Quantitative Social Research

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European Journal of Public Health, 1–6

Prevalence and risk factors of Internet addiction in high
school students
Tayyar S¸ as¸maz1, Seva O¨ ner1, A. O¨ ner Kurt1, Gu¨ lc¸in Yapici1, Aylin Ertekin Yazici2, Resul Bug? dayci1,
Mustafa S¸ is¸1
1 Department of Public Health, Mersin University School of Medicine, Turkey
2 Department of Psychiatry, Mersin University School of Medicine, Turkey
Correspondence: Tayyar S¸ as¸maz, Mersin Universitesi Tip Fak Halk Sagligi AD Ogretim Uyesi, C¸ iflikko¨ y Kampu¨ su¨ , 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 descriptive
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 16.10.9 years. Seventynine
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
The advent of computers and the Internet has led to a series of
dramatic changes and developments in the ways of generating,
storing and sharing knowledge. Overuse of computers and the
Internet creates physical, mental and social problems. Although it
is not recognized as a standard definition, Internet addiction is
defined as experiencing physical, mental and social problems
because of Internet and computer overuse. Internet addiction has
a negative impact on workplace relations, interaction with friends,
academic life and family life. Internet addicts spend most of their life
in front of the computer passing time with e-mails, chatting,
discussion forums and online games. In a sense, we can say that
Internet addicts move their social lives into the Internet environment.
Today, problematic Internet use and Internet addiction
appear to be social issues that should be addressed without delay.
In this regard, adolescents and young adults constitute the largest
target group.1–5
A meta-analysis of Internet addiction has noted that high school
students and young men are the high-risk groups.3 In Taiwan, the
prevalence of Internet addiction among high school students has
been reported as 13.8%, with higher rates in men and students
attending vocational schools.6 However, another study in Taiwan
showed the prevalence of Internet addiction in high school
students as 20.1%.4 In China, 2.4% of the adolescents were
Internet addicts, and scores for comorbid disease and impulsivity
scale scores are reported to be higher in students with Internet addiction.
7 In Korea, it was shown that 30% of the adolescents were
‘possible’ Internet addicts, and 4.3% were Internet addicts; the
prevalence of Internet addiction was 6.8% in male and 3.5% in
female adolescents. Furthermore, in Korea, the students with
Internet addiction were more frequently observed to have psychiatric
issues such as somatization, obsessive compulsivity, depression,
anxiety, hostility, phobic anxiety and psychosis.8
Such studies are also being performed and published in Turkey.
Here the prevalence of Internet use has been shown to be higher in
male than in female individuals, and the symptoms of psychiatric
diseases have been shown to become more common with increasing
duration of Internet use.9 The prevalence of ‘possible’ Internet
addiction has been noted to be 11.6% in high school students.10
Thirty-one percent of Turkish students connected to the Internet
at least once a day. Furthermore, the duration of Internet use
among Turkish students has been noted to be higher in male individuals
as well as in students at a moderate or high socioeconomic
level, attending vocational schools or having low success at school.11
Both national and international studies suggest that Internet
addiction is an important public health problem in adolescents
and young people. In our country, there is a need to investigate
the association of this issue with sociodemographic factors and psychiatric
issues. In this study, we aimed to investigate the prevalence
and risk factors of Internet addiction in high school students.
Methods
This cross-sectional study was conducted between 12 March 2012
and 6 April 2012 in high schools located in the central district of
Mersin. The students of those high schools constituted the study
population. The study was conducted by the Department of Public
Health, Faculty of Medicine, Mersin University, following receipt of
official permission and approval of the ethics committee of the
University.
Sample size and selection
National and international studies report that the prevalence of
Internet addiction in adolescents and high school students varies
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
sample size was calculated to be 850 students (10% prevalence,
95% confidence interval, 2 margin of error). Thus, we decided
to include 1200 individuals in the study.
Twelve schools to be included in the study were selected in a
randomized fashion. Although we had planned to enroll 9th, 10th,
11th and 12th graders, 12th graders could not be reached owing to
The European Journal of Public Health Advance Access published May 30, 2013
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their preparation for the Higher Education Examination. Therefore,
12th graders were excluded from the study and 1200 students were
targeted to be included.
Questionnaire
We used a structured questionnaire for the study. The questionnaire
consisted of three sections to be completed by the participants.
