Acta Pædiatrica ISSN 0803-5253
REGULAR ARTICLE
Problematic Internet use is associated with substance use in young adolescents Jeanine R€ucker1, Christina Akre1, Andre Berchtold2, Joan-Carles Suris ([email protected])1 1.Research Group on Adolescent Health, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland 2.Institute of Social Sciences & LIVES, University of Lausanne, Lausanne, Switzerland
Keywords Adolescents, Problematic Internet use, Risky behaviour, Substance use Correspondence ^le JC Suris, MD, PhD, GRSA/IUMSP, B^atiment Biopo 2, Rte de la Corniche 10, 1010 Lausanne, Switzerland. Tel: +4121 3147375 | Fax: +4121 3147373 | Email: [email protected] Received 19 November 2014; revised 6 January 2015; accepted 4 February 2015. DOI:10.1111/apa.12971
ABSTRACT Aim: This study examined whether problematic Internet use was associated with substance use among young adolescents and assessed whether this association accounted for the use of tobacco, alcohol, cannabis and other drugs. Methods: Using the Internet Addiction Test, we divided a representative sample of 3067 adolescents in Switzerland (mean age 14 years) into regular and problematic Internet users. We performed a bivariate analysis and two logistic regression models, to analyse substances separately and simultaneously, and developed a log-linear model to define the associations between significant variables. Results: Problematic Internet users were more likely to be female, to use substances, to come from nonintact families, to report poor emotional well-being and to be below average students. The first model showed significant associations between problematic users and each substance, with adjusted odds ratios of 2.05 for tobacco, 1.72 for alcohol, 1.94 for cannabis and 2.73 for other drugs. Only smoking remained significant in the second model, with an adjusted odds ratio of 1.71. Conclusion: Problematic Internet use is associated with other risky behaviours and may be an important early predictor of adolescent substance use. Therefore, it should be included in the psychosocial screening of adolescents.
INTRODUCTION Four decades ago, Jessor and Jessor (1) described the Problem Behaviour Theory to highlight the importance of recognising an interrelationship between various risky behaviours in adolescence. Since then, many studies on the co-occurrence of substance use and other risky behaviours have been conducted. For example, tobacco use among youths has been associated with alcohol use and with driving under the influence of alcohol and alcohol use and misuse have been associated with risky sexual behaviour (2), partner violence and assault (3). Furthermore, it has been found that substance use occurs with other risktaking behaviours, which include driving without a seatbelt, speeding, carrying a gun and carrying a knife (3). In recent years, Internet use has emerged as an addictive behaviour among adolescents (4), and it could be part of the adolescent problem behaviour. Problematic Internet use is described as a disorder involving symptoms such as restlessness or irritability when not online or feeling the need to spend more time online (5). The few studies that have been conducted on this phenomenon have revealed that smoking as well as drug use may predict a high risk for Internet addiction (6) and that adolescents addicted to the Internet were more likely to show problematic alcohol use (7) and to use substances (8). We hypothesised that
504
investigating the association between Internet and substance use in more detail might also reveal the reverse association, so that problematic Internet use might be a predictor of substance use. Most existing research has not differentiated between the substances that have been studied so that it remains unclear whether all of them are related to problematic Internet use or just some in particular. Furthermore, most of these studies used wide age ranges and did not specifically study young adolescents. Therefore, the aims of this research were to examine whether problematic Internet use was associated with
Key Notes
It is not clear whether problematic Internet use is associated with other risk behaviours such as substance use. Our study shows that problematic Internet use is associated with the use of legal and illegal substances, especially tobacco. Problematic Internet use should be included in the psychosocial screening of adolescents, and further studies are needed to assess whether it is a predictor of substance use among young adolescents.
©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 504–507
€cker et al. Ru
substance use among a randomised sample of young adolescents and to assess whether this accounted equally for the use of tobacco, alcohol, cannabis and other illegal drugs.
