DOI 10.1515/ijamh-2013-0508 Int J Adolesc Med Health 2014; 26(2): 187–194
Karl Peltzer*, Supa Pengpid and Tawatchai Apidechkul
Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students Abstract: The Internet provides significant benefits for learning about the world, but excessive Internet use can lead to negative outcomes. The aim of this study was to determine the associations between heavy Internet use and health-promoting behaviour, health risk behaviour and health outcomes among university students. The sample included 860 undergraduate university students chosen at random from Mae Fah Luang University in Thailand. Of the participants, 27.3% were male and and 72.7% were female in the age range of 18–25 years (M age = 20.1 years, SD = 1.3). Overall, students spent on average 5.3 h (SD = 2.6) per day on the internet, and 35.3% engaged in heavy internet use (6 or more hours per day). In multivariate logistic regression adjusting for sociodemographics, lack of dental check-ups, three health risk behaviours (sedentary lifestyle, illicit drug use and gambling) and three health outcomes [being underweight, overweight or obese and having screened positive for post-traumatic stress disorder (PTSD)] were found to be associated with heavy Internet use. The results from this study may support the importance of developing early protective and preventive actions against problematic Internet use to promote university student health. Keywords: health behaviour; heavy internet use; Thailand; university students. *Corresponding author: Karl Peltzer, HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council (HSRC), P/Bag X 41, Pretoria 0001, South Africa, E-mail: [email protected] Karl Peltzer and Supa Pengpid: Department of Psychology, University of Limpopo, Turfloop Campus, South Africa; and ASEAN Institute for Health Development, Madidol University, Salaya, Thailand Tawatchai Apidechkul: Mae Fah Luang University, Chiang Rai, Thailand
(1, 2). Nakornthap and Masateianwong (3) found that among Thai people ages 6–24 years, they spent 8 h/day using information and communication technology, such as watching television, playing on the Internet, talking on mobile phones and sending text messages. Wanajak (2011) found a 3.7% prevalence of internet addiction among secondary school students between the ages from 11 to 19-years-old in Chiang Mai, Thailand. Addictive Internet users spent approximately 29 h per week on the internet and normal users were online for about 16 h per week (4). Among Pakistani university students, it was found that they spent, on average, 12.3 h per week on the Internet (5) and Hong Kong university students used the Internet an average of 2.8 h/day and 14.9% reported heavy internet use ( > 4 h/day) (6). Factors associated with heavy, problematic or addictive Internet use can be grouped into sociodemographics (male students) (6–9), inverse relationship with healthpromoting behaviours (8–10), health risk behaviours (skipping meals, frequency of snacking, sleeping late) (8, 11), substance use, sexual intercourse, sedentary behavior (1, 11, 12) and health outcome factors such as lower academic grades (13, 14), being overweight and hypersomnia (2), poor mental health, depression, loneliness, stress, suicidal ideation, attempted suicide (1, 12, 13, 15–19), poor (physical) health status (10, 12), lower psychological well being/life satisfactioon (20) and aggressive behaviours (21). The aim of this study was to determine the association between heavy internet use and health-promoting behaviour, health risk behaviour and health outcomes among a sample of university students in Thailand.
Methods Sample and procedure
Introduction Internet use and problematic use may be more prevalent in some Asian countries than in some Western countries
The sample included 860 university undergraduate students chosen at random from Mae Fah Luang University in Thailand. In total, 8770 undergraduate students in the academic year 2012 were identified as the target population. The sample was randomised from the student lists in 29 study programmes. Data were collected by a self-adminis-
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188 Peltzer et al.: Association of Internet use with health risk and health-promoting behaviours tered questionnaire in a classroom situation after informed consent had been obtained. Permission to conduct the study was obtained from the senior faculty of the university, and ethical clearance was also received. The cover pages of the questionnaire briefly explained about the study and provided instructions to the respondents on how to fill it out. They also provided information about the researchers and also mentioned that anonymity and confidentiality would be maintained and that the participation of students was voluntary. The cover pages specified that data would be used only for research purposes. The questionnaire was translated from English to Thai and back-translated according to scientific standard procedures. The questionnaire was administered in the Thai language by external research assistants.
Measures Internet use was assessed by the question, “How many hours do you normally spend in a day on the internet?” Responses were classified into light users ( ≤ 2.59 h), moderate users (3–5.59 h) and heavy users ( ≥ 6 h). The median of the responses was used to arrive at the cut points of 3 and 6 h of Internet use.