First section: This included questions involving gender, age, grade
level, smoking and alcohol consumption status, characteristics of the
Internet and computer use and the educational and employment
status of the parents.
Second section: The Internet addiction level of the students was
evaluated by the Internet Addiction Scale, which is a valid and
reliable assessment tool. The Internet Addiction Scale is a 27-item
5-point Likert-type evaluation tool that was first developed by
Griffith17 and adapted into Turkish by Canan et al.10 The total
score that can be gained from the scale ranges between 27 and
135. The adapted Turkish version used 81 as the cutoff point.
Students who scored 81 were recognized as ‘Internet addicts’.
Third section: The symptoms of the psychiatric diseases were
determined by the Brief Symptom Inventory (BSI) scale. The
validity and reliability of the BSI scale was tested by Sahin and
Durak.18 High scores indicate the presence of psychiatric
symptoms in the related subgroup.
A pilot study of the questionnaire was tested on 30 students in a
high school that had not been included in the study group. After this
pilot study, the items that were not clearly understood by the
students were revised and corrected.
Data collection
The classes from the selected high schools were chosen in a
randomized fashion. The students were given parental consent
forms, and the students whose parents signed the parental consent
form were enrolled in the study on the following day. The teachers
were kept away from the class and the investigators were present
while the students completed the questionnaires.
A total of 1215 students received consent forms in the study. As 47
parents did not give consent, our study included 1168 students.
During the transfer of the questionnaires into the computer for
analysis, 12 students whose questionnaires had substantial missing
data were excluded from the study. Eventually, questionnaires from
1156 students were included in the study and analyzed. In all, 389
(33.7%) were 9th graders, 371 (32.0%) were 10th graders and 396
(34.3%) were 11th graders.
Data analysis
The data were summarized by descriptive statistics. The chi-squared
test and the linear-by-linear model were used for the comparison of
categorical variables; the Mann–Whitney U test was used for the
comparison of numerical variables; Pearson correlation coefficient
was used for the comparison of two numerical variables and binary
logistic regression was used for determination of risk factors for
Internet addiction. Independent variables exhibiting a statistically
significant correlation with Internet addiction in the univariate
analyses were included in the model.
Results
In total, 1156 students, 609 (52.7%) male and 547 (47.3%) female,
were included in the study. The mean age of the study population
was 16.10.9 years. Nine hundred thirteen (79.0%) of the students
had a computer at home, 444 (38.4%) of those had their own
computer, and 740 (64.0%) had Internet access at home. The percentage
of students with at least one e-mail or social network
account was 88.6 and 90.5%, respectively. Computers and the
Internet were reported to be used for education/homework/
research purposes by 918 (81.5%) students and for communication
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
20.4% in male individuals (P < 0.001). The prevalences of Internet
addiction were 18.0, 17.3 and 10.4% for grade 9, 10 and 11 students,
respectively; the prevalence of Internet addiction was observed to
show a decremental trend from lower- to higher-grade students, and
this relationship was statistically significant (linear-by-linear test,
P < 0.01). The analysis focusing on the relationship of Internet
addiction with subgroups of gender and grade level revealed that
there was no statistically significant correlation between Internet
addiction and grade level in male individuals (P > 0.05), whereas
Internet addiction was found to be higher in ninth-grade students
than in other students among female individuals, and this difference
was statistically significant (P < 0.05). Similarly, the comparison of
students relative to grade level showed that Internet addiction was
higher in male than in female individuals in all grades (9th grade,
P < 0.05; 10th grade, P < 0.001; 11th grade, P < 0.01) (tables 2 and 3).
The variables showing a statistically significant correlation with
Internet addiction were evaluated by the binary logistic regression
analysis. The final results revealed that Internet addiction was
2.0-fold more common in male than in female individuals;
2.7- and 2.3-fold more common in 9th and 10th graders than
11th graders, respectively; 1.2-fold more common in students with
increased daily duration of computer use; 2.1- and 3.3-fold more
common in students reading less than one book each month and
reading no book at all in a week, respectively and 2.9- and 2.3-fold
more common in students interested in computers as a hobby and in
students with no hobby at all, respectively. Furthermore, a BSI
showed that depression and negative self-perception raised
Internet addiction 1.03- and 1.05-fold, respectively (table 4).