PATIENTS AND METHODS Study population Data were drawn from ado @ internet.ch, a study based on a representative sample of 35 schools in the French-speaking part of Switzerland (canton of Vaud) (9). In total, 3367 students (50.3% girls) from the eighth year of mandatory school were invited to participate and 3077 of them (91.4%) completed the questionnaire as 6.8% (n = 230) were absent on the day the questionnaire was administered and 1.8% (n = 60) refused to participate. Among those participating in the study, 10 (0.3%) did not complete the questionnaire correctly and were excluded. Therefore, our results are based on a sample of 3067 adolescents – 91.1% of the initial sample – with a mean age of 14.2 years. Measures The anonymous self-administered questionnaire consisted of 51 questions and was filled in online in each school’s computer science room in spring 2012. Problematic internet use We used the French version of the Internet Addiction Test to appraise problematic Internet use (10). This test includes 20 items, such as ‘How often do you find that you stay online longer than you intended’? with possible answers ranging from one (rarely) to five (always) and a score of more than 49 indicating problematic Internet use. Based on the Internet Addiction Test score, we divided the sample into Regular Users when the score was below 50 (n = 2707) and Problematic Users when the score was above 49 (n = 360). Substance use The questions used to inquire about substance use were ‘Have you been drunk during the previous 30 days’? ‘Have you consumed cannabis during the previous 30 days’? and ‘Have you consumed any illegal drugs (other than cannabis) during the previous 30 days’? Five possible answers ranging from never to 10 or more times were dichotomised into never/at least once. In addition, respondents were asked whether they currently smoked tobacco. Confounding variables We controlled for potential confounding variables, which are known to be linked to risky behaviours (11). Such variables included age, gender, family (12) and type of student based on the adolescents’ self-reported assessment of being a good, average or below average student (13). Family structure was dichotomised into parents living together and others. In addition, we controlled for main Internet use purpose: mainly for education or work, mainly for leisure or in similar amounts for both. Finally, we
Internet and substance use by adolescents
controlled for emotional well-being as depression has been found to be associated with high Internet use (14). Therefore, we used the World Health Organization’s Well-being Index, which includes five items such as ‘Over the last 2 weeks I have felt cheerful and in good spirits’, rated on a six-point scale ranging from zero for when the feeling was not present to five when it was constantly present. Scores were summed up, with a raw score ranging from 0 to 25 and a score below 13 indicating poor emotional well-being (15). The study was approved by the Ethics Committee of the Canton of Vaud. Statistical analysis Using Stata 12, we first performed a bivariate analysis of all of the above-mentioned variables comparing Regular and Problematic users. In a second step, we developed two logistic regression models, which included all variables that were significant at the bivariate level. The first model was used to analyse each substance separately, and the second model included all substances at the same time. Results are given as adjusted odds ratios (aOR) with 95% confidence intervals. Significance was set at p < 0.05. We subsequently ran a log-linear analysis to reveal the global structure of association between all our variables of interest. On the basis of preliminary computations, we chose to start with a model including all bivariate relations. Unnecessary relations were then removed one by one using the Bayesian Information Criterion. The final model represented the minimal series of associations required to correctly describe the complex relationships among the whole set of variables.
RESULTS With the exception of age, all variables were significant at the bivariate level indicating that Problematic users were more likely to be female, to use any of the studied substances, to use the Internet for leisure rather than for work, to have parents who did not live together, to report poor emotional well-being and to be below average students (Table 1). Table 2 shows the results of both multivariate models. In the first one, Problematic users were significantly correlated with each substance after controlling for significant variables. In the second model, which included all substances at the same time, only current smoking remained significant. The log-linear model (Fig. 1) confirmed that problematic Internet use was directly linked to tobacco use, but only indirectly to all other studied substances via tobacco use.
