School-based Prevention for Adolescent Internet Addiction: Prevention is the Key. A Systematic Literature Review

Attitudes of Adolescents Toward Addictive Substances: Hope and Self-Control as Protective Factors

Background: Experiences of ostracism may be related to attitudes toward substance abuse. However, the protective factors underlying this relationship are still unclear. Therefore, based on the Need-threat and Self-control theory, we aimed to test a model in which self-control and hope mediate the relationship between ostracism and attitudes toward addictive substances. Methods: In this model, we highlighted risk factors (ostracism) and protective factors (self-control and hope). This study was a cross-sectional data analysis of 787 students (52.50% boys, 47.50% girls; Mage = 15.69, SD = 1.12). Results: The results revealed that ostracism was positively associated with attitudes toward addictive substances, and evidence was provided that this relationship was mediated by hope and self-control. Ultimately, the research highlights the link between ostracism and attitudes toward addictive substances, identifying hope and self-control as mediators. Conclusions: This study highlights individual risk and protective factors related to attitudes toward addictive substances and offers new perspectives on ways to prevent and reduce adolescents' positive attitudes toward substance use. School counselors and educators should help students strengthen skills such as hope and self-control to prevent them from developing positive attitudes toward substance use in the future.

Regulation Strategies, Contextual Problems, Addictive and Suicidal Behaviors: A Network Perspective with Adolescents

Adolescence is a period marked by challenges, including problems that appear in the adolescent's context. To manage these, adolescents use a series of emotional regulation skills that can be more or less adaptive. Less adaptive regulation is related to problem behaviors such as alcohol abuse, substance addiction, problematic internet use, and/or suicidal behavior. This study employs psychometric networks to analyze the association between these problem behaviors, the existence of contextual problems, and the use of cognitive emotional regulation strategies. We performed this analysis for the total sample: the male sample and the female sample. The total sample consists of 758 participants; 424 females (55.4%) and 341 males (44.6%) between the ages of 12 and 21 years (M age = 15.85; SD = 2311). The results show that less adaptive regulation strategies are the most central node, exhibiting a positive relationship with problem behaviors and contextual problems. In contrast, adaptive regulation strategies are a less influential node. Finally, problem behaviors are related to each other. Differences emerged between the male sample and the female sample. These findings contribute to improving our understanding of the phenomenon as well as to the construction of preventive interventions.

Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review

BACKGROUND

Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions.

OBJECTIVE

We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use.

METHODS

We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website.

RESULTS

We found 6416 citations, of which 41 (0.64%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions.

CONCLUSIONS

As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation.

TRIAL REGISTRATION

PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444387.

Adolescent short video addiction in China: unveiling key growth stages and driving factors behind behavioral patterns

The proliferation of short video apps has brought to the forefront the issue of adolescent addiction, a challenge that resonates across Chinese society. Despite growing attention, a comprehensive understanding of the factors propelling addiction at various adolescent stages and its impact on academic performance remains scarce. This study aims to fill this void by identifying key growth stages and crafting targeted intervention strategies. Our investigation engaged 1,896 Chinese students, averaging 15 years old, at pivotal educational junctures. Employing a mixed-method approach, we utilized interviews and surveys, enhanced by fixed effects models and instrumental variables, to discern patterns in short video addiction. The study revealed stage-specific catalysts for addiction: social identity in junior high, academic stress in senior high, and personality traits in university students. A concerning trend was the double and triple rate of severe addiction among senior high students compared to their junior high and university counterparts, respectively, with a peak of 52.7% mild addiction in university. Our predictive model provides a holistic perspective on the drivers of addiction. This groundbreaking analysis delineates the complex interplay of adolescent short video addiction in China, under-scoring its profound implications for academic progression in senior high. The findings under-score the urgent need for tailored interventions to counteract the adverse effects of addiction.

Does psychoeducation module-based community intervention address Internet addiction among school-going adolescents? A quasi-experimental study from Mangalore, India

Excessive and uncontrolled use of the Internet leads to Internet addiction and negatively affects the physical and mental health of adolescents. Normalization of the Internet and electronic gadgets during the COVID-19 pandemic increased the vulnerability of adolescents to developing behavioral dependency on Internet use. Intervention is needed to protect the formative years and to grow as responsible net users.

Aim

To study the effectiveness of psychoeducational module-based community intervention on Internet addiction in adolescents.

Method

This was a quasiexperimental study with pre- and post-test design. The study subjects were homogeneous and purposively selected single group from a secondary school in a city in southern India. Group intervention was executed for 5 to 6 hours with a prevalidated psychoeducation module on Internet addiction. The intervention focused on the prevention and control of Internet addiction. The level of Internet addiction was measured by using Kimberly Young's Internet Addiction Test-20.

Results

Of the total of 144 subjects, 72% were males and 28% were females. All were 14-16 years of age and were well versed with Internet gadgets and smartphone use and self-reported the use of the Internet/gadgets for at least 2 hours a day for recreational purposes. Descriptive analysis and RMANOVA show interventions were significantly effective (P < 0.001). Among total participants, the Internet addiction found at preintervention was 44.75 ± 19.69, with a postintervention at first month of 34.73 ± 16.14 and a postintervention at second month of 28.84 ± 13.98; reduced duration of Internet use was significant (P < 0.001) at postintervention.

Conclusion

The psychoeducation module-based group intervention in community school settings is well accepted and effective on Internet addiction in adolescents.

Internet Addiction and Sleep Quality Among School Children in South India

BACKGROUND AND AIM

Today's internet is an unavoidable component of educational sources, the entertainment field, and telecommunication processes. Internet usage is more likely among adolescents and young adults in the form of surfing, chatting, playing games, and fulfilling their social needs. The present study has been planned to assess the effect of internet addiction (IA) on sleep quality in school children.

METHODS

This cross-sectional school-based study was conducted among school students in Pondicherry. A total of 350 school students of both genders studying in grades six to 10 and having access to at least one device with internet for more than one year were recruited from government and private schools located in five randomly selected communes in Pondicherry by convenient sampling method. Assessment of IA was done using Young's Internet Addiction Test (YIAT). The Pittsburgh Sleep Quality Index (PQSI) questionnaire assessed the participants' sleep quality. All the data was tested for normality using the Kolmogorov-Smirnov test. Chi-square and unpaired t-tests were used for analysis.

RESULTS

The average age of the participants is 13 years. 49 (26.1%) are children and 139 (73.9%) are adolescents. The majority of them are females belonging to the adolescent age group (169, 89.4%). Around 17 (19.5%) children and 70 (80.5%) adolescents reported mild IA. Thirteen (59.1%) children and nine (40.9%) adolescents reported moderate IA. There is no significant difference in sleep quality between children and adolescents (4±2.33 vs. 3.62±2.61, p=0.37) but there is a considerable difference in their levels of IA (32.98±21.06 vs. 25.6±15.08, p=0.01).  Conclusion: This study found a significant relationship between IA and poor sleep quality among adolescents. Thus, adolescents, parents, school authorities, and researchers should understand the importance of regulating internet usage and encouraging sleep hygiene. Thus, appropriate measures should be taken to address the effects of IA on sleep quality.

Smartphone and social network addiction in early adolescents: The role of self-regulatory self-efficacy in a pilot school-based intervention

BACKGROUND

Youths' online problematic behaviors, such as smartphone or social network sites (SNS) addiction, gained increasing attention nowadays, due to their impact on concurrent and later adjustment, such as emotional and/or behavioral problems, academic impairments, or relational issues.

