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ORIGINAL ARTICLE Table of Contents  
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Internet: A double-edged sword? – A cross-sectional study

1 Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India
2 Department of Community Medicine, K D Medical College Hospital and Research Centre, Mathura, Uttar Pradesh, India
3 Department of Community Medicine, Dhanalakshmi Srinivasan Medical College, Perambalur, Tamil Nadu, India

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Date of Submission22-Mar-2019
Date of Decision14-Apr-2019
Date of Acceptance23-Apr-2019
Date of Web Publication15-Jul-2019


Introduction: The Internet has become a must-present factor in our day-to-day life. As like any other substance like plastic, the Internet also demonstrates threats which affect health and thereby life also. Objectives: To find the prevalence and impact of internet addiction on health and lifestyle of medical students in a private medical college in Kerala. Methodology: This cross-sectional study was conducted among medical students for a period of 1 month. A questionnaire was used to document the sociodemographic details, internet addiction by young's Internet Addiction Test, and questions regarding impact of the Internet on life. Results: In the present study, we found that 71% of students (mild 107 [54%] and moderate 34 [17%]) had internet addiction. Internet addiction was significantly associated with male gender, mobile/tablet usage, eye strain, time to initiate sleep, frequency of sleep trouble, hours spent on the Internet, money spent, presence of backache, and appetite change with internet addiction. Conclusion: The study finding of presence of internet addiction has to be considered seriously along with tobacco and alcohol consumption. Awareness has to be made relating to the right use, right amount, and right time of using the Internet.

Keywords: Addiction, cross-sectional study, double-edged sword, internet

How to cite this URL:
George M, Ahmed MS, George N, Simon S. Internet: A double-edged sword? – A cross-sectional study. Indian J Med Spec [Epub ahead of print] [cited 2019 Aug 19]. Available from: http://www.ijms.in/preprintarticle.asp?id=262725

  Introduction Top

The Internet is a global system which is interconnected and used by billions worldwide. It connects a broad array of networks and serves millions of private, public, academic, business, and government networks. It has become the world's biggest library where search for scientific resources is so easy by means of a single touch. In addition, this gives a prospect for others to intermingle with fellows to discuss any topic of interest to explore the world sitting at their home.[1]

Over the last 25 years, use of the Internet and social media has increased tremendously, especially in young minds. India stood third in the ranking of internet users just behind China and America.[2] In India, the number of mobile internet users increased by 17.22% from December 2016 to reach 456 million users by December 2017. Urban India witnessed an estimated 18.64% year-on-year rise, whereas rural India witnessed an estimated growth of 15.03% during the same period.[3]

Now, the Internet has emerged as a two-edged sword [Figure 1].
Figure 1: Internet-two edged sword

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The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition defines internet addiction disorder as a pattern of excessive and prolonged internet gaming that consequences to a bunch of cognitive and behavioral features, as well as growing loss of control over gaming, tolerance, and withdrawal symptoms, analogous to the symptoms of substance use disorders.[4]

Students are especially vulnerable to developing dependence on the Internet, which may be owing to several contributing factors such as faster acquaintance with changing technology, ease of use, availability of time, access to the Internet, psychological and developmental characteristics of young adults, feeling of independence, and relatively limited or no parental supervision.[5]

The prevalence of internet addiction varies from 1.5% to 25% in different populations.[6],[7],[8],[9] A recent study reported a prevalence of 0.7% among Indian adolescents.[10] Young individuals (i.e., among 18 and 24 years old) were more susceptible to develop into internet addicts than older persons.[11]

We hypothesized that internet addiction leads to poorer mental health status. As the adolescent population is at a rise now and due to increased penetration of mobile Internet, necessity aroused to evaluate the prevalence of Internet usage and its addiction among students, it was necessary to evaluate the prevalence of internet usage and its addiction among students.


  1. To find the prevalence of internet addiction among medical students in a private medical college in Kerala
  2. To find the impact of internet addiction on health and lifestyle of medical students in a private medical college in Kerala.

  Methodology Top

We conducted a cross-sectional study for a period of 1 month among the undergraduate students in a private medical college. Two-stage sampling was used. First, the students were divided according to their years, i.e., 1st, 2nd, 3rd, and 4th. Second, from each group, computer-generated random number table was used to select students equally. An equal number of students from both genders were selected.

The sample size was calculated using an estimated proportion of internet addiction of 13%[12] for 95% confidence limits with an absolute precision of 5%, and, anticipating a nonresponse rate of 10%, the sample size came up to 191. Before the initiation of the data collection, a pilot study was conducted on ten students and their review was taken.