DISCUSSION Our results are consistent with previous research (7,8) and show that problematic Internet use was associated with substance use, although the relationship was not similar with all of them. We found a direct link between Problematic users and smoking, but alcohol, cannabis and other illegal drugs were only linked to problematic Internet use
©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 504–507
505
€cker et al. Ru
Internet and substance use by adolescents
Table 1 Bivariate analysis comparing regular users and problematic users Regular users (N = 2707) Mean age (years) Gender (female) Family structure (other) Emotional well-being (poor) Type of student: Good Average Below average Main Internet use purpose: Work Leisure Both Current smoking Alcohol misuse (30 days) Cannabis use (30 days) Use of other illegal drugs (30 days)
Problematic users (N = 360)
p
14.23 0.01 49.3% 31.3% 13.6%
14.29 0.04 57.6% 37.8% 30.0%
NS
REGULAR ARTICLE
Problematic Internet use is associated with substance use in young adolescents Jeanine R€ucker1, Christina Akre1, Andre Berchtold2, Joan-Carles Suris ([email protected])1 1.Research Group on Adolescent Health, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland 2.Institute of Social Sciences & LIVES, University of Lausanne, Lausanne, Switzerland
Keywords Adolescents, Problematic Internet use, Risky behaviour, Substance use Correspondence ^le JC Suris, MD, PhD, GRSA/IUMSP, B^atiment Biopo 2, Rte de la Corniche 10, 1010 Lausanne, Switzerland. Tel: +4121 3147375 | Fax: +4121 3147373 | Email: [email protected] Received 19 November 2014; revised 6 January 2015; accepted 4 February 2015. DOI:10.1111/apa.12971
ABSTRACT Aim: This study examined whether problematic Internet use was associated with substance use among young adolescents and assessed whether this association accounted for the use of tobacco, alcohol, cannabis and other drugs. Methods: Using the Internet Addiction Test, we divided a representative sample of 3067 adolescents in Switzerland (mean age 14 years) into regular and problematic Internet users. We performed a bivariate analysis and two logistic regression models, to analyse substances separately and simultaneously, and developed a log-linear model to define the associations between significant variables. Results: Problematic Internet users were more likely to be female, to use substances, to come from nonintact families, to report poor emotional well-being and to be below average students. The first model showed significant associations between problematic users and each substance, with adjusted odds ratios of 2.05 for tobacco, 1.72 for alcohol, 1.94 for cannabis and 2.73 for other drugs. Only smoking remained significant in the second model, with an adjusted odds ratio of 1.71. Conclusion: Problematic Internet use is associated with other risky behaviours and may be an important early predictor of adolescent substance use. Therefore, it should be included in the psychosocial screening of adolescents.
INTRODUCTION Four decades ago, Jessor and Jessor (1) described the Problem Behaviour Theory to highlight the importance of recognising an interrelationship between various risky behaviours in adolescence. Since then, many studies on the co-occurrence of substance use and other risky behaviours have been conducted. For example, tobacco use among youths has been associated with alcohol use and with driving under the influence of alcohol and alcohol use and misuse have been associated with risky sexual behaviour (2), partner violence and assault (3). Furthermore, it has been found that substance use occurs with other risktaking behaviours, which include driving without a seatbelt, speeding, carrying a gun and carrying a knife (3). In recent years, Internet use has emerged as an addictive behaviour among adolescents (4), and it could be part of the adolescent problem behaviour. Problematic Internet use is described as a disorder involving symptoms such as restlessness or irritability when not online or feeling the need to spend more time online (5). The few studies that have been conducted on this phenomenon have revealed that smoking as well as drug use may predict a high risk for Internet addiction (6) and that adolescents addicted to the Internet were more likely to show problematic alcohol use (7) and to use substances (8). We hypothesised that
504
investigating the association between Internet and substance use in more detail might also reveal the reverse association, so that problematic Internet use might be a predictor of substance use. Most existing research has not differentiated between the substances that have been studied so that it remains unclear whether all of them are related to problematic Internet use or just some in particular. Furthermore, most of these studies used wide age ranges and did not specifically study young adolescents. Therefore, the aims of this research were to examine whether problematic Internet use was associated with
Key Notes
It is not clear whether problematic Internet use is associated with other risk behaviours such as substance use. Our study shows that problematic Internet use is associated with the use of legal and illegal substances, especially tobacco. Problematic Internet use should be included in the psychosocial screening of adolescents, and further studies are needed to assess whether it is a predictor of substance use among young adolescents.
©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 504–507
€cker et al. Ru
substance use among a randomised sample of young adolescents and to assess whether this accounted equally for the use of tobacco, alcohol, cannabis and other illegal drugs.