AIMS

This study aims to evaluate the effectiveness of a pilot school-based intervention to contrast online addictive behaviors while fostering adolescents' self-regulative abilities.

MATERIALS & METHODS

The intervention started in January 2022 in an Italian junior high school located in Rome, and consisted of four meetings with students. A total sample of 462 15-year-old adolescents (Mage = 15.2; SD = 0.50; 41% females; Ncontrol = 214; Nintervention = 248) was considered. Within the latent difference score framework, we examined short-term changes from the pre-to-the-postintervention levels of SNS and smartphone addiction, and self-regulatory self-efficacy (SRSE) beliefs as a possible booster of the intervention's effectiveness.

RESULTS

Results showed a significant decrease in both online addictions (SNS and smartphone addiction), controlling for age, gender, sexual orientation, and socioeconomic status, because of the short-term efficacy of the project. The buffering effect of SRSE beliefs was further supported.

CONCLUSION

These findings emphasized the usefulness of promoting youths' self-regulative beliefs to contrast problematic tendencies, according to a Positive Youth Development perspective which focused on resources rather than only on the prevention of negative outcomes for youths' adjustment.

Are School-Based Interventions Effective in Preventing Internet Misuse? A Systematic Review

Problems related to the use of the internet have triggered the appearance of internet addiction. With this problem comes the need for prevention. The objective of this study is to update the knowledge about the effectiveness of internet addiction prevention programs in schools. The specific aims are: (1) to identify the objectives of school's prevention programs, (2) to analyse the components and instruments used, (3) to evaluate the quality of the relevant studies and (4) to compare the results of the publications. A search with the terms "Internet", "Internet Use Disorder", "addiction", "prevention", "school", "effectiveness", and "prevention program" was carried out in 10 bibliographic databases in August 2021. For the selection of articles, the 25 quality criteria of the CONSORT 2010 list were used. Only articles that evaluated school prevention programs and had a quality score greater than 10 were selected. The results are shown in three tables. Eleven publications that met the inclusion criteria were identified. The measurement scales used are very heterogeneous. Ten of the 11 programs were effective in preventing adolescent internet misuse, abuse, or addiction. Increasing students' self-control reduces the problem of internet abuse. The validity of the results is discussed considering the methodological quality of the studies.

Internet Addiction Management: A Comprehensive Review of Clinical Interventions and Modalities

Internet addiction is a pervasive and complex issue that has gained increasing attention in the digital age. This comprehensive review provides an in-depth exploration of clinical interventions and modalities for managing internet addiction. It begins by examining the diagnostic criteria and assessment tools used to identify internet addiction, highlighting the diverse subtypes and varying degrees of severity. Subsequently, the review delves into various clinical interventions, including psychotherapeutic approaches like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness-based interventions. Pharmacological interventions, technology-based tools, and integrative approaches are also thoroughly analyzed. The review also outlines various treatment settings and modalities such as inpatient treatment centers, outpatient clinics, telehealth, support groups, and prevention programs for schools and communities. Furthermore, it discusses the efficacy and challenges associated with managing internet addiction, emphasizing the need for effective interventions, relapse prevention, ethical considerations, and addressing stigma and access barriers. In conclusion, the review offers practical implications for clinical practice. It emphasizes future research's importance in refining diagnostic criteria, exploring emerging technologies, and adapting interventions to an ever-evolving digital landscape. This comprehensive review is a valuable resource for clinicians, researchers, and policymakers seeking to understand and address the complexities of internet addiction.

The effects of self-esteem and parental phubbing on adolescent internet addiction and the moderating role of the classroom environment: a hierarchical linear model analysis

BACKGROUND

With the advent of the new media era, the understanding of adolescent internet addiction needs to be enriched. It is also necessary to distinguish the related factors of adolescent internet addiction at different levels to clarify the mechanisms of this phenomenon.

METHODS

This study used hierarchical linear model analysis to explore the effects of student-level factors and school-level factors on adolescent internet addiction, along with cross-level moderating effects. A total of 1,912 students between the 4th and 8th grades in China participated in the study. Participants completed the Self-Esteem Scale, Parents Phubbing Scale, Classroom Environment Scale, and the Diagnostic Questionnaire of Internet Addiction.

RESULTS

Correlational analyses revealed that internet addiction was found to be negatively correlated with both self-esteem and the teacher-student relationship (p < 0.01), while father phubbing, mother phubbing, and learning burden were shown to positively correlate with internet addiction (p < 0.01). Hierarchical linear model analysis suggested that student-level variables, including self-esteem, and mother phubbing, were significant predictors of internet addiction (β = -0.077, p < 0.001 and β = 0.028, p < 0.01, respectively). At the school level, learning burden significantly and negatively predicted internet addiction (β = 0.073, p < 0.05). Furthermore, the relationship between self-esteem and internet addiction was significantly moderated by learning burden (β = -0.007, p < 0.05). Meanwhile, the teacher-student relationship also had a significant moderating effect on the association between mother phubbing and internet addiction (β = -0.005, p < 0.01).

CONCLUSIONS

This study revealed the relationships between self-esteem, parental phubbing, and classroom environment with adolescent internet addiction, and these findings could provide insights into reducing adolescent internet addiction from the perspective of individuals, families, and schools.

Adolescent Screen Use: Problematic Internet Use and the Impact of Gender

OBJECTIVE

The relationship between screen use and problematic internet use (PIU; i.e., internet addiction) amongst adolescents has not been sufficiently explored. Further, there is even less research on how gender is associated with this relationship. The goal of the study was to examine adolescent screen use, PIU, and its impact on day-to-day routines of adolescents.

METHODS

Participants were recruited from an outpatient pediatric clinic in São Paulo, Brazil. A total of 180 adolescents completed questionnaires related to their screen use, extracurricular activities, and symptoms of PIU. Univariate and multivariate statistics were used to determine correlates and predictors of PIU, and to explore gender differences.

RESULTS

A total of 26.1% of adolescents met the criteria for PIU. There were no significant differences between boys and girls in PIU severity. However, there were significant gender differences in preferred use of the Internet, with boys being more likely to access the Internet to play video games (odds ratio [OR]=27.1) and girls being more likely to socialize with friends (OR=4.51). PIU severity increased proportionally to the number of hours of use of all screen devices with moderate-to-large effect sizes (η2=0.060-0.157). Using screens during meals and missing extracurricular activities were both associated with PIU.

CONCLUSION

Though gender was not associated with PIU, both excessive use of screen devices during meals and neglect of offline extracurriculars activities were identified as risk factors for PIU. Prevention measures should consider the impact of gender and associated patterns of motivation and Internet use.

A School-Based Program for Problematic Internet Use for Adolescents in Japan

Despite the serious influence of problematic Internet use on mental health among Japanese adolescents, no randomized clinical trials have investigated universal school-based interventions for this potential health challenge. Therefore, this study aimed to assess the efficacy of a school-based educational program. This two-armed, parallel, cluster-based randomized clinical trial included 5312 students from 13 high schools situated in a mid-sized Japanese city. The students in the intervention arm received 10 weekly standardized sessions, including a combination of information provision and interactive sessions by schoolteachers. The students in the control group followed a standard school curriculum. A generalized estimating equation model was applied to assess the primary (Korean Scale for Internet Addiction [K-scale] score) and secondary (behavioral change status according to changes in the transtheoretical model smartphone addiction score and Internet usage time) outcomes two months after intervention completion. The intention-to-treat analysis included 2597 (97.2%) and 2504 (94.9%) students in the intervention and control groups, respectively. Nevertheless, a significant discrepancy emerged regarding the behavioral change status. Therefore, this school-based program did not improve the Internet or smartphone addiction scores among Japanese adolescents. Further studies are needed to develop appropriate interventions for adolescents.

