Asia 

Conference on Emerging Issues in  30 November ‐ 2 December 2009, Hong 

Public Health Kong

Factors associated with Internet addiction 
among adolescents 

Lawrence T Lam1, Zi-wen Peng2 ,Jin-cheng Mai2 ,Jin Jing2

1 The School of Medicine Sydney,

The University of Notre Dame Australia

2 Department of Psychological Education of Elementary School and Secondary School,
GuangZhou City Ministry of Education, Guangdong Province, PR China.

INTRODUCTION
•Internet addiction has been described as an uncontrollable and 
damaging use of the Internet
as a mental health problem that exhibits similar signs
•Identified as a mental health problem that exhibits similar signs 
•Identified
and symptoms as other established additions since the mid‐90s.
•Clinical diagnosis has not been established in DSM IV.
•It has been advocated that it should be considered as 
“compulsive‐impulsive Internet usage disorder”, part of the 
spectrum of Impulsive Control Disorders (ICD) in recent
spectrum of Impulsive Control Disorders (ICD) in recent 
psychiatric literature.

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Asia Conference on Emerging Issues in  30 November ‐ 2 December 2009, Hong 
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INTRODUCTION
Epidemiology
•Basic epidemiology of the problem remains unclear.
•Information on population‐based prevalence is scarce
•Information on population‐based prevalence is scarce.
•It has been estimated that the population prevalence of 
Internet Addiction ranges from 0.3% to 1.0%.
•Among adolescents, different estimates have been reported 
depending on the assessment instrument, and geographic 
locations.
locations

INTRODUCTION
Epidemiology
Country Estimated prevalence
At‐risk user “Addicted” user
Greek 8% ‐
Norway 9% 2%
North Cyprus ‐ 1%
Iran 30% 3%
China (Hunan) ‐ 2%
Hong Kong 20% ‐
Taiwan 18% ‐
Singapore 17% ‐
Korea 10‐30% 4%

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Asia Conference on Emerging Issues in  30 November ‐ 2 December 2009, Hong 
Public Health Kong

INTRODUCTION
Risk Factors
•Biological factor – male predominance
•Psychiatric symptomatology ‐ depression, ADHD
•Psychiatric  symptomatology ‐ depression ADHD
•Other psychosocial factors ?

Aim of the study:
To examine  potential risk factors that are associated with 
Internet Addiction among adolescents
Internet Addiction among adolescents.

METHODS
Study design: Baseline cross‐sectional health survey of a 
longitudinal cohort study using a stratified random sample 

Sample frame:  Students attending  high schools in the 
Sample frame: Students attending high schools in the
Guangzhou city

Subjects: a random sample of high school students aged 13‐18 
years

Procedures: 
•Students were surveyed at different schools within the same 
week
•Self‐reported questionnaires were filled in by students with 
informed consent.

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Asia Conference on Emerging Issues in  30 November ‐ 2 December 2009, Hong 
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METHODS
Assessment of exposures:
•Demographics 
•Metropolitan or rural schools
Location of family residence
•Location of family residence
•Single child status
•Parental education levels
• Psychiatric symptomatology (depression) & other health conditions
•Risky health behaviours: drinking, smoking, physical activity,  sleep hours
•Other psychosocial : perception on family financial situation, parental 
expectation, burden of study, family satisfaction, recent stressful event.

Assessment of outcome:
•Internet Addiction  assessed using Young’s  Internet Addiction Scale.
•20 items self‐reported test with a Likert scale ranging from 1 to 5.
•Total scores: 20‐49 “normal user”; 50‐79”moderate”; 80‐100 “severe”

METHODS
Data analysis
•Bivariate analyses conducted to examine unadjusted 
association between each potential risk factor and Internet 
Addiction.

•Selection of potential risk factor for multivariate analyses 
based on a criterion of p<0.20.

•Unweighted logistic regression models were used to 
calculate the adjusted Odds Ratios and their corresponding
calculate the adjusted Odds Ratios and their corresponding 
95% C.I. in the multivariate analyses. 

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RESULTS
The sample
1639 recruited and 1618 provided useful information (response rate: 
98.7%).
Consisted mainly young people aged between 13 and 16 (64.5%) with slightly 
more females (54 6%)
more females (54.6%).

Internet Addiction – Moderate (10.2%), Severe (0.6%) 

Potential risk factors
Health conditions: experienced serious illness (3.3%);  slept 6‐8 hours 
(66.6%); regular physical activity (23.7%).
Risky behaviour: drinking (10%); smoking (2.1%).
y g( ); g( )
Psychosocial: perceived poorer financially (10.8%); burdened by study 
(54.9%) ; parental high expectation (79.7%); satisfied with family (20.5%).
Psychiatric symptomatology: experienced stressful event and felt stress 
(25.6%); depression (13%).

RESULTS
Table 1. Adjusted Odds Ratios (95%C.I.) of Internet addiction for
variables retained in the final logistic regression model
Variables retained in the final model OR (95%C.I.)
Male 1.5 (1.1‐2.2)

Drink more than 2 times 1.7 (1.1‐2.8)

Very dissatisfied with family 2.4 (1.3‐4.3)
Moderately dissatisfied 1.5 (0.8‐2.5)

Experienced and felt very stressful 10.0 (6.5‐12.2)
Experienced and felt moderately stressful 2.8 (1.8‐4.4)

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CONCLUSION
•Prevalence  of Internet Addiction is consistent with studies 
reported in the literature.
•Males are more at risk in comparison to females
•Potential risk factors identified in this study are stress‐
related variables
•Significant associations between these variables and 
Internet Addiction suggest that Internet provide a means of 
distraction from internal stress

CONCLUSION
•Should Internet Addiction be part of the spectrum of 
impulse control disorders (ICD), therapeutic approaches 
effective in other ICD could also be applied to Internet 
pp
Addiction
•Internet Addiction may be a reflection of a cluster of 
behavioural and mental health problems among adolescents

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Thank You

Is there any treatment?

Source: http://abcnews.go.com/Technology/story?id=6618895#at

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Asia Conference on Emerging Issues in  30 November ‐ 2 December 2009, Hong 
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Is there any treatment?

Source: http://technology.timesonline.co.uk/tol/news/tech_and_web/the_web/article6809831.ece

Is there any treatment?

Source: http://rnwdrupal‐
Source: http://rnwdrupal
test.omroep.nl/print/9859

Source: http://boingboing.net/2009/01/06/china‐treats‐
interne.html

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Asia Conference on Emerging Issues in  30 November ‐ 2 December 2009, Hong 
Public Health Kong

Is there any treatment?

Evidence-based treatment program reported in the literature
(Sh k DT,
(Shek DT Tang
T VM,
VM Lo
L CY.
CY Adolescence.
Ad l 2009
2009, 44
44:359-73.)
359 73 )

Include the following components:

•Cognitive-behavioural therapy
•Education on the process of change
g technique
•Motivational Interviewing q
•Family counselling
•Peer support and group work

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