Internet addiction in high school students 15

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European Journal of Public Health, Vol. 24, No. 1, 15–20
 The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
doi:10.1093/eurpub/ckt051 Advance Access published on 30 May 2013
.........................................................................................................
Prevalence and risk factors of Internet addiction in high
school students
Tayyar Şaşmaz1, Seva Öner1, A. Öner Kurt1, Gülçin Yapıcı1, Aylin Ertekin Yazıcı2, Resul Buğdaycı1,
Mustafa Şiş1

1 Department of Public Health, Mersin University School of Medicine, Turkey

2 Department of Psychiatry, Mersin University School of Medicine, Turkey

Correspondence: Tayyar Şaşmaz, Mersin Universitesi Tip Fak Halk Sagligi AD Ogretim Uyesi, Çiflikköy Kampüsü, 33343
Yenisehir Mersin, Turkey, Tel: +90 324 3610684/1048, Fax: +90 324 3412400, e-mail: sasmaz_tayyar@yahoo.com

Aim: In this study, the prevalence and risk factors of Internet addiction in high school students was investigated.
Material and Method: This cross-sectional study was performed in the Mersin Province in 2012. The study sample
consisted of students attending high school in the central district of Mersin. The data were summarized by de-
scriptive statistics and compared by a binary logistic regression. Results: Our study population included 1156
students, among whom 609 (52.7%) were male. The mean age of the students was 16.1  0.9 years. Seventy-
nine percent of the students had a computer at home, and 64.0% had a home Internet connection. In this study,
175 (15.1%) students were defined as Internet addicts. Whereas the addiction rate was 9.3% in girls, it was 20.4%
in boys (P < 0.001). In this study, Internet addiction was found to have an independent relationship with gender,
grade level, having a hobby, duration of daily computer use, depression and negative self-perception. Conclusion:
According to our study results, the prevalence of Internet addiction was high among high school students. We
recommend preventing Internet addiction among adolescents by building a healthy living environment around
them, controlling the computer and Internet use, promoting book reading and providing treatment to those with
a psychological problem.
.........................................................................................................

Introduction environment. Today, problematic Internet use and Internet

addiction appear to be social issues that should be addressed
he advent of computers and the Internet has led to a series of
Tdramatic changes and developments in the ways of generating, without delay. In this regard, adolescents and young adults
constitute the largest target group.1–5
storing and sharing knowledge. Overuse of computers and the A meta-analysis of Internet addiction has noted that high school
Internet creates physical, mental and social problems. Although it students and young men are the high-risk groups.3 In Taiwan, the
is not recognized as a standard definition, Internet addiction is prevalence of Internet addiction among high school students has
defined as experiencing physical, mental and social problems been reported as 13.8%, with higher rates in men and students
because of Internet and computer overuse. Internet addiction has attending vocational schools.6 However, another study in Taiwan
a negative impact on workplace relations, interaction with friends, showed the prevalence of Internet addiction in high school
academic life and family life. Internet addicts spend most of their life students as 20.1%.4 In China, 2.4% of the adolescents were
in front of the computer passing time with e-mails, chatting, Internet addicts, and scores for comorbid disease and impulsivity
discussion forums and online games. In a sense, we can say that scale scores are reported to be higher in students with Internet
Internet addicts move their social lives into the Internet addiction.7 In Korea, it was shown that 30% of the adolescents
16 European Journal of Public Health