Investigating links between Internet literacy, Internet use, and Internet addiction among Chinese youth and adolescents in the digital age

Introduction

In current digital era, adolescents' Internet use has increased exponentially, with the Internet playing a more and more important role in their education and entertainment. However, due to the ongoing cognitive, emotion, and social development processes, youth and adolescents are more vulnerable to Internet addiction. Attention has been paid to the increased use of Internet during the COVID-19 pandemic and the influence of Internet literacy in prevention and intervention of Internet addiction.

Methods

The present study proposes a conceptual model to investigate the links between Internet literacy, Internet use of different purpose and duration, and Internet addiction among Chinese youth and adolescents. In this study, N = 2,276 adolescents studying in primary and secondary schools in East China were recruited, and they completed self-reports on sociodemographic characteristics, Internet literacy scale, Internet use, and Internet addiction scale.

Results

The results showed a significant relationship between Internet use and Internet addiction. To be specific, the duration of Internet use significantly and positively affected Internet addiction. With different dimensions of Internet literacy required, entertainment-oriented Internet use had positive impact on Internet addiction, while education-oriented Internet use exerted negative effects on Internet addiction. As for Internet literacy, knowledge and skills for Internet (positively) and Internet self-management (negatively) significantly influenced the likelihood of Internet addiction.

Discussion

The findings suggest that Internet overuse increases the risk of Internet addiction in youth and adolescents, while entertainment-oriented rather than education-oriented Internet use is addictive. The role of Internet literacy is complicated, with critical Internet literacy preventing the development of Internet addiction among youth and adolescents, while functional Internet literacy increasing the risk.

School teachers' awareness of internet addiction in elementary school students: a regional survey in Japan

In recent years, concerns about internet addiction (IA) among children have been increasing. This study focused on the awareness of IA in elementary school teachers. A web-based anonymous survey was conducted in November 2021. The participants completed an original questionnaire about their awareness of IA. The participants were divided into three groups based on their positions in the classroom: class teachers, support teachers, and administrative teachers. Out of 283 participants, over 70% had not approached students with IA and had little practical knowledge about the disorder. Support and administrative teachers had more opportunities to interact with students with IA than class teachers (p < 0.001 in both cases). Support teachers had more opportunities to ask their colleagues about IA than class teachers (p < 0.01); similarly, administrative teachers also had more opportunities to discuss IA with colleagues than class teachers (p = 0.04). Preventive interventions are recommended for people who communicate with children with IA. Students with IA might cause anxiety among teachers; therefore, preventive education strategies should be implemented with the cooperation of psychiatrists, psychologists, and public health nurses.

Treatment Modalities for Internet Addiction in Children and Adolescents: A Systematic Review of Randomized Controlled Trials (RCTs)

BACKGROUND

In recent years, the use of the internet among children and adolescents has dramatically increased, leading to growing concerns regarding the potential risks of excessive internet use and addiction. Addressing these concerns, this systematic review aims to summarize current evidence on the effectiveness of treatment interventions for internet addiction among children and adolescents.

METHOD

We performed a systematic review using PubMed, Web of Science, PsycInfo, and Google Scholar with search terms including "internet addiction", "problematic internet use", "children" or "adolescents", "treatment" and "randomized controlled trial". We found 10 Randomized Controlled Trials (RCTs) meeting the criteria and included them in this systematic review.

RESULTS

This systematic review analyzed 10 randomized controlled trials focused on treatment interventions for internet addiction in adolescents and young adults. The interventions used were diverse, including cognitive-behavioral therapy (CBT), medication, electro-acupuncture (EA), and solution-focused approaches. The measures used to assess the effectiveness of the interventions also varied, but most studies reported moderate to large effect sizes for at least some outcomes. Overall, the studies suggest that interventions such as CBT and EA can be effective in reducing symptoms of internet addiction, internet gaming disorder, and unspecified internet use disorders. School-based programs and brief manualized CBT programs also show promise, though more research is needed to determine their long-term effectiveness.

CONCLUSION

Promising treatment approaches for internet addiction are emerging, but inconsistencies in conceptualization, language, and diagnostic criteria present some challenges. The growing recognition of problematic internet use, as shown by the DSM-5's recognition of Internet Gaming Disorder, highlights the need for a multidisciplinary approach and standardized criteria to facilitate accurate reporting across studies. Continued research is needed to identify effective treatments and diagnostic criteria for internet addiction, with the potential to offer practical insights into effective medications and therapies.

The interplay between social media use and problematic internet usage: Four behavioral patterns

Objective

The study aims to identify typical interplay between the use of social media apps on smartphones and Problematic Internet Usage (PIU).

Method

Our study utilizes data from a smartphone app that objectively monitors user usage, including the apps used and the start and finish times of each app session. This study included 334 participants who declared a need to be aware of their smartphone usage and control it. Problematic Internet Usage (PIU) was measured using the Problematic Internet Use Questionnaire-Short Form-6 (PIUQ-SF6). The total PIU score can range from 6 to 30, with a score above 15 indicating that a person is at risk of PIU. Time spent on Social Media (SM) apps of Facebook, WhatsApp, and Instagram, and whether people used each of these apps were studied along with the total PIU score. K-Prototype clustering was utilized for the analysis.

Results

Four distinct clusters, typifying the relationship between social media use and PIU, were identified. All the individuals in Cluster 1 (Light SM Use Cluster; Cluster size = 270, 80.84% of total dataset) spent between 0 and 109.01 min on Instagram, between 0 and 69.84 min on Facebook, and between 0 and 86.42 min on WhatsApp and its median PIU score was 17. Those who were in cluster 2 (Highly Visual SM Cluster; Cluster size = 23, 6.89% of total dataset) all used Instagram, and each member spent between 110 and 307.63 min on Instagram daily. The cluster median PIU score and average daily usage of Instagram were respectively 20 and 159.66 min. Those who were in Cluster 3 (Conversational SM Cluster; Cluster size = 19, 5.69% of total dataset) all used WhatsApp, and spent between 76.68 and 225.22 min on WhatsApp daily. The cluster median PIU score and average time spent per day on WhatsApp were 20 and 132.65 min, respectively. Those who were in Cluster 4 (Social Networking Cluster; (Cluster size = 22, 6.59% of total dataset) all used Facebook, and each spent between 73.09 and 272.85 min daily on Facebook. The cluster median PIU score and average time spent per day on Facebook were 18 and 133.61 min respectively.

Conclusion

The clusters indicate that those who use a particular social media app spend significantly less time on other social media apps. This indicates that problematic attachment to social media occurs primarily for one of three reasons: visual content and reels, conversations with peers, or surfing network content and news. This finding will help tailor interventions to fit each cluster, for example by strengthening interpersonal skills and resistance to peer pressure in the case of Cluster 3 and increasing impulse control in the case of Cluster 2.

Childhood trauma and problematic internet use: A meta-analysis based on students in mainland China

Background

In recent years, the relationship between childhood trauma and problematic Internet use has been widely studied by scholars, but the research conclusions on the relationship between them are not consistent. Some studies report that childhood trauma and problematic Internet use are significantly correlated. However, others believe that there is a weak correlation between them. So the relationship between them needs to be studied further. The aim of this study is to explore the relationship between childhood trauma and problematic Internet use, and the effects of some moderating variables on both for students in Mainland China.