Health-promoting and risk behaviours Dietary behaviour included: a) trying to avoid fat and cholesterol (yes, no); b) trying to eat fiber (yes, no); c) frequency of having breakfast; d) frequency of meals; and e) frequency of between-meal snacks (22). Physical activity was assessed using the short version of the International Physical Activity Questionnaire (IPAQ), self-admini stered during the last 7 days (IPAQ-S7S). We used the instructions given in the IPAQ manual for reliability and validity, which is detailed elsewhere (23). Summing up the single indicators to an overall indicator of physical activity (PA)-related energy expenditure (EE) (metabolic equivalent, MET min -1) is a major goal of the IPAQ instruments. As recommended, we followed the MET estimates of IPAQ: vigorous PA = 8 METs, moderate PA = 4 METs and walking (on average) = 3.3 METs. For calculating the overall METs of PA, each category was multiplied with its special MET estimate value. We also used the recommended categorical score, three levels of PA (low, moderate and high), as proposed in the IPAQ scoring protocol (short form). Low activity represented individuals who do not meet the criteria for moderate and vigorous intensity categories (
Karl Peltzer*, Supa Pengpid and Tawatchai Apidechkul
Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students Abstract: The Internet provides significant benefits for learning about the world, but excessive Internet use can lead to negative outcomes. The aim of this study was to determine the associations between heavy Internet use and health-promoting behaviour, health risk behaviour and health outcomes among university students. The sample included 860 undergraduate university students chosen at random from Mae Fah Luang University in Thailand. Of the participants, 27.3% were male and and 72.7% were female in the age range of 18–25 years (M age = 20.1 years, SD = 1.3). Overall, students spent on average 5.3 h (SD = 2.6) per day on the internet, and 35.3% engaged in heavy internet use (6 or more hours per day). In multivariate logistic regression adjusting for sociodemographics, lack of dental check-ups, three health risk behaviours (sedentary lifestyle, illicit drug use and gambling) and three health outcomes [being underweight, overweight or obese and having screened positive for post-traumatic stress disorder (PTSD)] were found to be associated with heavy Internet use. The results from this study may support the importance of developing early protective and preventive actions against problematic Internet use to promote university student health. Keywords: health behaviour; heavy internet use; Thailand; university students. *Corresponding author: Karl Peltzer, HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council (HSRC), P/Bag X 41, Pretoria 0001, South Africa, E-mail: [email protected] Karl Peltzer and Supa Pengpid: Department of Psychology, University of Limpopo, Turfloop Campus, South Africa; and ASEAN Institute for Health Development, Madidol University, Salaya, Thailand Tawatchai Apidechkul: Mae Fah Luang University, Chiang Rai, Thailand
(1, 2). Nakornthap and Masateianwong (3) found that among Thai people ages 6–24 years, they spent 8 h/day using information and communication technology, such as watching television, playing on the Internet, talking on mobile phones and sending text messages. Wanajak (2011) found a 3.7% prevalence of internet addiction among secondary school students between the ages from 11 to 19-years-old in Chiang Mai, Thailand. Addictive Internet users spent approximately 29 h per week on the internet and normal users were online for about 16 h per week (4). Among Pakistani university students, it was found that they spent, on average, 12.3 h per week on the Internet (5) and Hong Kong university students used the Internet an average of 2.8 h/day and 14.9% reported heavy internet use ( > 4 h/day) (6). Factors associated with heavy, problematic or addictive Internet use can be grouped into sociodemographics (male students) (6–9), inverse relationship with healthpromoting behaviours (8–10), health risk behaviours (skipping meals, frequency of snacking, sleeping late) (8, 11), substance use, sexual intercourse, sedentary behavior (1, 11, 12) and health outcome factors such as lower academic grades (13, 14), being overweight and hypersomnia (2), poor mental health, depression, loneliness, stress, suicidal ideation, attempted suicide (1, 12, 13, 15–19), poor (physical) health status (10, 12), lower psychological well being/life satisfactioon (20) and aggressive behaviours (21). The aim of this study was to determine the association between heavy internet use and health-promoting behaviour, health risk behaviour and health outcomes among a sample of university students in Thailand.
Methods Sample and procedure
Introduction Internet use and problematic use may be more prevalent in some Asian countries than in some Western countries
The sample included 860 university undergraduate students chosen at random from Mae Fah Luang University in Thailand. In total, 8770 undergraduate students in the academic year 2012 were identified as the target population. The sample was randomised from the student lists in 29 study programmes. Data were collected by a self-adminis-
Brought to you by | Lund University Libraries Authenticated Download Date | 10/11/16 7:09 PM
188 Peltzer et al.: Association of Internet use with health risk and health-promoting behaviours tered questionnaire in a classroom situation after informed consent had been obtained. Permission to conduct the study was obtained from the senior faculty of the university, and ethical clearance was also received. The cover pages of the questionnaire briefly explained about the study and provided instructions to the respondents on how to fill it out. They also provided information about the researchers and also mentioned that anonymity and confidentiality would be maintained and that the participation of students was voluntary. The cover pages specified that data would be used only for research purposes. The questionnaire was translated from English to Thai and back-translated according to scientific standard procedures. The questionnaire was administered in the Thai language by external research assistants.
Measures Internet use was assessed by the question, “How many hours do you normally spend in a day on the internet?” Responses were classified into light users ( ≤ 2.59 h), moderate users (3–5.59 h) and heavy users ( ≥ 6 h). The median of the responses was used to arrive at the cut points of 3 and 6 h of Internet use.
Health-promoting and risk behaviours Dietary behaviour included: a) trying to avoid fat and cholesterol (yes, no); b) trying to eat fiber (yes, no); c) frequency of having breakfast; d) frequency of meals; and e) frequency of between-meal snacks (22). Physical activity was assessed using the short version of the International Physical Activity Questionnaire (IPAQ), self-admini stered during the last 7 days (IPAQ-S7S). We used the instructions given in the IPAQ manual for reliability and validity, which is detailed elsewhere (23). Summing up the single indicators to an overall indicator of physical activity (PA)-related energy expenditure (EE) (metabolic equivalent, MET min -1) is a major goal of the IPAQ instruments. As recommended, we followed the MET estimates of IPAQ: vigorous PA = 8 METs, moderate PA = 4 METs and walking (on average) = 3.3 METs. For calculating the overall METs of PA, each category was multiplied with its special MET estimate value. We also used the recommended categorical score, three levels of PA (low, moderate and high), as proposed in the IPAQ scoring protocol (short form). Low activity represented individuals who do not meet the criteria for moderate and vigorous intensity categories (
