.82–2.10) 0.254
family relationships [45]. The multivariate analysis of
logistic regression explores the role played by each of Constant −0.359 0.699 0.006
the variables in the problematic use of each ICT when Video games Coefficient OR (CI 95 %) p
combined with other variables [32, 42]. Female −0.704 0.49 (0.41–0.60) <0.001
The risk of problematic use of mobile phones is simi- Good relationship with family −0.645 0.53 (0.41–0.67) <0.001
lar to other studies [37, 46]. It is greatest in the public Binge drinking 0.392 1.48 (1.17–1.87) 0.001
school students, as well as in those who use tobacco,
Cannabis 0.406 1.50 (1.15–1.97) 0.003
have poor family relationships and that send more than
Smoking 0.954 2.60 (2.00–3.37) <0.001
10 SMS messages per day [29]. While we are unaware of
the association mechanism for type of school with prob- After-school activities
lematic mobile phone behaviour, is may be related to so- 1 day −0.725 0.48 (0.34–0.69) <0.001
cioeconomic status. Tobacco may constitute a group 2 days −0.678 0.51 (0.40–0.64) <0.001
socialization marker. Once again, the main risk factor is 3 days −0.906 0.40 (0.33–0.50) <0.001
intensity of use, measured as the number of SMS messages. Problematic use of video games
Clearly, today SMS text messages would be substituted
Occasional problems 0.042 1.04 (0.85–1.28) 0.692
by WhatsApp messages. Our data suggest that, compar-
Frequent problems 0.483 1.62 (1.18–2.23) 0.003
ing to Internet and video games, there is a scarce evi-
dence for considering mobile use as a problematic Constant −0.413 0.66 0.009
behaviour [22]. The adolescent not considered video
games, which generate intense social alarm, as prob- present study (6.2 %) indicates a highly comparable
lematic as other ICT [37]. In our case, the prevalence prevalence than those found in other European coun-
rate of problematic use of video games found in the tries [10, 47, 48].
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 9 of 11

Those students whose parents controlled their game that some losses correspond to individuals with an at-risk
playing time had more occasional problems with this profile, although data collection was carried out during
technology. We feel that this may be explained as a reac- the academic day in order to minimize this possibility.
tion to the intensification of playing time in children by The fast evolution of the ICT has limited the study’s
parents who are more sensitized and active in the con- future validity, since current mobile phone devices
trol of video game use. In the multivariate analysis, already permit access to the Internet, interaction in the
problematic use was associated with the profile of a male social networks and on-line games, which at the time of
student, solitary player, dedicating many hours to the this study were at very early stages.
game, and having poor family relationships.
Based on the results obtained, data suggest that in all Conclusions
of the analysed ICT, intensive use is a good marker of Of the surveyed adolescents, 13.6 % presented addictive
addiction, regardless of the type of use that is engaged behaviour in regards to the Internet. However, the preva-
in. Similarly, poor family relationships appear to be an lence with respect to mobile phones and video games was
important risk factor for ICT problems. quite lower.
As for academic failure, we feel that this may be a good The coexistence of problematic ICT use with the use
indicator of the effect of the use of the new technologies in of drugs, intensive use of technology, poor family rela-
adolescents, although there are authors who have observed tionships and poor academic performance was observed.
more failure in youth who do not use computers [49]. In Intensive use was a good marker of problematic use of
our case, it has been associated with the presence of fre- the ICT.
quent problems with Internet and video game use and oc- The role of the family may be fundamental in preven-
casional problems with mobile phone use. In an earlier tion efforts.
article, we reported the relationship between low academic Interventions at an early age may be necessary in order
performance and the intensive use of the ICT [28]. to strengthen a healthy adolescent relationship with the
In the multivariate analysis, poor academic perform- ICT, primarily with the Internet.