Methods

This study followed the requirements of Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement for literature screening. We searched the related studies on childhood trauma and problematic Internet use in Mainland China from January 2009 to November 2022 from CNKI, Wanfang Data, Chongqing VIP Information Co., Ltd. (VIP), Baidu scholar, ProQuest dissertations, SAGE Online Journals, Elsevier SDOL, Taylor &amp; Francis, Springer, Web of Science, Google Scholar, EBSCO, Medline, Scopus Database, PubMed Central, Embase, The Cochrane Library, PsycINFO, CMA 3.0 was used to analyse the overall effect and test the moderating effect.

Results

Among the papers included in the meta-analysis in this study, 31 papers reflected the relationship between childhood trauma and problematic Internet use, involving 52,503 subjects, and the sample size ranged from 388 to 16,130. This relationship between childhood trauma and problematic Internet use can be considered as a moderate correlation (r = 0.281, 95%CI[0.221, 0.338], p &lt; 0.001). The results showed that the relationship between childhood trauma and problematic Internet use was affected by different problematic Internet use measures. Meanwhile, meta-regression demonstrated that the relationship between childhood trauma and problematic Internet use was moderated by survey’s year. Specifically, the correlation coefficient between childhood trauma and problematic Internet use also increases with increasing year. However, the relationship between childhood trauma and problematic Internet use was not affected by the region, grade, childhood trauma measures, publication source.

Conclusion

Childhood trauma is closely related to problematic Internet use. In order to reduce problematic Internet use, corresponding prevention and intervention measures should be taken.

Effects of an App-Based Intervention Program to Reduce Substance Use, Gambling, and Digital Media Use in Adolescents and Young Adults: A Multicenter, Cluster-Randomized Controlled Trial in Vocational Schools in Germany

Vocational students are a risk group for problematic substance use and addictive behaviors. The study aim was to evaluate the effects of an app-based intervention on tobacco, e-cigarettes, alcohol, and cannabis use as well as gambling and digital media-related behaviors in the vocational school setting. A total of 277 classes with 4591 students (mean age 19.2 years) were consecutively recruited and randomized into an intervention (IG) or waitlist control group (CG). Students from IG classes received access to an app, which encouraged a voluntary commitment to reduce or completely abstain from the use of a specific substance, gambling, or media-related habit for 2 weeks. Substance use, gambling, and digital media use were assessed before and after the intervention in both groups with a mean of 7.7 weeks between assessments. Multi-level logistic regression models were used to test group differences. Intention-to-treat-results indicated that students from IG classes had a significantly larger improvement on a general adverse health behavior measure compared to CG (OR = 1.24, p = 0.010). This difference was mainly due to a significantly higher reduction of students' social media use in the IG (OR = 1.31, p < 0.001). Results indicate that the app "Meine Zeit ohne" is feasible for the target group and seems to have a small but measurable impact on students' health behavior.

The Effect of Pythagorean Self-Awareness on Heart Rate Variability, Perceived Stress and Behavior of Preschool Children

Stress is associated with unhealthy habits and non-communicable diseases. It is also linked to communicable diseases due to its impact on immune function. These can be prevented through intervention programs in schools. The aim of this study was to examine the effect of the simplified Pythagorean Self-Awareness Intervention on heart rate variability (HRV) parameters, perceived stress and behaviors of preschool children. The sample of the study consisted of 45 preschool students. A “one group (double) pretest—posttest design” was used, to allow for comparisons of the measurements before and after the intervention. Students were assessed via two questionnaires (“Perceived Stress Scale for Children” (PSS-C) and “Checklist for Screening Behavioral Problems in Preschool Children”) and a photoplethysmographic (PPG) device. The intervention lasted 9 weeks and included practicing of the Pythagorean Self-awareness techniques and the adoption of healthy behaviors. The results showed no statistically significant differences between the two pretests (p > 0.05 for all comparisons) and statistically significant differences between the second pretest and posttest (“Perceived Stress Scale for Children”, (PSS-C) p < 0.0001, “Checklist for Screening Behavioral Problems in Preschool Children” p < 0.0001 and two indices of PPG device: heart rate mean, p < 0.0001, low frequency/very low frequency, p = 0.034). In conclusion, the Pythagorean Self-Awareness Intervention had a beneficial effect on the sample of preschool students examined, as the results showed an improvement in the perceived stress and the HRV parameters tested, and in engaging healthier behaviors, findings that indicate a relaxed psychologic state and a healthier lifestyle.

A Study of Occupational Therapy Strategies and Psychological Regulation of Students' Internet Addiction in the Mobile Social Media Environment

This paper provides an in-depth research analysis of occupational therapy strategies and psychological regulation of students' Internet addiction in the existing mobile social media environment. Based on the definition of Internet use peer pressure, a preliminary scale with 2 dimensions of specific behavioral pressure and psychological cognitive pressure was developed. First, a professor of mental health education and a master's degree student in mental health education were invited to rate the scale, while 47 junior high school students were selected to try the scale to ensure that the questions of the scale were clearly expressed. Secondly, 461 subjects were selected to take the initial test of the scale, and item tests and exploratory factor analysis were conducted to ensure that the structure of the scale was as expected and the scale was expressed to psychometric standards. Finally, 810 subjects were selected for the scale retest, and item analysis and validated factor analysis were conducted, and their results met the psychometric criteria. Student peer attachment significantly and positively predicted adolescent Internet addiction; Internet use peer pressure played an incomplete mediating role in the prediction of peer attachment to Internet addiction; loneliness played a moderating role in the pathway of peer attachment to Internet addiction, and loneliness also played a moderating role in the pathway of peer attachment to Internet use peer pressure. The attitude towards online games is entertainment to kill time, a tool to escape the pressure of study and to gain the fun of friends comparing with each other. The main online motivations of adolescents included individual and situational factors, and behaviors were characterized by pan-entertainment and gamification, mainly through mobile social networks to obtain external information and knowledge, maintain interpersonal relationships, and gain a sense of belonging; they were characterized by a fixation on time, space, and online content. The interaction of family members is more of a behavioral habit, and the communication habits and behavior patterns established in the family will influence the construction of children's relationships with others, while parents' head-down behavior will also influence children's attention to various needs of an Internet-dependent behavior problem, which in turn affects children's problem-solving and intimate relationships with family members.

Problematic Social Media Use and Cyber Aggression in Italian Adolescents: The Remarkable Role of Social Support

The recent increase in electronic and social media use among young people has highlighted the importance of focusing on problematic social media use (PSMU) and the concurrent phenomenon of cyber aggression, as well as the role of social support. As part of the 2018 Health Behavior in School-aged Children study in Italy, this study aims to explore the role of family, peer, and teacher support in the association between cyberbullying and PSMU.

METHODS

Data were collected from 4183 school classes in Italy for a total of 58,976 adolescents aged 11, 13, and 15 years. The prevalence of cyber aggression (both cybervictimization and perpetration) and PSMU was estimated across subgroups of different age, gender, and geographical residence. A set of multivariable logistic regressions was then used to investigate the association between cyberbullying and PSMU, considering the effect of social support.

RESULTS

Cybervictimization was more frequent among girls than in boys. PSMU was higher in 11-year-old boys and 13-year-old girls; 8.3% and 12.7%, respectively. Social support was highest in 11-year-olds, for both sexes, and then decreased with increasing age. The risk of cyberbullying, both suffered and perpetrated, was higher in girls and in the presence of PSMU. Social support showed to be highly protective against PSMU and cyberbullying in all ages and both genders.