Discussion
In this study, we determined a high prevalence (15.1%) of Internet
addiction among adolescents. Furthermore, Internet addiction was
found to be independently related to gender, grade level, duration of
computer use, book reading, having a hobby, depression and
negative self-perception. Although rates of computer and Internet
use have been increasing both in our country and worldwide at all
ages, they show a particular increase among adolescents. As adolescents
undergo serious developmental changes while growing up, it is
easier for them to be carried away by the rich and captivating environment
of the Internet and begin to experience social, mental and
physical problems as a result. Therefore, the adolescents can be
regarded as the most vulnerable age group for Internet addiction.
Studies note that the prevalence of Internet addiction varies
between 2.4 and 18.8%.4,6–8,10,12–16 This rate is reported to vary
between 0 and 26.3% in the USA19 and 4.4 and 13.5% in the
European Union.20 According to the literature data, the prevalence
of Internet addiction appears to vary within a wide range. In our
study, the prevalence of Internet addiction among adolescents was
observed to be close to the upper limit. Such a high rate may be
associated with poor reading habit and inadequate involvement in
cultural, artistic and sportive activities.
In the present study, there was a negative correlation between the
frequency of book reading and the development of Internet
addiction. Thus, reading no books at all and reading less than one
book per month were shown to be independent risk factors of
Internet addiction. To our knowledge, there are no literature data
about this. This result is an original finding of our study. It is recommended
that book reading should be considered in the struggle
against Internet addiction, and students should be oriented toward
book reading.
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In the literature, Internet addiction and ‘problematic’ Internet use
are reported to be more common in men.1-4,6,8,10,12,13,15,16,19-22
Unlike other studies, a study in Korea reported no statistically significant
correlation between gender and Internet addiction or
‘possible’ Internet addiction.23 In our study, the prevalence of
Internet addiction was higher in male individuals of all grade
levels, and being a male was found to present a 2-fold increased
risk of Internet addiction. Our study result supports the results of
other studies, with the exception of the study in Korea. This result
can be explained in two ways. First, male and female individuals
have different aims with regard to computer and Internet use.
Studies show that men use the Internet longer than women, and
they are also known to use it more for gaming, sex, entertainment
and social networking, but less for academic works.1,12,20,24 Second,
men are known to use other addictive substances more commonly as
well.25 A meta-analysis on Internet addiction3 notes that people with
a history of addiction are at a higher risk for development of Internet
addiction. These factors may explain the elevated rate of Internet
addiction among men. Therefore, it is recommended to choose male
individuals as the target group in studies focusing on curbing
Internet addiction at schools.
Ko et al.4 conducted a study on adolescents and reported a direct
correlation between age and Internet addiction. Yang and Tung6
Table 1 Demographic and computer use characteristics of the study
population
Variables n %/median
Age (median) 1156 16.0
Gender
Male 609 52.7
Female 547 47.3
School type
Anatolian high school 356 30.8
Regular high school 332 28.7
Private high school 48 4.2
Vocational school 420 36.3
Grade level
9 389 33.7
10 371 32.0
11 396 34.3
Frequency of book reading
Once a week 259 23.2
Once a month 425 38.0
Less frequent 308 27.6
Not reading 125 11.2
Meeting with friends
Each day 192 17.2
3–4 days a week 221 19.8
1–2 days a week 391 35.1
Less frequent 311 27.9
Hobbya
Sports (football, basketball, tennis, etc.) 603 52.2
Art (music, painting, theatre, etc.) 512 44.3
Literature (book reading, poetry, essays, etc.) 352 30.4
Computer (games, Internet, communication, etc.) 198 17.1
Walking for pleasure 179 15.5
TV (documentary, series, news, etc.) 51 4.4
No hobby 109 9.4
Median monthly allowance (Turkish Lira) 1096 25.0
Median monthly family income (Turkish Lira) 951 1500.0
Computer at home
No computer 243 21.0
One shared computer 469 40.6
Own computer 444 38.4
Computer type
No computer 243 21.0
At least one desktop computer 654 56.6
Other computer 259 22.4
Internet at home
No 416 36.0
Yes 740 64.0
Internet with quota 206 17.8
Internet without quota 534 46.2
Computer/Internet use outside the home
Yes 762 65.9
No 394 34.1
Having an e-mail account
No 132 11.4
Yes 1024 88.6
Having a social network account
No 110 9.5
Yes 1046 90.5
Aim of Internet usea
Education, homework, research 918 81.5
Communication, social networking 761 67.6
Entertainment, music, movies 458 40.7
Gaming, gambling 388 34.5
aThe participants provided more than one answer.
