Background: Despite its exclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, Internet addiction disorder (IAD) has received attention especially from the psychiatric community. Associated with multiple factors, IAD among adolescents may cause physical, emotional, social, and function impairments that extend to adulthood. Objective: This systematic review explores the prevalence of IAD among adolescents and identifies associated factors. Methods: The databases of Medline and PubMed were searched for related literature through the Boolean Advanced Search using the keywords “Internet” or “cyber,” “addiction” or “dependence,” and “adolescent” or “youth” from 2003 to 2013. A total of 232 articles were retrieved and screened. Only 11 cross-sectional studies from 5 countries were included in this systematic review. The age of adolescent participants in these studies ranged from 13.8 to 17.3 years. Four assessments were employed to explore IAD among adolescents in the 11 reviewed studies. Among these studies, 4 employed the Young’s Internet Addiction (IA) Test, 4 utilized the Chen IA Scale, 2 studies used the Internet-Related Addiction Scale, and one study adhered to the Young’s DRM 52 Scale of Internet use among adolescents. Results: The prevalence of IAD among adolescents range from 1.5% to 18.8%. In this review, factors associated with high prevalence of IAD among adolescents include psychological (e.g., depression, attention deficiency, and hyperactivity disorder), social (e.g., family conflict),and demographic factors (e.g., male gender and older age), as well as use of the Internet (e.g., longer use of the Internet, online chatting, and gaming). Conclusions: With the increasing use of the Internet in managing daily activities, including learning, communication, and entertainment, it has become an essential part of human living in the modern world. The negative effects of IAD among adolescents might result in high healthcare cost, particularly in psychiatric treatment and rehabilitation. Thus, prevention of IAD at the early stage and promotion of healthy use of the Internet are important in safeguarding the mental wellness of people. The result of this review showed the prevalence of IAD among adolescents is associated with psychological, socio-demographic, environmental and living factors. Primary preventive education that focuses on the healthy use of the Internet and guidance could be promoted among adolescents and parents at the school and community levels, respectively. Moreover, secondary prevention programs that concentrate on the early prevention and identification of IAD and specifically designed for the at-risk group could be launched. Extra resources for the employment of counseling personnel should be considered. Future research on the at-risk group population of IAD among adolescents could be conducted. These initiatives could assist in designing a tailor-made intervention, and eventually in preventing the early onset of IAD. / published_or_final_version / Public Health / Master / Master of Public Health

青少年網絡成癮已成為一個值得關註的問題。以往研究顯示，青少年網絡成癮的比例在4%到14%之間。網絡成癮的主要癥狀包括：過度使用，退縮反應，耐受性和強迫性。網絡成癮對青少年的健康，學業和人際關系都有負面影響。 / 以往對網絡成癮的研究已經發現了一些危險因素。但是以往研究存在兩方面不足。第一，多為簡單迴歸模型，較少中介模型， 較少探討危險因素之間可能的互動關係。第二，危險因素多為個人因素或網絡使用因素， 較少關注個人與環境的互動是如何提高網絡成癮風險。 / 為了彌補以上知識鴻溝，本研究提出了一個新的解釋網絡成癮的理論模型。這個模型中既包括個人因素又包括環境因素。這個理論模型的核心假設是當青少年認為網絡是滿足需要或者處理壓力的唯一途徑時，他們有可能會花費大量時間上網，也因此引發了較高的網絡成癮的風險。本研究進一步假設社交焦慮和缺乏親密朋友是導致青少年在現實生活中無法滿足人際交往需要的原因。本研究還假設壓力和迴避式應對壓力傾向是青少年不能在現實生活中處理壓力而將網絡視作應對壓力唯一途徑的原因。 / 本研究在中國上海進行。本研究是斷代式問卷研究。前測研究測量了量表的信效度，并根據結果對相關量表做進一步修正。正式研究通過非隨機抽樣方式邀請了892位年齡在12到18歲之間的中學生參加。結果顯示，52位（5.83%）參加者可被看作網絡成癮高危人群。高危人群更長時間上網，也具有更高的社交焦慮，更大的壓力和更強的迴避式應對壓力傾向。此外，中介模型的統計分析結果顯示，個人期待網絡使用是滿足需要和處理壓力的唯一途徑這一中介變量，解釋了部分社交焦慮，壓力和退縮型處理壓力傾向與網絡成癮症狀之間的關聯，該結果對本研究所假設的理論模型提供了初步的支持。 / 文末討論了本研究的限制和進一步研究的方向，并根據研究結果提出了對社會工作實務（包括預防及干預青少年網絡成癮）的建議。 / Adolescents have been found to be a vulnerable group for Internet addiction. The reportedly prevalence of "Internet addicts" ranged from 4% to 14%. The major symptoms of Internet addiction are: excessive use, withdrawal, tolerance, and compulsive use. Negative consequences of Internet addiction include physical complaints, worsening performance in work or study, and relationship problems. / Despite a number of risk factors identified, prior studies were limited in two aspects. First, previous studies assumed that risk factors operate in an additive manner with increasing numbers of risk factors leading to an increasing probability of becoming internet addicted. Not enough attention has been paid to relationships among the risk factors. Second, most risk factors were either personal attributes or internet use behaviors. This might lead to the biased assertion that either the person or the internet should be blamed for becoming addicted. / This research tried to extend previous research by proposing and testing a theoretical model which argued that the some adolescents became attached to the internet as it provided an alternative way of needs satisfaction or stress coping; the needs satisfaction or stress coping was not possible in realistic life due to some personal or contextual risk factors. The theoretical model was constructed based on outcome expectancy theory (Bandura, 1977; Jones, Corbin & Fromme, 2001; Oei & Baldwin, 1994), substitute gratification theory (Peele, 1998), and stress coping theory (Lazarus & Folkman, 1984; Abrams & Niaura, 1987) as well as some findings of previous research. / A cross-sectional survey was conducted in Shanghai, China. A non-random sample 892 adolescents (aged 12 to 18) from six secondary schools were recruited. 52(5.83%) participants were included in the high-risk group of internet addiction. Risk factors for internet addition were: male, senior secondary school students, social anxiety, stress, avoidance coping style, desirable outcome expectancy of substitute gratification (need to belong), desirable outcome expectancy of stress coping, frequency of online gaming, frequency of idling online and time spent online during weekdays. Moreover, social anxiety, stress, and avoidance coping style had both direct and indirect effects on severity of internet addiction symptoms via the mediators of desirable outcome expectancy of substitute gratification (need to belong) and desirable outcome expectancy of stress coping; the results provided preliminary support to the theoretical model proposed in this study. / Both conceptual and methodological limitations and their implications for further research were discussed. Prevention and intervention programs were proposed according to results of this study. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Gu, Minmin. / "November 2012." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 191-207). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese. / Acknowledgements --- p.i / Table of Contents --- p.iii / List of Tables --- p.vi / List of Figures --- p.viii / CHAPTER ONE --- p.1 / THE RESEARCH PROBLEM --- p.1 / BACKGROUND OF THE STUDY --- p.1 / Internet Addiction as an Emerging Problem --- p.1 / Knowledge Gaps in Previous Research on Internet Addiction --- p.3 / Intervention for Internet Addiction --- p.4 / RESEARCH OBJECTIVES --- p.6 / ORGANIZATION OF THE THESIS --- p.7 / CHAPTER TWO --- p.8 / LITERATURE REVIEW --- p.8 / DEFINITION AND MEASUREMENT OF INTERNET ADDICTION --- p.9 / Definition and Measurements of Internet Addiction in Previous Studies --- p.9 / The Evolved Definition of Addiction --- p.15 / Categorical Approach to Diagnosis for Addiction --- p.18 / Dimensional Approach to Diagnosis for Addiction --- p.21 / EMPIRICAL RESEARCH ON INTERNET ADDICTION --- p.23 / Risk Factors Identified in Mainland China --- p.23 / Risk Factors Identified in other Eastern Societies and Western Societies --- p.25 / THEORIES OF ADDICTION --- p.34 / The Relationship between Repetitive