Prediction of internet addiction among high school students in a rural Southern Karnataka, India—A cross-sectional study

Abstract

BACKGROUND:

According to the World Health Organization, there is an explosion in the use of electronic devices, the internet, and gaming platforms. In many countries, it is a significant public health concern, prompting calls to identify adequate public policy. We aimed to investigate the prevalence of internet addiction (IA) among high school students and to assess the relationship between the internet addiction level of high school students and their demographic features with internet use.

MATERIALS AND METHODS:

A cross-sectional study was conducted among 424 high school children studying in eighth standard–tenth standard. Among 121 public and private high schools listed by the BEO (Block Education Officer) Office in Kolar Taluk four high schools were selected by lottery method from July 2021 to August 2021. The Internet Addiction Test (IAT) by Young was used to assess the intensity of internet usage.

RESULTS:

The mean IAT score of study participants was 29.6. The mean age of the study population was 14.4 ± 0.84 years. The odds of internet addiction among female students were 4.5 times higher than among male students. The majority (91.5%) of the students had used the internet for educational purpose and the other common reasons for internet usage is social media (43%), entertainment (43%), and gaming purpose (21%).

CONCLUSION:

The prevalence of IA among high school students is 14.6% with the moderate-risk population was 12.5% and the high-risk population was 2.1%. Students using the internet for both academic and non-academic purposes were more internet addicted. The real challenge is to have control over the usage of social sites—the amount of time being spent and the type of activities adolescents are doing online.

Introduction

According to the World Health Organization, there is an explosion in the use of electronic devices, the internet, and gaming platforms. Excess internet use was documented with negative health concerns. In an increasing number of countries, the problem is now of significant public health concern, prompting calls to identify adequate public policy and health sector responses.[1]

We live in an age of “The Internet revolution” At this point, the availability and the cost of the Internet and the user devices have become so much affordable that the “Internet penetration rate” stood at around 50% in 2020. In 2020 half of the 1.37 billion Indians had access to the Internet and over 749 million Internet users across the country. This figure was projected to grow to over 1.5 billion users by 2040, indicating a big market potential in internet services for the South Asian country. India was ranked as the second-largest online market worldwide in 2019, coming second only to China.[2]

There has been an increase in accessibility and usage of the internet in all age groups tremendously since the past decade. There has been a remarkable increase in internet use from less than 1% in 1995 to approximately 48% of the total world population today. In 2014, the percentage of internet users worldwide was 40.4% and in India 19.9% of the total population.[3]

Internet technology is welcoming for all age groups. There is a remarkable increase in internet users. Internet usage via mobile devices is high among high school students, which is high when compared to other groups of people. The impact of this is observed in their social lives, family relations, and friendships.[4]

The Internet has revolutionized communications, to the extent that now it is our preferred medium of everyday communication. We use the Internet for ordering a pizza, buying a television, sharing a moment with a friend, and sending a picture over instant messaging. Before the Internet, if you wanted to keep up with the news, you had to walk down to the newsstand when it opened in the morning and buy a local edition reporting what had happened the previous day. But today a click or two is enough to read a local paper and any news source from anywhere in the world.[5]

Healthy internet use will serve the purpose in a reasonable amount of time without cognitive or behavioral discomfort whereas problematic internet use or Internet addiction (IA) is a psychiatric condition that can lead to maladaptive thoughts and pathological behavior.[6] In the present situation, it is difficult to estimate how widespread Internet addiction is among adolescents. Internet addicts spend most of their life in front of the computer passing time with e-mails, chatting, discussion forums, and online games. Today, problematic Internet use and Internet addiction appear to be social issues that should be addressed without delay.[7] Studies have been done to assess the prevalence of IA, a study done by Greenfield D among the general population reported IA of about 6%.[8] A study done among the college-based population by Scherer reported an internet addiction of 14%.[9]

The major symptoms of IA include (1) preoccupation with the internet, (2) withdrawal symptoms like restlessness or irritability including a feeling of anger, tension, and depression when the computer is inaccessible, (3) repeated unsuccessful efforts to control, cut back, or stop internet and so on.[10]

Internet Addiction, Internet Addiction Disorder, Compulsive Internet Use, Computer Addiction, Internet Dependence, and Problematic Internet Use – all of these are inter-changeable terms that have been applied to those who spend excessive amounts of time online at the expense of other aspects of their lives.[11]

With the internet being available around the hour and at the palm of our hand. People have become so immersed and dependent on this experience that they have immersed themselves in their online world. People not only started spending so much money on it but also used their most precious currency in browsing the internet.[12]