CONCLUSION

Although cyber aggression is less represented in Italy than in other European countries, it is likely to increase. PSMU appears to be an important contributor to the risk of cyber aggression; however, social support has been shown to be capable of reducing the risk of both phenomena. Public health policies fostering familiar and school support can help protect adolescents' mental health, reducing the risk of problematic media use and cyberbullying.

Pattern of mobile phone and internet use among 11-15-years-old

OBJECTIVE

To assess the pattern of problematic internet and mobile use in a sample of adolescents.

METHOD

Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected.

RESULTS

446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11-15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12h on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001).

CONCLUSIONS

The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.

Impact of a single school-based intervention for COVID-19 on improving mental health among Japanese children

An underlying concern about the COVID-19 pandemic is the decline of children's mental health. The present study is aimed to investigate whether a single school-based intervention, including self-monitoring and psychoeducation for COVID-19, effectively achieved its aim to promote children's mental health. The study was conducted in a junior high school. We assigned the third grade as the intervention group, the second grade as the announcement group, and the first grade as the control group. We hypothesized that the intervention group would experience improved mental health and reduced fear of COVID-19 compared to the announcement and control groups. Interaction effects were observed only for depression, indicating a significant effect in the intervention group. These findings suggest that a single school-based intervention that includes self-monitoring and psychoeducation for COVID-19 can help improve children's mental health. It is suggested that school-based interventions that intend to raise children's awareness of COVID-19 promote their healthy development and adaptation to crises within the school.

The More Internet Access, the More Mental Symptoms Students Got, the More Problematic Internet Use They Suffered: a Meta-analysis of Mainland Chinese Adolescents and Young Adults

The traditional view is that mental symptoms and problematic Internet use are positively related. Still, other researchers have questioned this view, and they believe that mental symptoms are negatively associated with problematic Internet use. Since then, this controversy has continued yet. The current study attempts to use meta-analysis to explore the relationship between mental symptoms and problematic Internet use in mainland Chinese students to provide a reliable basis for resolving this dispute. Sixty-three articles were included in this study, including 66 sample sizes and 47,968 subjects. It found that mental symptoms are positively correlated with problematic Internet use (r = .288, 95% confidence interval [.255, .320]). The correlation is affected by regions. Compared with coastal areas, problematic Internet users in the non-coastal areas are more likely to be affected by mental symptoms. In addition, gender differences also significantly affect the relationship between mental symptoms and problematic Internet use. The correlation coefficient between mental symptoms and problematic Internet use of girls is significantly higher than that of boys. Moreover, year also significantly affects the relationship between mental symptoms and problematic Internet use-the correlation increases by growing years.

Self-perceived substance and behavioral addictions among Jewish Israeli adolescents during the COVID-19 pandemic

This study examined self-perceived substance and behavioral addictions among Israeli adolescents during the COVID-19 pandemic across different sociodemographic categories. The sample comprised 2,074 adolescents (40% males, 60% females) aged 12-19 years who completed the survey anonymously and with parental consent. We examined what is the prevalence of self-perceived substance and behavioral addictions in this population in the COVID-19 pandemic context. Participants reported self-perceived addictions to social networks (70%), shopping (46%), binge eating (34%), gaming (30%), sex-related behavior (15%), psychoactive substance (31%, including alcohol, tobacco, cannabis, and/or cocaine), and gambling (3%). Moreover, differences were found to be directly related to age, biological sex, religiosity, socioeconomic status, and immigration status. From a lay epidemiological perspective, the current research expands our knowledge about self-perceived addiction among adolescents during the COVID-19 pandemic, offering better understanding of the likelihood probability factors for self-perceived addiction among adolescents and its related negative outcomes, including increased risk factors for later adult life.

The Comparative Efficacy of Treatments for Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An Updated Meta-Analysis

Internet gaming disorder (IGD) is a formal mental disorder leading to bad outcomes for children and adolescents. This study comprehensively compared the estimated effect of various pharmacotherapy and psychosocial interventions for IGD from randomized controlled trials (RCT) through updated meta-analysis, using meta-regression. A search of PubMed/MEDLINE, Cochrane Library, and Airiti Library between 2000 and 2017 was conducted for various IA/IGD intervention modalities. A total of 124 studies from 29 selected papers involving 5601 children and young adults with IA/IGD were found. Meta-analyzing the pooled standardized mean difference (SMD) revealed a preliminary random effect of 1.399 with a 95% confidence interval of 1.272–1.527, suggesting highly effective treatment of IA/IGD. After adjusting for the confounding risks of age, publication year, type of subjects, and type of study, this study revealed that combining pharmacotherapy with cognitive behavioral therapy (CBT) or multi-level counseling (MLC) was the most effective treatment option. Using a scale of time spent online or a severity of IA symptoms scale was a more effective measurement, with p-values = 0.006 and 0.002, respectively. IA/IGD patients with comorbid depression showed worse outcomes than youth with another comorbidity. The corresponding model goodness-of-fit indices were τ² = 1.188; I²-Residual = 89.74%; and Adjusted-R² = 16.10%. This systematic review indicates that pharmacotherapy combined with CBT or MLC might be an effective therapeutic strategy for youth with gaming disorder.

Development and validation of the smartphone addiction risk children questionnaire (SARCQ)

Smartphone abuse interferes with all activities in daily life. Young people who tend to have a smartphone addiction (SA) also have social, familiar and academic problems. Furthermore, smartphone provides immediate access to communication as well as avoids experiencing social anxiety. This research aims to evaluate the factorial structure of Smartphone Addiction Risk Children Questionnaire (SARCQ), a specific questionnaire created to assess the risk of SA in primary school children (8–11 years). An exploratory factor analysis before and a confirmatory factor analysis after were performed in order to establish the factorial structure of the questionnaire. Results showed a two-factor structure explaining 49.30% of total variance. The outstanding dimensions are: “I'm not afraid with you” (INAWY) and “Linus blanket” (LB). SARCQ will be useful to assess the risk of SA in childhood in order to operate early effective therapeutic interventions.

Effectiveness of Cognitive Behavioral Therapy-Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents: A Cluster Randomized Clinical Trial

IMPORTANCE

Behavioral addictions were introduced as novel mental disorders in the International Classification of Diseases, 11th Revision, based on evidence that human behavior itself can become addictive, similar to addiction to substances. However, previous studies on prevention of gaming disorder and unspecified internet use disorder lacked randomization, follow-up measurements, and diagnostic interviews that assessed incidence rates; this trial was intended to fill this gap.

OBJECTIVES

To investigate whether the PROTECT (Professioneller Umgang mit technischen Medien [Professional Use of Technical Media]) intervention can reduce the symptom severity and prevent full syndrome and subthreshold onset of gaming disorder and unspecified internet use disorder in at-risk adolescents.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter cluster randomized clinical trial conducted recruitment, screening, intervention delivery, and data collection among at-risk adolescents aged 12 to 18 years in 33 high schools in Germany. Inclusion criteria for the study and symptom severity analyses were elevated symptoms of gaming disorder and unspecified internet use disorder. A subsample that met the inclusion criteria for incidence analyses (no full syndrome of gaming disorder or unspecified internet use disorder, depression, or anxiety at baseline) was analyzed for illness onset. Participants were randomized to either the PROTECT intervention group or the assessment-only control group. Participants were assessed at baseline, 1-month follow-up, 4-month follow-up, and 12-month follow-up between October 1, 2015, and September 30, 2018. Based on intent-to-treat principle, data analyses were conducted from February 8, 2019, to May 7, 2021.