Table 2 Internet addiction relative to demographic characteristics
Variables Internet addiction P
Yes No
n %/median n %/median
School type
Anatolian high school 47 13.2 309 86.8 >0.05
Regular high school 46 13.9 286 86.1
Private high school 6 12.5 42 87.5
Vocational high school 76 18.1 344 81.9
Gender
Male 124 20.4 485 79.6 <0.001
Female 51 9.3 496 90.7
Grade level
9 70 18.0 319 82.0 <0.01a
10 64 17.3 307 82.7
11 41 10.4 355 89.6
Frequency of book reading
Once a week 27 10.4 232 89.6 <0.001a
Once a month 50 11.8 375 88.2
Less frequent 52 16.9 256 83.1
Not reading 41 32.8 84 67.2
Meeting with friends
Everyday 41 21.4 151 78.6 <0.01
Less frequent 127 13.8 796 86.2
Having at least one hobby
Yes 154 14.7 893 85.3 >0.05
No 21 19.3 88 80.7
Hobbyb
Computer (gaming, Internet, etc.) 67 33.8 131 66.2 <0.001
Other hobbies 87 10.2 762 89.8
Art (music, painting, theatre, etc.) 56 10.9 456 89.1 <0.01
Other hobbies 98 18.3 437 81.7
Literature (book reading,
poetry, etc.)
35 9.9 317 90.1 <0.01
Other hobbies 119 17.1 576 90.1
Median monthly allowance 225 25 926 25 0.05c
Median monthly family income 152 1500 799 1500 0.05c
History of at least one
cigarette smoking
53 23.7 171 76.3 <0.001
No history of cigarette smoking 122 13.1 810 86.9
Parent
Both alive and together 154 15.4 849 84.6 0.05
Other 21 13.7 132 86.3
Father’s education background
Primary school or less 63 14.9 360 85.1 >0.05
Junior high school 29 15.2 162 84.8
High school 53 17.8 244 82.2
University 29 13.2 191 86.8
Mother’s education background
Primary school or less 85 14.2 515 85.8 <0.05
Junior high school 26 16.0 136 84.0
High school 49 19.5 202 80.5
University 12 9.0 121 91.0
aLinear-by-linear association.
bThe participants mentioned a variety of hobbies. The students
categorized in our major hobby groups were separately compared
with the ones having other hobbies.
cMann–Whitney U test.
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studied high school students and noted that although the prevalence
of Internet addiction drops with grade, this was not statistically
significant. Johansson and Gotestam12 studied Norwegian high
school students and found no relationship between age and
Internet addiction. In our study, we did not find a significant correlation
between age and Internet addiction either. However, the
prevalence of Internet addiction was higher in 9th and 10th
graders than in 11th graders. This result may be associated with
the education and examination systems of our country, as there is
a difficult examination between primary school and high school.
When students enrol in a high school (as a 9th grader) according
to the results of this examination, they tend to relax and exhibit a
declining interest in lessons, while spending more time in leisure
activities such as those involving computers and the Internet.
However, there is a Higher Education Examination, also called the
university examination, awaiting them in the 12th grade. Therefore,
students generally perceive the seriousness of the situation in the
final high school years and start to devote most of their time to
preparations for the university examination. Thus, the education
and examination system of our country may be the underlying
cause of high Internet addiction rates during the first years of high
school, which then show a decline toward final years.
Computer and Internet are used in every aspect of life, from entertainment
to shopping and banking procedures. The dazzling
speed of new technologies widens the use of computer and
Internet in daily life. Recently, particularly among adolescents, the
duration of computer and Internet use has been further increased as
a result 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 raised durations of Internet use.1,3 Internet addiction is not
only related to the duration of computer and Internet use, it is
associated with the ‘purpose’ of computer and Internet use as
well. The literature data show that using computer and Internet
for non-educational purposes (download programs, music or
movies; enter pornographic sites; play online games or chat) contributes
to Internet addiction.6,8 Similarly, in our study, having a
hobby related to computers and increased duration of Internet use
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
aMann–Whitney U test.
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were found to be independent risk factors for Internet addiction.