People have been so immersed in this experience that they started risking their hard-earned money in online gambling and online gaming. They reduced the time spent with their loved ones leading to the development of stress on multiple bases like economic, social, psychological, etc. There were cases, where people lost their livelihoods, homes, and social lives, due to excessive usage of online gaming.[13]

Although the internet contributes positively in many ways, reduction in individual productivity and other harmful effects make internet addiction a crucial issue to be considered immediately. Investigating its intensity among youths helps to intervene effectively to protect them from the threats of impaired academic performance, and physical, psychological, and social well-being. Literature regarding their health problems, prevalence, and needs is largely limited in rural India. We conducted this study to find out the internet addiction level and the various factors involved in internet addiction.

Objectives

1. To investigate the prevalence of internet addiction among high school students.

2. To identify some social and demographic factors associated with Internet Addiction among high school students during the Covid-19 pandemic.

Materials and Methods

Study design and setting

A cross-sectional study was conducted among the schools in Kolar District, Karnataka.

Study participants and sampling

Taking the 50% prevalence of IA among school students in a study by Sharma A, Sharma R in Central India.[14] The minimum sample size was calculated to be 384 students (50% prevalence, 95% confidence interval, and 10% non-response rate). Thus, we decided to include 424 (384 + 40 ≈ 424) individuals in the study.

Data collection tool and technique

Among 121 public and private high schools listed by the BEO (Block Education Officer) Office in Kolar Taluk about four high schools were selected by lottery method from July 2021 to August 2021. The Vidya Jyothi School, Jalappa School, India Public School, and Gnana Bodha School were selected. From each school, students were selected randomly who were in the age group of 14–16 years and studying in eighth, ninth, and tenth standard. From each school, 106 students were randomly selected so that a sample size of 424 was achieved from the four schools.

1. The first part of the questionnaire: Semi-structured proforma representing details of demographics, purpose of using the internet (by choosing among the options like education, entertainment, business transactions, or social networking), money spent per month, place of access (home or cybercafé) the time of day when the internet is accessed the most (by choosing between morning, afternoon, evening, or night), and the average duration of use per day was collected. Data were collected from those using the internet for at least since last six months.

2. The second part of the questionnaire: The Internet Addiction Test (IAT; Young, 1998) was a 20-item 5-point Likert scale that measures the severity of self-reported compulsive use of the Internet. Total internet addiction scores were calculated, with the possible scores for the sum of 20 items ranging from 0 to 100. The data capturing was done by Google Forms from the individual school. The Google Forms were sent to all the students’ or parents’ emails and WhatsApp groups that were procured from the concerned class teacher. The students were given complete information in the regular class regarding the study that was conducted. Google Forms were used instead of personal interviews for data collection due to the COVID-19 pandemic situation.

Statistical analysis

Data were entered in Microsoft Excel; data coding and data cleaning were done later transferred to SPSS(Statistical Package for the Social Sciences) statistical licensed software version 22 for analysis. Descriptive analysis and binominal logistic regression were done to find an association between IA and various categorical variables. A P value of <0.05 was considered statistically significant.

Ethical consideration

The study was approved by the Institutional Ethics Committee, Sri Devaraj Urs Medical College, Tamaka, Kolar (IEC Ref No, SDUMC/KLR/IEC/541/2021-22).

Results

The study sampled a total of 424 participants, everyone had exposure to the Internet. It was because due to this COVID lockdown, the classes of students were conducted online and it became almost mandatory for students to have internet exposure. The mean age of the study population was 14.4 ± 0.84 years. Among the study population, 39.6% were boys and 60.4% were girls. The study population belonged to the eighth and ninth standard.

Among them, the proportion of boys and girls was almost similar to the original ratio that was 44 (40.7%) boys and 64 (59.3%) girls for VIDYAJYOTI SCHOOL, 43 (38.7%) boys and 68 (61.3%) girls for JALAPPA SCHOOL, 40 (40%) males and 60 (60%) females for INDIA PUBLIC SCHOOL, and 41 (39.1%) boys and 64 (60.9%) girls for GNANA BODHA SCHOOL.

The maternal and paternal education were below graduation for (36%) of mothers and (34%) of fathers. The maternal and paternal education were graduation and above for (64%) of mothers and (66%) of fathers. The major occupation of fathers observed was Business (31%) proceeded by Farmer (11%) followed by Teacher (10%). For mothers, the major occupation seen was Home Maker (59%) proceeded by Teacher (21%) followed by doctor/nurse (5%) [Table 1].