were ‘possible’ Internet addicts, and 4.3% were Internet addicts; the Third section: The symptoms of the psychiatric diseases were
prevalence of Internet addiction was 6.8% in male and 3.5% in determined by the Brief Symptom Inventory (BSI) scale. The
female adolescents. Furthermore, in Korea, the students with validity and reliability of the BSI scale was tested by Sahin and
Internet addiction were more frequently observed to have psychi- Durak.18 High scores indicate the presence of psychiatric
atric issues such as somatization, obsessive compulsivity, depression, symptoms in the related subgroup.
anxiety, hostility, phobic anxiety and psychosis.8 A pilot study of the questionnaire was tested on 30 students in a
Such studies are also being performed and published in Turkey. high school that had not been included in the study group. After this
Here the prevalence of Internet use has been shown to be higher in pilot study, the items that were not clearly understood by the
male than in female individuals, and the symptoms of psychiatric students were revised and corrected.
diseases have been shown to become more common with increasing
duration of Internet use.9 The prevalence of ‘possible’ Internet
Data collection
addiction has been noted to be 11.6% in high school students.10
Thirty-one percent of Turkish students connected to the Internet The classes from the selected high schools were chosen in a
at least once a day. Furthermore, the duration of Internet use randomized fashion. The students were given parental consent
among Turkish students has been noted to be higher in male forms, and the students whose parents signed the parental consent
individuals as well as in students at a moderate or high form were enrolled in the study on the following day. The teachers
socioeconomic level, attending vocational schools or having low were kept away from the class and the investigators were present
success at school.11 while the students completed the questionnaires.
Both national and international studies suggest that Internet A total of 1215 students received consent forms in the study. As 47
addiction is an important public health problem in adolescents parents did not give consent, our study included 1168 students.
and young people. In our country, there is a need to investigate During the transfer of the questionnaires into the computer for
the association of this issue with sociodemographic factors and analysis, 12 students whose questionnaires had substantial missing
psychiatric issues. In this study, we aimed to investigate the data were excluded from the study. Eventually, questionnaires from
prevalence and risk factors of Internet addiction in high school 1156 students were included in the study and analyzed. In all, 389
students. (33.7%) were 9th graders, 371 (32.0%) were 10th graders and 396
(34.3%) were 11th graders.

Methods
Data analysis
This cross-sectional study was conducted between 12 March 2012 The data were summarized by descriptive statistics. The chi-squared
and 6 April 2012 in high schools located in the central district of test and the linear-by-linear model were used for the comparison of
Mersin. The students of those high schools constituted the study categorical variables; the Mann–Whitney U test was used for the
population. The study was conducted by the Department of Public comparison of numerical variables; Pearson correlation coefficient
Health, Faculty of Medicine, Mersin University, following receipt of was used for the comparison of two numerical variables and binary
official permission and approval of the ethics committee of the logistic regression was used for determination of risk factors for
University. Internet addiction. Independent variables exhibiting a statistically
significant correlation with Internet addiction in the univariate
Sample size and selection analyses were included in the model.
National and international studies report that the prevalence of
Internet addiction in adolescents and high school students varies Results
between 2.4 and 18.8%.4,6–8,10,12–16 In total, 52 467 students attend
91 high schools in the central district of Mersin. The minimum In total, 1156 students, 609 (52.7%) male and 547 (47.3%) female,
sample size was calculated to be 850 students (10% prevalence, were included in the study. The mean age of the study population
95% confidence interval, 2 margin of error). Thus, we decided was 16.1  0.9 years. Nine hundred thirteen (79.0%) of the students
to include 1200 individuals in the study. had a computer at home, 444 (38.4%) of those had their own
Twelve schools to be included in the study were selected in a computer, and 740 (64.0%) had Internet access at home. The
randomized fashion. Although we had planned to enroll 9th, 10th, percentage of students with at least one e-mail or social network
11th and 12th graders, 12th graders could not be reached owing to account was 88.6 and 90.5%, respectively. Computers and the
their preparation for the Higher Education Examination. Therefore, Internet were reported to be used for education/homework/
12th graders were excluded from the study and 1200 students were research purposes by 918 (81.5%) students and for communication
targeted to be included. and social networking by 761 (67.6%) students (table 1).
One hundred seventy-five (15.1%) of the students were classified
as Internet addicts. The prevalence was 9.3% in female and as high as
Questionnaire 20.4% in male individuals (P < 0.001). The prevalences of Internet
We used a structured questionnaire for the study. The questionnaire addiction were 18.0, 17.3 and 10.4% for grade 9, 10 and 11 students,
consisted of three sections to be completed by the participants. respectively; the prevalence of Internet addiction was observed to
First section: This included questions involving gender, age, grade show a decremental trend from lower- to higher-grade students, and
level, smoking and alcohol consumption status, characteristics of the this relationship was statistically significant (linear-by-linear test,
Internet and computer use and the educational and employment P < 0.01). The analysis focusing on the relationship of Internet
status of the parents. addiction with subgroups of gender and grade level revealed that
Second section: The Internet addiction level of the students was there was no statistically significant correlation between Internet
evaluated by the Internet Addiction Scale, which is a valid and addiction and grade level in male individuals (P > 0.05), whereas
reliable assessment tool. The Internet Addiction Scale is a 27-item Internet addiction was found to be higher in ninth-grade students
5-point Likert-type evaluation tool that was first developed by than in other students among female individuals, and this difference
Griffith17 and adapted into Turkish by Canan et al.10 The total was statistically significant (P < 0.05). Similarly, the comparison of
score that can be gained from the scale ranges between 27 and students relative to grade level showed that Internet addiction was
135. The adapted Turkish version used 81 as the cutoff point. higher in male than in female individuals in all grades (9th grade,
Students who scored 81 were recognized as ‘Internet addicts’. P < 0.05; 10th grade, P < 0.001; 11th grade, P < 0.01) (tables 2 and 3).
 Internet addiction in high school students 17