INTERVENTIONS

PROTECT, a theory-driven, manualized, cognitive behavioral therapy-based indicated preventive group intervention that is delivered in 4 sessions by trained psychologists. It targets changes in addictive reward processing and pathological cognitive mechanisms.

MAIN OUTCOMES AND MEASURES

The primary outcome was symptom severity (measured by CSAS [Computerspielabhängigkeitsskala], a modified German video game dependency scale with a score range of 0-56 [higher scores indicating greater pathology]) along with incidence rates (assessed by a structured clinical interview) after 12 months. Secondary outcomes were comorbid psychopathology and problem behaviors.

RESULTS

A total of 422 at-risk adolescents (mean [SD] age, 15.11 [2.01] years; 229 female participants [54.3%]) were randomized to either the PROTECT intervention group (n = 167; mean [SD] risk score, 29.05 [6.98]) or the assessment-only control group (n = 255; mean [SD] risk score, 26.21 [5.01]) and were included in the symptom severity analyses. Compared with the control group, the PROTECT group showed a significantly greater reduction in symptom severity of gaming disorder or unspecified internet use disorder (γ11 = -0.128; 95% CI, -0.246 to -0.011; P = .03), reflecting a 39.8% vs 27.7% reduction of symptoms with an effect size of Cohen d = 0.67 (baseline vs 12-month follow-up) for the PROTECT group. Differences in incidence rates did not reach statistical significance. The PROTECT group showed a significantly greater decrease in procrastination (γ11 = -0.458; 95% CI, -0.735 to -0.180; P < .001) over 12 months, but no significant differences were found for other secondary outcomes.

CONCLUSIONS AND RELEVANCE

Results of this trial showed that the PROTECT intervention effectively reduced symptoms of gaming disorder and unspecified internet use disorder over 12 months. The intervention did not change incidence rates of gaming disorder or unspecified internet use disorder.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02907658.

Positive Youth Development and Internet Use in a Sample of Spanish Adolescents

During the COVID-19 pandemic, the use of Internet in the adolescent population has increased. A growing research interest has been developed about the consequences of Internet use for adolescent development. Despite most studies have examined the impact of Internet use on some indicators of psychological maladjustment, few studies have addressed the detrimental impact on the positive indicators of mental health. Positive youth development (PYD) represents a positive view of adolescent transition to adulthood which focuses on building the strengths that make young people more resistant to negative outcomes and more capable to choose a positive life direction. This study aimed to analyze the relationships between different aspects of Internet use and overall PYD in a sample of Spanish adolescents. To reach this aim, a sample of 1,038 adolescents (50.1% boys, M age = 14.19, SD = 1.38), enrolled in 14 high schools in the city of Huelva (Spain), filled in some self-report measures of PYD and Internet use and experience, such as the frequency of Internet use on weekdays or weekends, the different uses of Internet (i.e., social networks, playing online, reading, surfing or looking for information, playing or downloading music, and searching, selling, or buying products), and the subjective experience using the Internet (i.e., acknowledgment of spending too much time playing or in the networks, and being in a bad mood if they do not play or use the networks). Results of a hierarchical regression analysis showed that the more hours using Internet on weekdays, the less PYD. Moreover, the experience of feeling bad when not using the networks and spending too much time with online playing was related to lower PYD. However, the use of Internet for reading or looking for information had a positive association with PYD. These results suggest some implications for practice, such as the need to promote an adaptive Internet use, by providing a safe online context that encourages the acquisition of positive social values and life skills.

The Association of Internet Addiction with Burnout, Depression, Insomnia, and Quality of Life among Hungarian High School Teachers

The extensive availability of Internet has led to the recognition of problematic Internet use (so called Internet addiction, IA) mostly involving adolescents. There are limited data about the prevalence and consequences of IA in adults especially among high school teachers. Here, we present a cross-sectional prospective study focusing on the association of Internet addiction with burnout, depression, insomnia, and lower quality of life among high school teachers taking many co-variates into account. Overall, 623 males (34.3%) and 1194 females (65.7%) participated in our study. Internet addiction was detected in 5.2% (95/1817) based on the Problematic Internet Use Questionnaire. Internet addiction was associated with severe burnout (10.5 vs. 2.7%, p < 0.001), moderate (36.8 vs. 1.7%, p < 0.001), and severe (6.3 vs. 0.1%, p < 0.001) depression, insomnia (23.1 vs. 11.4%, p < 0.001), and severe sleep disturbance (severe insomnia, 27.4 vs. 3.8%, p < 0.001) and lower quality of life in all domains (p < 0.001). There was also a significant correlation of the severity of the above-mentioned parameters and the severity of IA (overall scores, p < 0.001 in all cases). In a multivariate analysis including demographic criteria, risk factors medical conditions and the above-mentioned parameters as co-variates internet addiction was significantly associated with depression (OR = 3.836, CI: 2.92-5.44, p = 0.03), and insomnia (OR: 3.932, CI: 3.6-5.69, p = 0.002). This is the first study from Hungary and is one of the first studies showing the association of IA with mental issues, burnout, and lower quality of life among adults. It underlines the clinical importance of problematic Internet use among adults.

Draconian policy measures are unlikely to prevent disordered gaming

In August of 2021, China imposed severe restrictions on children's online gaming time. We argue that such a policy may seem useful on the surface but does not reflect the current evidence concerning prevention of disordered gaming. Videogame play is normal for children worldwide, and like other leisure activities can lead to benefits for the majority and problems for a minority. Problematic or disordered play results from the interaction of multiple risk factors that are not addressed by draconian policy measures. Identifying these factors through stakeholder-engaged research and current evidence will be much more likely to succeed in preventing disordered gaming and promoting youth wellbeing.

Internet Addiction and Depression Among Postgraduate Residents: A cross-sectional survey

Objectives

This study aimed to estimate the prevalence of social media usage and Internet addiction among Oman Medical Specialty Board (OMSB) residents and to determine associations between Internet addiction, sociodemographic characteristics and symptoms of depression.

Methods

This cross-sectional study took place between January and March 2017. All 499 residents enrolled in OMSB training programmes during the 2016–2017 academic year were targeted. A self-administered questionnaire was distributed to collect information concerning sociodemographic characteristics. In addition, the Patient Health Questionnaire-9 and Internet Addiction Test were used to screen for depression and Internet addiction, respectively.

Results

A total of 399 residents participated in the study (response rate: 80%). Overall, 115 residents (28.8%) had varying degrees of depression and 149 (37.3%) were addicted to the Internet; moreover, among those addicted, 54 (36.2%) had depression. While no significant associations were observed between Internet addiction and sociodemographic characteristics, the association between Internet addiction and depression was statistically significant (P = 0.012).

Conclusion

Internet addiction was clearly detected among many OMSB residents, with a significant association observed between Internet addiction and depression. Although a causal link between these two variables cannot be established as depression is multifactorial in origin, the disadvantages and harmful effects of excessive Internet and social media usage need to be addressed. Further research on the consequences of Internet addiction and its effect on quality of life and academic achievement is recommended.