Table 1.

Sociodemographic characteristics of the study participants

Variables	Number n=300	Percentage (%)
Age in years (mean±SD)	14.4±0.84
Gender
Male	256	39.6
Female	168	60.4
Education (Father)
Undergraduate	145	34
Graduate	215	51
Postgraduate	64	15
Education (Mother)		6.7
Undergraduate	153	36
Graduate	174	41
Postgraduate	95	23
Occupation (Father)
Business	129	31
Farmer	47	11
Teacher	45	10
Engineer	16	4
Doctor	16	4
Others	171	40
Occupation (Mother)
Homemaker	252	59
Farmer	7	2
Teacher	88	21
Doctor	20	5
Other	57	13
Socio-economic status (Annual Income)
<1,00,000	234	55
1,00,001-2,50,000	91	21
2,50,001-5,00,000	51	12
5,00,001-10,00,000	24	6
10,00,001	24	6

The majority of the study population had access to the internet at home (93%) with some using the internet at an internet café or friend's house (7%). Of them almost (73.8%) of children had access to the Internet for more than 2 years and around (25.5%) of children had access to the Internet for around 1-2 years whereas (0.7%) of children were relatively new to the Internet for exposure of less than 1 year. Daily time spent on the internet was less than 2 hours per day for (60.8%), 2-5 hours per day for (38.6%), and more than 5 hours per day for (0.6%) children.

According to the data, internet usage was most seen in the evening, around (70%) of the children. The children who used the internet during the morning and afternoon were around (34%) and during the night internet-using children were also (34%) of the total. The most common purpose of internet usage by children as told was Education purposes that were around (91.5%) followed by social media (Facebook/Instagram/WhatsApp, etc.) that were around (42.5%), and entertainment purposes (YouTube/Netflix/Amazon Prime, etc.) that were also (42.5%) whereas some children also used internet for Gaming and Streaming purposes that were around (21%) of the users [Table 2].

Table 2.

Frequency of Internet Use and Other Social Factors of Internet Use

Socio-demographic characteristic	Number=424	Percentage (%)
Young's S
0-24(low risk)	191	45.05
25-49(mid risk)	171	40.44
50-79(moderate risk)	53	12.5
80-100(high risk)	9	2.12
Years online
< 1 year	3	0.7
1 – 2 years	109	25.5
2 – 4 years	310	73.3
4 years	2	0.5
Daily time spent on the internet
less than 2 hours	258	60.8
2-5 hours	164	38.6
5-8 hours	2	0.6
Amount Spent on Internet Use
<3,600	212	50
3,601-7,200	80	19
>7,201	132	31
Purpose of Internet Usage
Education purposes	388	91.5
Social media like Facebook/Instagram/WhatsApp etc.	180	42.5
Entertainment like youtube/Netflix/amazon prime etc.	180	42.5
Business uses and transactions	16	4
Gaming/Streaming/Twitch etc.	88	21
Place of Internet Usage
Internet cafe/cyber cafe	20	5
Home	396	93
Friend's House	8	2
Time of Internet usage
Morning and afternoon	144	34
Evening	298	70
Night	144	34

The majority of people (50%) had a monthly expenditure of around 300₹, (19%) spent around 301₹–600₹whereas, (31%) spent more than 601₹. The most observed annual income of a family is seen to be <1,00,000₹ that was around 55%, then 1,00,001–2,50,000₹ that was around 21%, then 2,50,001–5,00,000₹that was around 12%, then 5,00,001–10,00,000₹ that was around 6% followed by >10,00,001₹ that was around 6% [Table 2].

The mean IAT score of study participants was 29.66, while the Low-risk population with Young's IAT score of 0–25 out of 100 is (45.05%), Mild risk population with Young's IAT score of 25–50 out of 100 is (40.33%), Moderate risk population with Young's IAT score of 50–79 out of 100 is (12.5%), and High-risk population with Young's IAT score of 80–100 out of 100 is (2.12%). The odds of internet addiction among females is 4.5 times higher than males and it is statistically significant. The odds of internet usage for education purposes are 1.28 times when compared to any other purposes but it is not statistically significant, but 92% of the students were using the internet for education purposes that were statistically significant. The other reasons for internet usage are social media (43%), entertainment (43%), gaming purposes (21%), and other purposes (4%). The odds of spending time than <2 hours on the internet is about 2.8 times compared to >2 hours or >5 hours and it is not significant. The majority of the students were using the internet at home (93%) and it was significant (>0.003) [Table 3].