Internet Use and Internet Addiction --- p.34 / Psychosocial Theories Explaining Repetitive Internet Use --- p.39 / CHAPTER THREE --- p.55 / CONCEPTUAL FRAMEWORK --- p.55 / THE CONCEPTUAL FRAMEWORK --- p.55 / RESEARCH HYPOTHESES --- p.63 / CHAPTER FOUR --- p.68 / RESEARCH METHOD --- p.68 / RESEARCH SITE --- p.68 / Social and Economical Condition of Shanghai --- p.69 / Schooling and Extra-curricular Activities in Shanghai --- p.70 / Internet Use and Internet Addiction among Adolescents in Shanghai --- p.71 / RESEARCH DESIGN --- p.72 / PILOT STUDY --- p.72 / Samples --- p.72 / Data Collection --- p.73 / Data Analysis --- p.81 / MAIN STUDY --- p.82 / Samples --- p.82 / Data Collection --- p.86 / Data Analysis --- p.86 / ETHIC CONSIDERATIONS --- p.89 / CHAPTER FIVE --- p.90 / PILOT STUDY --- p.90 / CHINESE INTERNET ADDICTION SCALE (CIAS) --- p.92 / SELF-DEVELOPED MEASURE OF DESIRABLE OUTCOME EXPECTANCY --- p.102 / SOCIAL ANXIETY SCALE FOR ADOLESCENTS (SAS-A) --- p.104 / FRIENDSHIP INTIMACY (ADAPTED FROM THE NETWORK OF RELATIONSHIP INVENTORY) --- p.107 / SELF-DEVELOPED MEASURE OF STRESS FOR ADOLESCENTS --- p.108 / AVOIDANCE COPING STYLE (ADAPTED FROM COPE INVENTORY) --- p.112 / CHAPTER SIX --- p.115 / MAIN STUDY --- p.115 / PSYCHOMETRIC ANALYSES --- p.115 / DESCRIPTIVE STATISTICS --- p.119 / Severity of Internet Addiction Symptoms --- p.119 / Time Spent Online during Holidays, Weekends, and Weekdays --- p.120 / Zero Hour User in the Three Time Phases --- p.121 / Time Spent on Various Online Activities --- p.123 / Risk Factors --- p.124 / COMPARISON OF HIGH-RISK GROUP AND NON-HIGH-RISK GROUP --- p.126 / High-Risk Group --- p.126 / Group Differences in Time Spent Online during Holidays, Weekends and Weekdays --- p.126 / Group Differences in Time Spent on Various Online Activities --- p.127 / Group Differences in Risk Factors --- p.129 / PREDICTORS FOR SEVERITY OF INTERNET ADDICTION SYMPTOMS --- p.132 / Correlation of Dependent and Independent Variables --- p.132 / Hierarchical Regression Predicting Severity of Internet Addiction Symptoms via Demographic Variables, Personal or Environmental Inadequacies, Desirable Outcome Expectancy, Preference for Online Activities and Time Spent Online --- p.136 / Mediation Effects of Desirable Outcome Expectancies --- p.140 / CHAPTER SEVEN --- p.155 / DISCUSSION OF FINDINGS --- p.155 / ZERO-HOUR USER IN THREE DIFFERENT TIME PHASES --- p.155 / HIGH RISK GROUP OF INTERNET ADDICTION --- p.156 / GENDER DIFFERENCE IN RATE OF INTERNET ADDICTION AND SEVERITY OF INTERNET ADDICTION SYMPTOMS --- p.158 / GRADE DIFFERENCE IN SEVERITY OF INTERNET ADDICTION SYMPTOMS --- p.159 / PREFERENCE FOR ONLINE ACTIVITIES AND HIGH-RISK GROUP OF INTERNET ADDICTION --- p.160 / DESIRABLE OUTCOME EXPECTANCY OF SUBSTITUTE GRATIFICATION (NEED TO BELONG) --- p.162 / SOCIAL ANXIETY, DESIRABLE OUTCOME EXPECTANCY OF SUBSTITUTE GRATIFICATION (NEED TO BELONG) AND SEVERITY OF INTERNET ADDICTION SYMPTOMS --- p.162 / FRIENDSHIP INTIMACY, SOCIAL ANXIETY, DESIRABLE OUTCOME EXPECTANCY OF SUBSTITUTE GRATIFICATION (NEED TO BELONG) AND SEVERITY OF INTERNET ADDICTION SYMPTOMS --- p.165 / STRESS, DESIRABLE OUTCOME EXPECTANCY OF STRESS COPING AND SEVERITY OF INTERNET ADDICTION SYMPTOMS --- p.167 / AVOIDANCE COPING STYLE, DESIRABLE OUTCOME EXPECTANCY OF STRESS COPING AND SEVERITY OF INTERNET ADDICTION SYMPTOMS --- p.168 / CHAPTER EIGHT --- p.170 / LIMITATIONS AND IMPLICATIONS --- p.170 / SUMMARY OF MAJOR FINDINGS --- p.170 / LIMITATIONS OF THE THEORETICAL MODEL AND SUGGESTIONS FOR FUTURE RESEARCH --- p.173 / Unexplored Other Types of Desirable Outcome Expectancies --- p.173 / Unexplored Other Psychosocial Risk Factors --- p.174 / Reciprocal Relationship between Risk Factors and Severity of Internet Addiction Symptoms --- p.174 / A New Population of Interest: College Students --- p.175 / METHODLOGICAL LIMITATIONS AND SUGGESTIONS FOR FUTURE RESEARCH --- p.176 / The Limitations of Cross-sectional Design