Table 1 Demographic and computer use characteristics of the study Table 2 Internet addiction relative to demographic characteristics
population
Variables Internet addiction P
Variables n %/median
Yes No
Age (median) 1156 16.0
Gender n %/median n %/median
Male 609 52.7
Female 547 47.3 School type
School type Anatolian high school 47 13.2 309 86.8 >0.05
Anatolian high school 356 30.8 Regular high school 46 13.9 286 86.1
Regular high school 332 28.7 Private high school 6 12.5 42 87.5
Private high school 48 4.2 Vocational high school 76 18.1 344 81.9
Vocational school 420 36.3 Gender
Grade level Male 124 20.4 485 79.6 <0.001
9 389 33.7 Female 51 9.3 496 90.7
10 371 32.0 Grade level
11 396 34.3 9 70 18.0 319 82.0 <0.01a
Frequency of book reading 10 64 17.3 307 82.7
Once a week 259 23.2 11 41 10.4 355 89.6
Once a month 425 38.0 Frequency of book reading
Less frequent 308 27.6 Once a week 27 10.4 232 89.6 <0.001a
Not reading 125 11.2 Once a month 50 11.8 375 88.2
Meeting with friends Less frequent 52 16.9 256 83.1
Each day 192 17.2 Not reading 41 32.8 84 67.2
3–4 days a week 221 19.8 Meeting with friends
1–2 days a week 391 35.1 Everyday 41 21.4 151 78.6 <0.01
Less frequent 311 27.9 Less frequent 127 13.8 796 86.2
Hobbya Having at least one hobby
Sports (football, basketball, tennis, etc.) 603 52.2 Yes 154 14.7 893 85.3 >0.05
Art (music, painting, theatre, etc.) 512 44.3 No 21 19.3 88 80.7
Literature (book reading, poetry, essays, etc.) 352 30.4 Hobbyb
Computer (games, Internet, communication, etc.) 198 17.1 Computer (gaming, Internet, etc.) 67 33.8 131 66.2 <0.001
Walking for pleasure 179 15.5 Other hobbies 87 10.2 762 89.8
TV (documentary, series, news, etc.) 51 4.4 Art (music, painting, theatre, etc.) 56 10.9 456 89.1 <0.01
No hobby 109 9.4 Other hobbies 98 18.3 437 81.7
Median monthly allowance (Turkish Lira) 1096 25.0 Literature (book reading, 35 9.9 317 90.1 <0.01
Median monthly family income (Turkish Lira) 951 1500.0 poetry, etc.)
Computer at home Other hobbies 119 17.1 576 90.1
No computer 243 21.0 Median monthly allowance 225 25 926 25 0.05c
One shared computer 469 40.6 Median monthly family income 152 1500 799 1500 0.05c
Own computer 444 38.4 History of at least one 53 23.7 171 76.3 <0.001
Computer type cigarette smoking
No computer 243 21.0 No history of cigarette smoking 122 13.1 810 86.9
At least one desktop computer 654 56.6 Parent
Other computer 259 22.4 Both alive and together 154 15.4 849 84.6 0.05
Internet at home Other 21 13.7 132 86.3
No 416 36.0 Father’s education background
Yes 740 64.0 Primary school or less 63 14.9 360 85.1 >0.05
Internet with quota 206 17.8 Junior high school 29 15.2 162 84.8
Internet without quota 534 46.2 High school 53 17.8 244 82.2
Computer/Internet use outside the home University 29 13.2 191 86.8
Yes 762 65.9 Mother’s education background
No 394 34.1 Primary school or less 85 14.2 515 85.8 <0.05
Having an e-mail account Junior high school 26 16.0 136 84.0
No 132 11.4 High school 49 19.5 202 80.5
Yes 1024 88.6 University 12 9.0 121 91.0
Having a social network account
No 110 9.5 a
Linear-by-linear association.
Yes 1046 90.5 b
The participants mentioned a variety of hobbies. The students
Aim of Internet usea
Education, homework, research 918 81.5
categorized in our major hobby groups were separately compared
Communication, social networking 761 67.6 with the ones having other hobbies.
c
Entertainment, music, movies 458 40.7 Mann–Whitney U test.
Gaming, gambling 388 34.5
a
The participants provided more than one answer. showed that depression and negative self-perception raised
Internet addiction 1.03- and 1.05-fold, respectively (table 4).