Table 3.

Factors related to internet addiction and internet use pattern among school children

Category			Internet Addiction		P	Odds Ratio (95% CL)
Gender	No	%	No	%
Male	168	39.6	45	10.6	0.01	4.535
Female	256	60.4	17	4
Internet Use in Years
<1 year	3	0.7	1	0.2	1	1.297
1 – 2 years	109	25.5	7	1.6		1.295
3 – 4 years	310	73.3	55	13		1.711
> 4 years	2	0.5	2	0.5		6.707
Place of Internet Use
Internet Café	20	5	2	0.47	0.028	0.069
Home	396	93	55	13	0.003	0.065
Friends Home	8	2	5	1.2	…	…

Discussion

In our study, we estimated 12.5% (Moderate level) as the prevalence of IA among high school students. Severe IA was a little higher 2.1% when compared to a study conducted by Tenzin k et al. in which 1.58% of students had severe IA.[15] In a study conducted by Prabhakaran MC et al., the prevalence of IA was found to be 8.7%. In the study conducted at Jodhpur City by Sharma P et al., the prevalence was found to be 4.8%.[16,17] The mean age of the school children was 14.4 ± 0.84 years in our study similarly a mean age of 14.3 ± 1 years was used to find the IA and other predictors by Shresta N, D'mello MK. in Karnataka, which was found to be an important age category for IA prediction.[18] Our study revealed that the odds of IA were 4.53 times higher when compared to girls. There was a closer resemblance with our study where male children of similar age had significant IA with (Odd's Ratio) OR of 5.96 in a study conducted by E Anwar at Lucknow.[19] Whereas in the study conducted by Kayastha B et al. there was no gender difference, but other sociodemographic findings revealed closely with our study of which no statistical significance like the purpose of internet use, father education, mother education, time of internet use, duration of internet use, and amount spent on internet use.[20] The present study showed that school children use the internet for education purposes were 91.5%, for social media like Facebook, WhatsApp, and Instagram at 42.5%, for entertainment like YouTube, Netflix, and Amazon Prime about 42.5%, and for gaming purposes about 21% of the children were browsing the internet. There is a little closer association for social media use like chatting (55.2%), online friendship (22.7%), and online gaming (35.4%) in a study conducted at Vadodara.[16] In a study conducted by A Kalkim and Z. Emlek Sert in Turkey among primary school students browsing the internet for education purposes showed 45.5% whereas in our study school children used the internet for education purposes almost double (91.5%). There is a significant association (>0.00) for IA among the students browsing for more than two hours (25.6%) but in our study, only 7.1% of the students who were browsing for more than two hours were internet addicts that were not significant (1.000).[21] The students who are browsing the internet at home were found to be internet addicts (13%) and this is statistically significant. Similar findings were reported by Arthanari S et al. where IA for home browsers among the students came to be statistically significant.[10] Around 164 (38.6%) high school students spent 2–5 hours on the internet daily, whereas among the 196 (50.9%) nursing students have spent 3–4 hours daily on the internet.[22]

Limitation and recommendation:

We performed our study from July 2021 to August 2021 thatis the second wave of the COVID-19 pandemic. During this period, many schools were closed and classes were scheduled through online modes of teaching (Through WhatsApp video calls or Zoom classes). In this regard, there is a chance of more school students using smartphones and the bias of more internet addiction could be estimated.

The results of the present study indicate that the problem of internet addiction is real and needs appropriate attention from authorities. In our study, the prevalence of IA among high school students in this study is 14.6% with the moderate-risk population being 12.5% and the high-risk population was 2.1%. Students using the internet for both academic as well as non-academic purposes were more internet addicted. The real challenge is to have control over the usage of social sites – the amount of time being spent and the type of activities adolescents are doing online. It is essential to have control of social sites. At present, computer and internet education have become a regular part of the curriculum in all schools. Educational programs about safe internet use, prevention programs, recovery centers, support groups, and integration of training workshops specializing in IA must be encouraged to address this problem, especially among students. The role of teachers and parents is crucial in monitoring children's internet use, educating them about the appropriate use of the internet, the hazards of internet use, and balancing the time among internet surfing, studies, and outdoor physical activities.

Internet addiction, as an emerging lifestyle problem, has caught the attention of health care providers, and internet de-addiction centers are already established in many cities of India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.