and Recommendation for Longitudinal Research --- p.176 / The Limitations of Non-random Sampling and Recommendations for Random Sampling --- p.177 / The limitations of Self-report Data and Recommendations for Data Collection from Multiple Sources --- p.177 / The Limitations of Quantitative Research and Recommendations for Qualitative Research --- p.178 / THEORTICAL CONTRIBUTIONS --- p.179 / Replicating and Extending Previous Empirical Research on Internet Addiction --- p.180 / Applying Outcome Expectancy Theory to Internet Addiction Research --- p.180 / Applying of Stress Coping Theory to Internet Addiction Research --- p.181 / Applying Substitute Gratification Theory to Internet Addiction Research --- p.182 / PRACTICAL IMPLICATIONS --- p.183 / Intervention Programs --- p.183 / Prevention Programs --- p.189 / References --- p.191 / Chapter Appendix I --- Questionnaire for Pilot Study --- p.208 / Chapter Appendix II --- Questionnaire for Pilot Study --- p.228

Background Internet addiction, along with the development of internet and internet accessing tools, is affecting more and more people. It can give impact on various aspects of people’s life, including physical and mental health, family relationship, peer relationship, academic performance and job performance. Internet addiction has been raised up to public health issue in some countries, such as China and Korea. Teenagers, as the high risk group of internet addiction, a lot of studies have been done on the prevalence and characteristic among this group of population. However, internet addiction studies in Macau are rather limited, and are not up-to-date. Objective The objectives of this study are: 1) To evaluate the trend of internet addiction disorder among Macau teenagers. 2) Characterizing the internet addiction by internet usage pattern. 3) To investigate the risk factors and impact of Internet Addiction. 4) Provider information of Young’s internet diagnostic questionnaire (YDQ) and Chen Internet Addiction Scale (CIAS) in measuring internet addiction disorder. 5) To estimate the prediction rate of self-evaluation of internet addiction. Method Cross-sectional study was used in the study. Cluster sampling was applied in the participated schools. One class was selected from each grade, and all students in that class would be included in the study. Invitation letter was sent to all the regular education secondary schools in Macau. All the data were collected by a self-administered questionnaire. Result Totally, 511 valid data from 6 schools was included in the analysis. By using YDQ and CIAS to measure internet addiction, 10.6% and 24.7% of the respondent were classified as internet addicts respectively. Some significant association was found between internet addiction and internet usage pattern, as well as the relationship between demographic information and internet usage. Grade, go online in cybercaf?, online hours (both weekday and weekend) and playing online game were found to be risk factors of internet addiction. Self-evaluation of IAD together with the awareness of internet addiction, was found to be significant predictor of internet addiction. Conclusion Internet addiction is suggested to have increasing trend in Macau among teenagers. Relationships between demographic information, internet usage pattern, internet addiction, together with the risk factor of IAD were discussed. Teachers, social workers and parents should pay attention to teenagers’ internet usage pattern, especially for the risk factor. Help the teenager to recognize the problem of internet addiction. Education and promotion of internet addiction disorder should be provided to teenagers to prevent problematic internet usage. / published_or_final_version / Medicine / Master / Master of Public Health

Huang, Hanyun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 224-242). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendix in Chinese.