The variables showing a statistically significant correlation with

Internet addiction were evaluated by the binary logistic regression
Discussion
analysis. The final results revealed that Internet addiction was In this study, we determined a high prevalence (15.1%) of Internet
2.0-fold more common in male than in female individuals; addiction among adolescents. Furthermore, Internet addiction was
2.7- and 2.3-fold more common in 9th and 10th graders than found to be independently related to gender, grade level, duration of
11th graders, respectively; 1.2-fold more common in students with computer use, book reading, having a hobby, depression and
increased daily duration of computer use; 2.1- and 3.3-fold more negative self-perception. Although rates of computer and Internet
common in students reading less than one book each month and use have been increasing both in our country and worldwide at all
reading no book at all in a week, respectively and 2.9- and 2.3-fold ages, they show a particular increase among adolescents. As adoles-
more common in students interested in computers as a hobby and in cents undergo serious developmental changes while growing up, it is
students with no hobby at all, respectively. Furthermore, a BSI easier for them to be carried away by the rich and captivating
18 European Journal of Public Health

Table 3 Relationship of Internet addiction with computer/Internet use and Brief Symptom Inventory in students

Variables Internet addiction P

Yes No

n %/median n %/median

Computer at home
No computer 24 9.9 219 90.1 <0.01
One shared computer 64 13.6 405 86.4
Own computer 87 19.6 357 80.4
Computer type
No computer 24 9.9 219 90.1 <0.01
At least one desktop computer 122 18.7 532 81.3
Other computer 29 11.2 230 88.8
Internet at home
No 41 9.9 375 90.1 <0.001
Yes 134 18.1 606 81.9
Internet with quota 32 15.5 174 84.5 >0.05
Internet without quota 102 19.1 432 80.9
Computer/Internet use outside the home
Yes 133 17.5 629 82.5 <0.01
No 42 10.7 352 89.3
Internet access through cell phone
Have no cell phone 19 11.3 149 88.7 =0.05
Not connecting through cell phone 38 12.5 265 87.5
Connecting through cell phone 118 17.2 567 82.8
Having an e-mail account
No 9 6.8 123 93.2 <0.01
Yes 166 16.2 858 83.8
Having a social network account
No 5 4.5 105 95.5 <0.01
Yes 170 16.3 876 83.7
Aim of computer use
Education, homework, research 125 13.6 793 86.4 <0.01
Other 48 23.1 160 76.9
Communication, social networking 132 17.3 629 82.7 <0.01
Other 41 11.2 324 88.8
Gaming, gambling 90 23.2 298 76.8 <0.01
Other 83 11.2 655 88.8
Median duration of computer use (h/day) 166 3.0 864 1.5 <0.001a
Median duration of staying connected (h/day) 155 2.5 756 1.0 <0.001a
Median duration of staying connected to Internet through cell phone (h/day) 118 3.0 567 1.0 <0.001a
Median number of e-mail accounts 175 2.0 981 1.0 <0.001a
Median number of social network sites 175 2.0 981 1.0 <0.001a
Median anxiety score 175 19.0 981 9.0 <0.001a
Median depression score 175 20.0 981 11.0 <0.001a
Median negative self-perception score 175 17.0 981 8.0 <0.001a
Median somatization score 175 9.0 981 5.0 <0.001a
Median hostility score 175 13.0 981 8.0 <0.001a
a
Mann–Whitney U test.