Adolescents tend to use Internet for easier and entertaining activities
such as playing games, chatting and watching movies rather than for
educational purposes. Adolescents who fail to socialize in real life
feel more comfortable on the Internet and therefore gradually
increase their duration of Internet use to boost their feeling of joy.
This process of self-satisfaction increases the risk of developing
Internet addiction. Therefore, hobbies and activities (sports, art,
science, travel and cultural activities) associated with real life
should be highlighted, and children should be encouraged to use
Internet and computers for these activities.
Research on adolescents indicates a significant relationship of
Internet addiction with psychological and psychiatric problems.
Based on these studies, Internet addiction has been reported to
have a relationship with depression, anxiety, attention deficit and
hyperactivity disorder, social phobia, solitude, hostility, aggressive
behaviours, suicide, psychological dysfunction and emotional and
behaviour problems.4,5,7,9,15,16,18,20,23,26,27 Similarly, in our study,
depression and negative self-perception were shown to be independent
risk factors for Internet addiction. The association between
Internet addiction and psychological problems is noted to be a
two-way relationship, that is, psychological problems may lead to
Internet addiction and Internet addiction may cause psychological
problems as well. Furthermore, negative factors such as depressive
thoughts, low self-confidence and poor self-perception may also
contribute to the development of Internet addiction. On the other
hand, Internet may help people to forget their insurmountable
problems. Such mental satisfactions may explain the urge felt by
people to start using Internet again. Some emotions such as
euphoria, excitement and happiness may be supportive of Internet
use. When an Internet addict does not use the Internet, he/she experiences
negative emotions and feels unhappy, lonely and anxious;
however, all those negative emotions are instantly replaced by joy,
euphoria and excitement on gaining Internet access. In this process,
psychological problems contribute to the Internet addiction, whereas
Internet addiction may increase the psychological problems as
well.3,28,29 Therefore, students with a psychological problem
constitute a risky group for Internet addiction. To curb Internet
addiction, it is recommended that these students are given psychological
and medical support.
In conclusion, the prevalence of Internet addiction among adolescents
was found to be as high as 15.1%. The independent risk
factors of Internet addiction were determined to be the male gender,
being a 9th or 10th grader, increased duration of Internet use, having
a hobby related to computers or having no hobby at all, reading less
than one book per month or reading no book at all, depression and
negative self-perception.
Study Limitations
Because we performed our study close to the date of higher
education examination, 12th graders could not be reached at
schools and therefore were excluded from the study. The participation
rate will be higher in future studies if such periods of absence
are considered beforehand.
Acknowledgements
The authors acknowledge the collaboration of the administrators
and teachers at Mersin Hac| Sabanc| Anatolian High School
during the pilot study of the questionnaire. They also gratefully acknowledge
Ray W. Guillery and Sibel Kalaca for their assistance with
the English edition of this article.
Funding
This project was supported by the Scientific Research Projects Unit
of Mersin University within scope of the Rapid Support Project
(protocol code, BAP-TF DTB [CTS] 2012-2 HD).
Conflicts of interest: None declared.
Key points
 15.1% of the students were classified as Internet addicts.
 Internet addiction was 2.0-fold more common in male than
in female individuals.
 Internet addiction is more common in 9th and 10th graders
as well as in those who use Internet longer and have a hobby
related to computers.
 Internet addiction was 2.1- and 3.3-fold more common in
students reading less than one book each month and reading
no book at all than once a week, respectively.
 Depression and negative self-perception raised Internet
addiction 1.03- and 1.05-fold, respectively.
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Table 4 Risk factors of Internet addiction
Variables Exp(B) 95% CI P
Gender
Male 2.00 1.23–3.24 <0.01
Female 1.00
Grade level
9 2.72 1.60–4.63 <0.001
10 2.37 1.40–4.02 <0.01
11 1.00
Hobby
Other hobby 1.00
Computer-related hobby 2.99 1.88–4.75 <0.001
No hobby 2.31 1.19–4.49 <0.05
Frequency of book reading
Once a week 1.00 0.80–2.66 >0.05
Once a month 1.46 1.15–3.92 <0.05
Less frequent 2.12 1.67–6.82 <0.01
Not reading 3.38
Depression 1.03 1.01–1.05 <0.01
Duration of computer use (h/day) 1.26 1.16–1.37 <0.001
Negative self-perception 1.05 1.02–1.07 <0.001
Constant: 5.56
Internet addiction in high school students 5 of 6
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