PATIENTS AND METHODS Study population Data were drawn from ado @ internet.ch, a study based on a representative sample of 35 schools in the French-speaking part of Switzerland (canton of Vaud) (9). In total, 3367 students (50.3% girls) from the eighth year of mandatory school were invited to participate and 3077 of them (91.4%) completed the questionnaire as 6.8% (n = 230) were absent on the day the questionnaire was administered and 1.8% (n = 60) refused to participate. Among those participating in the study, 10 (0.3%) did not complete the questionnaire correctly and were excluded. Therefore, our results are based on a sample of 3067 adolescents – 91.1% of the initial sample – with a mean age of 14.2 years. Measures The anonymous self-administered questionnaire consisted of 51 questions and was filled in online in each school’s computer science room in spring 2012. Problematic internet use We used the French version of the Internet Addiction Test to appraise problematic Internet use (10). This test includes 20 items, such as ‘How often do you find that you stay online longer than you intended’? with possible answers ranging from one (rarely) to five (always) and a score of more than 49 indicating problematic Internet use. Based on the Internet Addiction Test score, we divided the sample into Regular Users when the score was below 50 (n = 2707) and Problematic Users when the score was above 49 (n = 360). Substance use The questions used to inquire about substance use were ‘Have you been drunk during the previous 30 days’? ‘Have you consumed cannabis during the previous 30 days’? and ‘Have you consumed any illegal drugs (other than cannabis) during the previous 30 days’? Five possible answers ranging from never to 10 or more times were dichotomised into never/at least once. In addition, respondents were asked whether they currently smoked tobacco. Confounding variables We controlled for potential confounding variables, which are known to be linked to risky behaviours (11). Such variables included age, gender, family (12) and type of student based on the adolescents’ self-reported assessment of being a good, average or below average student (13). Family structure was dichotomised into parents living together and others. In addition, we controlled for main Internet use purpose: mainly for education or work, mainly for leisure or in similar amounts for both. Finally, we
Internet and substance use by adolescents
controlled for emotional well-being as depression has been found to be associated with high Internet use (14). Therefore, we used the World Health Organization’s Well-being Index, which includes five items such as ‘Over the last 2 weeks I have felt cheerful and in good spirits’, rated on a six-point scale ranging from zero for when the feeling was not present to five when it was constantly present. Scores were summed up, with a raw score ranging from 0 to 25 and a score below 13 indicating poor emotional well-being (15). The study was approved by the Ethics Committee of the Canton of Vaud. Statistical analysis Using Stata 12, we first performed a bivariate analysis of all of the above-mentioned variables comparing Regular and Problematic users. In a second step, we developed two logistic regression models, which included all variables that were significant at the bivariate level. The first model was used to analyse each substance separately, and the second model included all substances at the same time. Results are given as adjusted odds ratios (aOR) with 95% confidence intervals. Significance was set at p < 0.05. We subsequently ran a log-linear analysis to reveal the global structure of association between all our variables of interest. On the basis of preliminary computations, we chose to start with a model including all bivariate relations. Unnecessary relations were then removed one by one using the Bayesian Information Criterion. The final model represented the minimal series of associations required to correctly describe the complex relationships among the whole set of variables.
RESULTS With the exception of age, all variables were significant at the bivariate level indicating that Problematic users were more likely to be female, to use any of the studied substances, to use the Internet for leisure rather than for work, to have parents who did not live together, to report poor emotional well-being and to be below average students (Table 1). Table 2 shows the results of both multivariate models. In the first one, Problematic users were significantly correlated with each substance after controlling for significant variables. In the second model, which included all substances at the same time, only current smoking remained significant. The log-linear model (Fig. 1) confirmed that problematic Internet use was directly linked to tobacco use, but only indirectly to all other studied substances via tobacco use.
DISCUSSION Our results are consistent with previous research (7,8) and show that problematic Internet use was associated with substance use, although the relationship was not similar with all of them. We found a direct link between Problematic users and smoking, but alcohol, cannabis and other illegal drugs were only linked to problematic Internet use
©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 504–507
505
€cker et al. Ru
Internet and substance use by adolescents
Table 1 Bivariate analysis comparing regular users and problematic users Regular users (N = 2707) Mean age (years) Gender (female) Family structure (other) Emotional well-being (poor) Type of student: Good Average Below average Main Internet use purpose: Work Leisure Both Current smoking Alcohol misuse (30 days) Cannabis use (30 days) Use of other illegal drugs (30 days)
Problematic users (N = 360)
p
14.23 0.01 49.3% 31.3% 13.6%
14.29 0.04 57.6% 37.8% 30.0%
NS