Table 4 Risk factors of Internet addiction

environment of the Internet and begin to experience social, mental
Variables Exp(B) 95% CI P and physical problems as a result. Therefore, the adolescents can be
regarded as the most vulnerable age group for Internet addiction.
Gender Studies note that the prevalence of Internet addiction varies
Male 2.00 1.23–3.24 <0.01
Female 1.00
between 2.4 and 18.8%.4,6–8,10,12–16 This rate is reported to vary
Grade level between 0 and 26.3% in the USA19 and 4.4 and 13.5% in the
9 2.72 1.60–4.63 <0.001 European Union.20 According to the literature data, the prevalence
10 2.37 1.40–4.02 <0.01 of Internet addiction appears to vary within a wide range. In our
11 1.00 study, the prevalence of Internet addiction among adolescents was
Hobby
Other hobby 1.00
observed to be close to the upper limit. Such a high rate may be
Computer-related hobby 2.99 1.88–4.75 <0.001 associated with poor reading habit and inadequate involvement in
No hobby 2.31 1.19–4.49 <0.05 cultural, artistic and sportive activities.
Frequency of book reading In the present study, there was a negative correlation between the
Once a week 1.00 0.80–2.66 >0.05 frequency of book reading and the development of Internet addiction.
Once a month 1.46 1.15–3.92 <0.05
Thus, reading no books at all and reading less than one book per
Less frequent 2.12 1.67–6.82 <0.01
Not reading 3.38 month were shown to be independent risk factors of Internet
Depression 1.03 1.01–1.05 <0.01 addiction. To our knowledge, there are no literature data about this.
Duration of computer use (h/day) 1.26 1.16–1.37 <0.001 This result is an original finding of our study. It is recommended that
Negative self-perception 1.05 1.02–1.07 <0.001 book reading should be considered in the struggle against Internet
Constant: 5.56
addiction, and students should be oriented toward book reading.
 Internet addiction in high school students 19