Impulsivity mediates the impact of early life adversity on high risk behaviors among Tunisian adolescents

Adverse childhood experience (ACE) has become an alarming phenomenon exposing youth at a great risk of developing mental health issues. Several studies have examined the mechanism by which ACE affects adolescent's engagement in risky behaviors. However, little is known about these associations in the Tunisian/African context. We investigated the role of impulsivity in the link between ACE and health risk behaviors among schooled adolescents in Tunisia. We performed a cross sectional study among 1940 schooled adolescents in the city of Mahdia (Tunisia) from January to February 2020. To measure ACE, we used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale and the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. A total of 2520 adolescents were recruited. Of those, 1940 returned the questionnaires with an overall response rate of 77%. The majority (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported intra-familial ACEs. Males had higher rates of exposure to social violence than females. The most common risky behavior was internet addiction (50%, 95%CI = [47.9-52.3%]). Our survey revealed that ACEs score predict problematic behaviors through impulsiveness (% mediated = 16.7%). Specifically, we found a major mediating role of impulsivity between the exposure to ACE and the risk of internet addiction (% mediated = 37.5%). Our results indicate the role of impulsivity in translating the risk associated with ACE leading to engagement in high risk behaviors.

Association of Unhealthy Behaviors with Self-Harm in Chinese Adolescents: A Study Using Latent Class Analysis

Previous studies have demonstrated the link between individual unhealthy behaviors and self-harm, but little is known about the influence of multiple unhealthy behaviors on self-harm among adolescents. This study aims to identify the potential patterns of unhealthy behaviors and to examine their associations with self-harm, which may become a useful tool for the screening of self-harm in adolescents. A total of 22,628 middle school students (10,990 males and 11,638 females) in six cities was enrolled in this study by multistage stratified cluster sampling from November 2015 to January 2016. Latent class analysis (LCA) was performed based on five kinds of unhealthy behaviors (unhealthy losing weight (ULW), tobacco use (TU), alcohol use (AU), screen time (ST), and mobile phone dependence (MPD)). Multivariate logistic regressions were used to examine associations between identified subgroups and self-harm. Four subgroups of unhealthy behaviors were identified. Class 1 (71.2%) had the lowest engagement in unhealthy behaviors. Class 2 ((ULW/MPD), 22.3%) had a relatively high prevalence of ULW and MPD. Class 3 ((TU/AU/ST), 3.2%) had a relatively high prevalence of TU, AU, and ST. Class 4 (3.3%) consistently engaged in unhealthy behaviors. Compared to class 1, class 2 (ULW/MPD), class 3 (TU/AU/ST), and class 4 showed OR (95%CI) values of 2.101 (1.964–2.248), 2.153 (1.839–2.520), and 3.979 (3.407–4.645) (p < 0.001 for each), respectively. Class 1, class 2 (ULW/MPD), and class 3 (TU/AU/ST) engagement in unhealthy behaviors was associated with increased self-harm. These findings strongly suggested that self-harm prevention efforts focusing on multiple unhealthy behaviors should be seriously considered for early detection of self-harm.

Managing Problematic Usage of the Internet and Related Disorders in an Era of Diagnostic Transition: An Updated Review

INTRODUCTION

Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.

METHODS

Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.

RESULTS

In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.

CONCLUSION

The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.

[Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study]

Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study Abstract. Objective: To date, childhood has hardly been considered in the development of effective prevention and intervention programs for gaming disorder and Internet addiction. PROTECTdissonance was therefore designed as a 1-hour dissonance-based, universal primary prevention program for grade 5 high-school students. This pilot study examines the immediate effects of dissonance induction on attitudes toward gaming. Method: A single-arm A+B design with three measurement points (T0, T1, T2) assessed attitudes toward gaming using the Gaming Attitude Test (GAT). The baseline sequence (sequence A, T0 to T1, subsample) included N = 83 high-school students (age: M = 10.27; SD = 0.48) and the intervention sequence (sequence B, T1 to T2, total sample) included N = 200 pupils (age: M = 10.24; SD = 0.47). Acceptance and satisfaction were recorded after the intervention. Results: Hierarchical linear growth models showed a significant reduction of GAT symptoms through the intervention, both in the total GAT score and on the subscale "Trivialization of Negative Consequences." There were no changes in the natural course (baseline sequence A). Pupils correspondingly reported a high rate of satisfaction with PROTECTdissonance. Conclusions: A brief, targeted dissonance-induction exercise shows immediate effects on an attitudinal measure of gaming. To follow up on this promising approach, future studies should investigate whether reduced trivialization of negative consequences of gaming is actually reflected in behavioral change.

Prävention der exzessiven Mediennutzung im Kindes- und Jugendalter

Hintergrund

Für Kinder und Jugendliche ist die Nutzung digitaler Medien ein zentraler Bestandteil der Freizeitgestaltung. Bei etwa 8 % der 12- bis 17-Jährigen ist von einer computerspiel- oder internetbezogenen Störung auszugehen.

Ziel der Arbeit

Ziel war die Überprüfung der Wirksamkeit eines schulbasierten „Peer-to-peer“-Programms zur Prävention der exzessiven Mediennutzung im Kindes- und Jugendalter („Net-Piloten“). Das primärpräventive Programm wird Schulen mit Sekundarstufe I von der Bundeszentrale für gesundheitliche Aufklärung (BZgA) in Zusammenarbeit mit den Landesstellen für Suchtfragen kostenfrei zugänglich gemacht.

Material und Methode

Die Wirksamkeit von „Net-Piloten“ wurde in einer kontrollierten Studie (1:1-Matching) überprüft. Die Datenerhebung erfolgte über einen Online-Fragebogen im 1. Schulhalbjahr 2019/2020, an der insgesamt 834 Kinder und Jugendliche teilnahmen (mittleres Alter: 12 Jahre). Die Interventionsgruppe nahm an einem von Peers durchgeführten Workshop zur Sensibilisierung für die Risiken von exzessiver Mediennutzung und zur Förderung der Selbstreflexion teil.

Ergebnisse

Schüler*innen der Interventionsbedingung verfügten über ein höheres Wissen über negative Konsequenzen exzessiver Mediennutzung und wiesen geringere Nutzungszeiten (Computerspieldauer F (1,832) = 6,45, p = 0,011) auf als die Vergleichsgruppe. Der Anteil an Schüler*innen mit problematischer Mediennutzung war nach „Net-Piloten“-Teilnahme geringer im Vergleich zur Kontrolle (F (1,832) = 14,76, p < 0,001).

Diskussion

Die Befunde stehen im Einklang mit früheren Studien zur Effektivität von schulbasierten Programmen zur Vermeidung der problematischen Mediennutzung. Sie deuten darauf hin, dass schulbasierte Programme einer exzessiv-dysfunktionalen Mediennutzung vorbeugen können.

Policy Recommendations for Preventing Problematic Internet Use in Schools: A Qualitative Study of Parental Perspectives

Parenting in the digital age has been characterized as one of the most challenging tasks of the modern era. Parents are ambivalent about their mediating role. However, problematic aspects of adolescent online use have not been adequately addressed in education. The present study investigated parental perceptions of intervention needs within schools to prevent excessive/problematic use, enhance parent-child communication, and reduce family conflicts. Nine interviews with parents of adolescents residing in the UK were carried out and analyzed utilizing thematic analysis. Three main themes emerged as parental proposals: (i) schools as digital education providers and prevention hubs, (ii) provision of mental health literacy to raise awareness, resolve ambiguity regarding impacts and mitigate excessive use and impacts, and (iii) psychoeducation and upskilling. The third theme related to impacts from time spent on screens (time displacement), content-related impacts, and context-related impacts. The present study offers recommendations for media literacy during adolescence beyond e-safety (i.e., addressing interpersonal communication problems, privacy vs. disclosure issues), based on parents' views, and provides new insights for media and emotional health literacy collaboration efforts. Future work should investigate the feasibility and effectiveness of such interventions to support the emotional health of young people and prevent problematic internet use escalation.