ance appears to be related with a combination of con-
Acknowledgements
sumption of toxic substances and the moderate or This study has been made possible thanks to the collaboration of the
frequent use of the Internet, mobile phones or video students and teachers of the secondary education centres from Sabadell
games. Being female, having good family relationships (IES Ferran Casablancas, IES Arraona, IES Agustí Serra, IES Miquel Crusafont,
IES Pau Vila, IES Vallès, IES Jonqueres, IES Ribot i Serra, El Carme, Servator,
and participating in after-school activities appear as pro- Bertran, Tarrés, La Immaculada, Mare de Déu de la Salut, Ramar 1, Santa
tective factors (Table 6). Clara, Sant Nicolau), Castellar del Vallès (IES Castellar, IES Puig de la Creu,
These findings suggest that in adolescents, the prob- El Casal, La Immaculada), Santa Perpètua de Mogoda (IES Estela Ibèrica, IES
Rovira Forns, Sagrada Família), Palau-Solità i Plegamans (Marinada), IES Sant
lematic use of ICT is a risk factor for academic failure, Quirze del Vallès, IES Sentmenat and IES Polinyà, as well as of nurses from
in addition to others that may be inherent in this evolu- the Salut i Escola program: Dolors Alcaraz Sanz, M. Ángeles Gómez Mateo,
tionary stage such as starting to consume toxic sub- Concepción Caminal Olivé, Cristina Arranz Delgado, Concepció Mestres
Hugas, Piedad Díaz Borja, Mónica Baraut Martínez, María Clotilde González
stances. This damaging effect is possibly related to the Calvo, Cecília Quer Raves, Vanessa Cruz Muñoz, Pilar Padilla Monclús, Núria
interference and imbalance caused in the acquisition of Llistar Verdú, Maria Franquesa Freixanet, Carme Forts Llorens, María José
study habits. Therefore, we agree with other authors that Montoto Lamela, Carmina Gil Guitart, Laura Cubinsà Esquius, Meritxell Virgós
Soler, Matilde Fernández Juan, Ángeles Vara Ortiz and Assumpta Fatjó Gené.
during the 1st cycle of ESO, it is necessary to undertake They all participated in data collection for this study.
more future preventative actions in this area [5, 30]. We also wish to thank Fernando Rupérez Vielba and Marta Serra Laguarta
(Servei d’Atenció Primària Vallès Occidental) for their contributions to the protocol
creation; Cristina Moreno Ramos (Direcció d’Atenció Primària Metropolitana Nord),
Limitations Eulàlia Picas Riera, Josep Arnau Figueras, Rosa M. Perarnau Piñero and Gemma
Although the transversal design of the study does not Morales Puig (Departament d’Ensenyament - Serveis Territorials del Vallès
permit the establishment of causality between the vari- Occidental) and Paqui Vargas Manzano (Direcció d’Atenció Primària
Metropolitana Nord) for their logistical support and dedication.
ables, we have generated hypotheses that should be ex-
amined in future longitudinal studies. In fact, despite Funding
certain variability in some results, there is a considerable This project has not received funding.
agreement found with other studies. The use of different Availability of data and materials
validated instruments to evaluate the problematic use of The data supporting the conclusions of this study are available upon
Internet, video games and mobile phones and the variety of reasonable request and under the supervision of IDIAP Jordi Gol.
cultural contexts prevents the comparison between studies. Authors’ contributions
Since this was a self-administered study, it is possible JMM, NM and PT contributed to the conceptualization, study design and
that under-declaration took place for those behaviours data analysis. RMM, ROG, MRLM and CBM contributed to the
conceptualization, design, data collection and writing of the article. AC and
that are considered to be socially negative, as is the case XC contributed to the writing of the article. All of the authors reviewed and
with academic failure or drug consumption. It is possible approved the article prior to its publication.
Muñoz-Miralles et al. BMC Pediatrics (2016) 16:140 Page 10 of 11

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Barcelona, Spain. 3Àrea Bàsica de Salut Manresa 2, Institut Català de la Salut, 22. Billieux J, Maurage P, Lopez-Fernandez O, Kuss DJ, Griffiths MD. Can
Manresa, Barcelona, Spain. 4Centre d’Atenció Primària Santa Perpètua de disordered mobile phone use be considered a behavioral addiction? An
Mogoda, Institut Català de la Salut, Santa Perpètua de Mogoda, Barcelona, update on current evidence and a comprehensive model for future
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