In the literature, Internet addiction and ‘problematic’ Internet therefore gradually increase their duration of Internet use to
use are reported to be more common in men.1-4,6,8,10,12,13,15,16,19-22 boost their feeling of joy. This process of self-satisfaction
Unlike other studies, a study in Korea reported no statistically increases the risk of developing Internet addiction. Therefore,
significant correlation between gender and Internet addiction or hobbies and activities (sports, art, science, travel and cultural
‘possible’ Internet addiction.23 In our study, the prevalence of activities) associated with real life should be highlighted, and
Internet addiction was higher in male individuals of all grade children should be encouraged to use Internet and computers for
levels, and being a male was found to present a 2-fold these activities.
increased risk of Internet addiction. Our study result supports Research on adolescents indicates a significant relationship of
the results of other studies, with the exception of the study in Internet addiction with psychological and psychiatric problems.
Korea. This result can be explained in two ways. First, male and Based on these studies, Internet addiction has been reported
female individuals have different aims with regard to computer to have a relationship with depression, anxiety, attention deficit
and Internet use. Studies show that men use the Internet longer and hyperactivity disorder, social phobia, solitude, hostility,
than women, and they are also known to use it more for gaming, aggressive behaviours, suicide, psychological dysfunction and
sex, entertainment and social networking, but less for academic emotional and behaviour problems.4,5,7,9,15,16,18,20,23,26,27 Similarly,
works.1,12,20,24 Second, men are known to use other addictive in our study, depression and negative self-perception were shown
substances more commonly as well.25 A meta-analysis on to be independent risk factors for Internet addiction. The associ-
Internet addiction3 notes that people with a history of addiction ation between Internet addiction and psychological problems is
are at a higher risk for development of Internet addiction. These noted to be a two-way relationship, that is, psychological
factors may explain the elevated rate of Internet addiction among problems may lead to Internet addiction and Internet addiction
men. Therefore, it is recommended to choose male individuals as may cause psychological problems as well. Furthermore, negative
the target group in studies focusing on curbing Internet addiction factors such as depressive thoughts, low self-confidence and
at schools. poor self-perception may also contribute to the development of
Ko et al.4 conducted a study on adolescents and reported a direct Internet addiction. On the other hand, Internet may help people
correlation between age and Internet addiction. Yang and Tung6 to forget their insurmountable problems. Such mental satisfac-
studied high school students and noted that although the tions may explain the urge felt by people to start using Internet
prevalence of Internet addiction drops with grade, this was not stat- again. Some emotions such as euphoria, excitement and happiness
istically significant. Johansson and Gotestam12 studied Norwegian may be supportive of Internet use. When an Internet addict does
high school students and found no relationship between age not use the Internet, he/she experiences negative emotions and
and Internet addiction. In our study, we did not find a significant feels unhappy, lonely and anxious; however, all those negative
correlation between age and Internet addiction either. However, emotions are instantly replaced by joy, euphoria and excitement
the prevalence of Internet addiction was higher in 9th and 10th on gaining Internet access. In this process, psychological problems
graders than in 11th graders. This result may be associated with contribute to the Internet addiction, whereas Internet addiction
the education and examination systems of our country, as there may increase the psychological problems as well.3,28,29 Therefore,
is a difficult examination between primary school and high school. students with a psychological problem constitute a risky group
When students enrol in a high school (as a 9th grader) according for Internet addiction. To curb Internet addiction, it is recom-
to the results of this examination, they tend to relax and exhibit mended that these students are given psychological and medical
a declining interest in lessons, while spending more time in leisure support.
activities such as those involving computers and the Internet. In conclusion, the prevalence of Internet addiction among ado-
However, there is a Higher Education Examination, also called lescents was found to be as high as 15.1%. The independent risk
the university examination, awaiting them in the 12th grade. factors of Internet addiction were determined to be the male gender,
Therefore, students generally perceive the seriousness of the being a 9th or 10th grader, increased duration of Internet use, having
situation in the final high school years and start to devote most a hobby related to computers or having no hobby at all, reading less
of their time to preparations for the university examination. Thus, than one book per month or reading no book at all, depression and
the education and examination system of our country may be negative self-perception.
the underlying cause of high Internet addiction rates during the
first years of high school, which then show a decline toward final
years.
Study Limitations
Computer and Internet are used in every aspect of life, from Because we performed our study close to the date of higher
entertainment to shopping and banking procedures. The dazzling education examination, 12th graders could not be reached at
speed of new technologies widens the use of computer and Internet schools and therefore were excluded from the study. The participa-
in daily life. Recently, particularly among adolescents, the duration tion rate will be higher in future studies if such periods of absence
of computer and Internet use has been further increased as a result are considered beforehand.
of the availability of cell phones with Internet access. Published
data demonstrate that Internet addicts exhibit a longer duration
of Internet use, and the risk of Internet addiction increases with
Acknowledgements
raised durations of Internet use.1,3 Internet addiction is not only The authors acknowledge the collaboration of the administrators
related to the duration of computer and Internet use, it is and teachers at Mersin Hac| Sabanc| Anatolian High School
associated with the ‘purpose’ of computer and Internet use as during the pilot study of the questionnaire. They also gratefully ac-
well. The literature data show that using computer and Internet knowledge Ray W. Guillery and Sibel Kalaca for their assistance with
for non-educational purposes (download programs, music or the English edition of this article.
movies; enter pornographic sites; play online games or chat) con-
tributes to Internet addiction.6,8 Similarly, in our study, having a
hobby related to computers and increased duration of Internet use Funding
were found to be independent risk factors for Internet addiction. This project was supported by the Scientific Research Projects Unit
Adolescents tend to use Internet for easier and entertaining of Mersin University within scope of the Rapid Support Project
activities such as playing games, chatting and watching movies (protocol code, BAP-TF DTB [CTS] 2012-2 HD).
rather than for educational purposes. Adolescents who fail to
socialize in real life feel more comfortable on the Internet and Conflicts of interest: None declared.
20 European Journal of Public Health

13 Choi K, Son H, Park M, et al. Internet overuse and excessive daytime sleepiness in
Key points adolescents. Psychiatry Clin Neurosci 2009;63:455–62.
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 Depression and negative self-perception raised Internet Sychology and the Internet. New York: Academic Press, 1998: 61–75.
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