School-based relationships and problematic internet use amongst Chinese students

The potential for adolescent mental health problems arising from heavy internet use is significant. There is a need to better understand the risk and protective factors related to problematic internet use (PIU) amongst adolescents. This study examined the role of adolescents’ perceptions of school-based relationships as potential contextual antecedents to problematic internet use. Specifically, 6552 adolescent students (55.9% boys, 13.51 ± 2. 93 years) from 22 primary and middle schools in southern China completed questionnaires to measure the degree of adolescent conflict with peers, teachers and other staff, school connectedness, perceived classroom atmosphere and problematic internet use. Self-reported data was collected using a two-level stratified sampling. Multiple regression analyses showed that conflict with peers and teachers was positively associated with higher levels of PIU, while school connectedness and perceived classroom atmosphere were negatively associated with PIU. An interaction effect was found for conflict with peers and grade level, such that the association between conflict with peers and PIU was stronger for secondary students compared to primary school students. The results support the need for school-based interventions for PIU to include a focus on conflict with peers and teachers, and for a focus on the enhancement of school connectedness and classroom atmosphere.

Perceived Challenges and Online Harms from Social Media Use on a Severity Continuum: A Qualitative Psychological Stakeholder Perspective

Evidence suggests that problematic use of gaming, the internet, and social media among adolescents is on the rise, affecting multiple psycho-emotional domains. However, research providing a comprehensive and triangulated stakeholder perspective of perceived harms is lacking. How are adolescent online harms experienced and conceptualized by students, parents, and teachers? The present study comprised part of a qualitative needs assessment investigation with the use of focus groups and individual interviews among key stakeholder groups assessing perceived impacts with a focus on the negative consequences and perceived harms. The study’s sample consisted of students (N = 42, M_age = 13.5, SD = 2.3), parents (N = 9, M_age = 37, SD = 5.6) and teachers (N = 9, M_age = 34, SD = 4.9) from the UK. Data were analysed with thematic analysis. Findings focused primarily on social media use impacts and indicated that processes underlying impacts experienced by adolescents may be conceptualized on a severity continuum. Stakeholder consensus on perceptions of challenges and perceived harms formed the second theme, with impacts further analysed as relating to time displacement, peer judgement, sensory overload and context of the adolescent with functional (performance, task switching, use of multiple devices), cognitive (loss or deterioration of attentional focus, attention deficit), and emotional consequences (stress, anxiety, obsessive-compulsive/checking behaviours). A third theme formed was individual vulnerabilities predisposing poor mental health outcomes. The final theme related to impacts dependent on context and meaning attached. Findings suggest a consideration of a spectrum approach encompassing a broader range of potential psychological challenges and perceived harms beyond safety concerns and addiction in understanding problematic adolescent online experiences. Understanding perceived harms can aid the objective setting of interventions and consideration of mental health literacy in school curricula.

Prevalence and Risk Factors of Internet Addiction among Hungarian High School Teachers

The extensive availability of internet has led to the the recognition of problematic internet use (so called internet addiction, IA) mostly involving adolescents. There is limited data about the prevalence of IA in adults. Here we present a study focusing on the prevalence and risk factors of internet addiction among high school teachers. Overall 2500 paper-based questionnaires were successfully delivered and 1817 responses received (response rate of 72.7%). In our study 1194 females (65.7%) and 623 males (34.3%) participated. In a multivariate analysis including of all factors (demographic data, internet habits, comorbidity etc.) age <35 years (OR: 6.098, CI: 5.09-7.08, p < 0.001), male gender (OR = 5.413, CI: 4.39-6.18, p = 0.002), surfing on the internet > 5 h daily (OR 2.568, CI: 2.03-3.39, p < 0.001), having no children (OR: 1.353, CI: 1.13-1.99, p = 0.0248), and having secondary employment (OR = 11.377, CI: 8.67-13.07, p = 0.001) were significantly associated with internet addiction. This is the first study from Hungary showing the prevalence and risk factors of internet addiction among high school teachers. A small, but significant proportion suffered from IA. Our study also draws attention to the risk factors of IA such as younger age, family status and working type.

Concurrent and Longitudinal Relationships between Positive Youth Development Attributes and Adolescent Internet Addiction Symptoms in Chinese Mainland High School Students

In view of growing adolescent Internet addiction (IA) in the global context, there is a great need to understand the predictors of IA and design related evidence-based intervention and prevention programs. This longitudinal study investigated the relationships between Positive Youth Development (PYD) attributes and IA problems and the mediating role of life satisfaction using a large sample of Chinese high school students (N = 2648). Separated by one academic year, students completed a questionnaire evaluating their adolescent psychosocial adjustment, including validated PYD and IA measures. Multiple regression and structural equation modeling analyses were used. Consistent with the theoretical predictions of PYD models, results revealed a significant negative influence of PYD attributes on IA symptoms concurrently and longitudinally. In particular, general PYD attributes, such as emotional competence, spirituality, and resilience, showed strong and stable protective effects against IA. Life satisfaction also served as a mediator of the influence of all measures of PYD attributes on IA symptoms. The study underlines the importance of PYD attributes in promoting adolescents’ life satisfaction and preventing IA, and thus contributes to the design and implementation of evidence-based intervention and prevention programs.

Substance Use and Addictive Behavior in Spanish Adolescents in Secondary School

The detection and prevention of addictive behaviour at an early age is essential given the relationship between the age of the onset of consumption and the appearance of addiction disorders. The aim of this study was to describe the behavior related to substance use and addictive behaviors in adolescents at secondary school from 12 to 16 years of age. A cross-sectional descriptive study has been conducted. The prevalence of consumption of different addictive substances (alcohol, tobacco, cannabis, cocaine) and addictive behaviours (use of social networks and video games) were collated, and the influence of the surrounding social environment and risk perception were evaluated. The final sample was 1298 students. Alcohol, tobacco and cannabis use reflect the prevalence of last month’s consumption: 14% (11.8–15.6), 15% (13.4–17.4) and 3% (1.9–2.7) respectively. 76% of the sample frequently use the Internet (5–7 days per week). There is a positive association between the frequency of use and use in the immediate environment. The relationships found show the need for educational and preventive intervention aimed at parents and students that will allow them to know and effectively deal with possible problems associated with the consumption of addictive substances.

Debate: Behavioural addictions and technology use - risk and policy recommendations for problematic online gambling and gaming

Digital technology allows people to connect and share similar interests across geographical and temporal borders. Two behavioural disorders related to Internet use have been officially recognised as mental health disorders: Gambling Disorder by the American Psychiatric Association and Gaming Disorder by the World Health Organization. The prevalence estimates and risk indicators of developing problems associated with excessive technology use differ considerably across countries. Individual, structural and situational factors need to be taken into consideration when evaluating existing study outcomes. Based on the current evidence base regarding prevention of problematic technology use including gaming and online gambling and reducing harm, whilst paying attention not to overpathologise everyday behaviours, we recommend a multi-stakeholder approach, engaging researchers, clinicians, regulators and government bodies, community organisations and the industry. Implications for clinical practice include engaging in dialogue across experts and using evidence-based treatment approaches to support those in need of professional help.