随着经济的快速发展与社会的重大转型，青少年网瘾问题成为中国大陆困扰家庭的社会问题。对于这种新兴的青少年越轨行为，已有研究往往关注青少年自身的心理因素及同伴影响，从社会学角度对青少年问题网络行为及其背后的家庭因素进行系统分析的研究相对缺乏。因此，本研究重新聚焦家庭，整合社会资本理论与一般压力理论，深入地探究家庭对于青少年问题网络行为的影响，并进一步比较家庭和同伴对于青少年上网行为的作用。 / 研究数据来自于2008年的"北京青少年上网行为调查"项目，该项目在海淀区14所中学中抽取697名初中二年级的学生，最终获得有效问卷668份。结合数据，我们将样本划分为安全群体、危险群体及网瘾群体，三个群体占样本总数的比例分别为37.6%、46.4%及16.0%。通过回归分析发现，产生于家庭内部的一般性社会资本（比如孩子对父母的依恋）会对青少年问题网络行为产生显著的负向效应，而功能性家庭社会资本（比如父母与孩子共同上网的行为等）与青少年问题网络行为之间并未出现显著的相关关系。同时，来自于父母的家庭压力（比如孩子遭受父母虐待等）以及越轨同伴都对青少年问题网络行为有显著的正向影响。另外，本研究进一步探究了家庭和同伴的互动关系，并发现因上网而越轨的同伴作为中介变量，跟孩子与父母的负面关系（包括孩子遭受父母虐待及孩子与父母之间的冲突）共同对青少年问题网络行为产生影响作用。本研究还结合了定性分析，对青少年从"正常"到"成瘾"过程中家庭因素的影响做了更深入和全面的分析。不仅从理论层面填补了社会学领域以家庭为焦点解释青少年问题网络行为的空白，而且也为实证领域对青少年网瘾进行有效的预防和疏导提供了重要参考。 / With the rapid economic development and great social change in Mainland China, Internet Addiction among adolescents has become a serious social problem disturbing families. Concerning this rising adolescent deviant behavior, previous studies mainly emphasized the individual psychological factors and some peer influences, but few studies have systematically explained the familial influences behind the adolescent problematic Internet use from sociological perspective. Therefore, this study has returned back to family, combining Social Capital Theory and General Strain Theory in a sociological framework, to explore the interactive mechanism between familial factors and adolescent problematic Internet use. Furthermore, we compare the influences of family and of peers on such deviant behavior. / This study used the data collected by the project of Internet Use among Beijing Adolescents in 2008, which sampled 697 students in Junior 2 from 14 middle schools of Haidian District and finally got 668 valid questionnaires for analysis. We divided the sample into three groups according to the risk degree of their Internet use, i.e., safe group, risk group and addicted group, and the percentages of the three groups to the whole sample are 37.6%, 46.4% and 16.0%. With the regression analysis, we found that the general internal-family social capital (e,g., attachment to parents) was significantly negatively related to the adolescent problematic Internet use, while the functional family social capital (e.g., aligned Internet use between parents and children) had no significant effect on adolescent problematic Internet use. And, both family strain (e.g., experience of parental maltreatment) and deviant peers had significant positive influence on adolescent problematic Internet use. Furthermore, we explored the interactive relationships among family strain, deviant peers and adolescent problematic Internet use, and found deviant peers, as a mediating factor, together exerted influences on adolescent problematic Internet use. / This study also combined the qualitative analysis to explain the deeper familial reasons in the process of adolescent becoming "addicted". It not only filled out the gap in sociological research area with focusing on family to systematically explore the social influences on adolescent problematic Internet use, but also provided important references to the practical prevention and treatment of adolescent Internet Addiction. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 孟宏. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 117-137). / Abstracts also in English. / Meng Hong.

published_or_final_version / Educational Psychology / Master / Master of Social Sciences

The research project evolved from my concerns and those of parents and teachers about students’ inability to regulate their smartphone use in schools. A preliminary review of literature revealed growing concerns worldwide about adolescent smartphone dependence which was affecting students’ academic and social development, amongst many others. It also revealed the area of adolescents’ smartphone dependence to be scantly researched especially in developing countries. Hence, this study. The purpose of the study was to explore levels of smartphone dependence in adolescents at a private school in Myanmar. The study was set in a social constructivist framework and the methodology was qualitative in nature, incorporating a literature review. Participants were purposively selected. Data was collected through semi-structured interviews, observations, focus group discussions and questionnaires. The study found that the level of smartphone use at the school was a cause of concern for the stakeholders; adolescents at the target school could be considered dependent on their smartphones. Recommendations to reduce the adolescents’ total screen time were made. Further studies into the management of children’s smartphone use were recommended. / Educational Foundations / M. Ed. (Comparative Education)