A structured interview schedule was administered to the study population. The interview schedule consisted of two parts. The first part included sociodemographic detail of the students including age, gender, education, marital status, family income, and number of family members. The age at which internet usage started, pattern and mode of usage, time spent online each day, and the amount spent for internet usage in a month were assessed. We also intended to find out the impact of continuous internet usage on health such as change in appetite, backache, eye strain, and difficulty in falling asleep.

The second part is the original form of Internet Addiction Test developed by Dr. Kimberly Young[13] comprising twenty items that measure mild, moderate, and severe levels of internet addiction, with a 5-point scale (0 – does not apply, 1 – rarely, 2 – occasionally, 3 – frequently, 4 – often, and 5 – always). The higher the score range, the greater the level of addiction. The range and their description are described as follows:

  • 20–49 points – You are an average online user. You may surf the web a bit too long at times, but you have control over your usage – mild internet addiction
  • 50–79 points – You are experiencing occasional or frequent problems because of the Internet. You should consider their full impact on your life – moderate internet addiction
  • 80–100 points – Your internet usage is causing significant problems in your life. You should elevate the impact of the internet on your life and address the problems directly caused by your internet usage – severe internet addiction.

The data collected were entered in Microsoft Excel and analyzed using SPSS software version 16 (SPSS Inc., SPSS for Windows, Version 16.0. Chicago, SPSS Inc). Descriptive analysis was employed using frequencies, mean, standard deviation, and proportions. Appropriate statistical tests were conducted to find further association.

  Results Top

The age and gender distribution of the study population is depicted in [Figure 2]. The mean age of the study population was 21.3 ± 1.25 years. The youngest study participant was 18 years old and the oldest study participant was 26 years old. Majority (150 [75%]) were staying in the hostel. Majority of the students' father (95 [47.5%]) and mother (101 [50.5%]) were graduate. The age and gender distribution of the study population is depicted in [Figure 2].
Figure 2: Age and gender distribution of the study population

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Majority of the participants (96 [48%]) initiated internet usage by their 15 years, and 124 (62%) students spend more than 2 h for the Internet and related activities. Majority (107 [53.5%]) of them spent more than Rs. 200/month on the Internet. Nearly 91.5% of the students under study used mobile and tab for internet usage. One hundred and six (53%) participants were using the Internet for more than 5 years and 94 (47%) were using the Internet maximum at night. In the study 34(17%) had moderate internet addiction and maximum 107(54%) had mild internet addiction according to the internet addiction test [Figure 3]. Majority were using the Internet for educational purposes (139 [69.5%]), for entertainment (147 [73.5%]), and for social networking (152 [76%]).
Figure 3: Internet addiction according to the Internet Addiction Test

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Majority (156 [78%]) had satisfaction in their life. One hundred and three (51.5%) participants had fine mental status and 125 (62.5%) were doing physical activity for <5 days a week. One-hundred and thirty five (67.5%) participants had no recent appetite change. Twenty (10%) and 14 (7%) participants had reported having tobacco and alcohol consumption, respectively.

Majority (144 [72%]) complained of having eye strain and 42 (21%) of having backache for at least once after internet usage. One hundred and eight (54%) participants complained of having difficulty in falling asleep at least once in the past 2 weeks. The presence of internet addiction according to the test is depicted in [Figure 3].

There was a significant association between male gender, mobile/tablet usage, eye strain, time to initiate sleep, and frequency of sleep trouble with internet addiction [Table 1].
Table 1: Association between internet addiction and various variables

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In our study, gender, presence of eye strain, sleep initiation time, and frequency of sleep trouble were found significant even after regressing other factors [Table 2].
Table 2: Multiple linear regression analysis between internet addiction and significant variables

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If one unit change happens in the case of gender (male), internet addiction score changes by 8.26. If one unit change happens in eye strain (always presence of eye strain), sleep initiation time (>30 min), and frequency of sleep trouble (every night), internet addiction score changes by 3.69, 3.85, and 3.31, respectively.

There was a significant association between hours spent on internet, money spent, presence of backache, and appetite change with internet addiction [Table 3].
Table 3: Association between internet addiction and various variables

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Multinomial regression analysis showed that those who spent ≥2 h on the Internet have 3.22 times and 2.74 times chance of developing mild and moderate internet addiction, respectively. In addition, those who have spent > Rs. 200 on the Internet had 4.19 times chance of developing moderate internet addiction. Along with that, those who had moderate internet addiction have 4.49 times chance of developing internet addiction [Table 4].
Table 4: Multinomial logistic regression analysis between internet addiction and significant variables

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  Discussion Top

The objective of our study was to find the prevalence and impact of internet addiction among medical students. Our study found that 34 (17%) participants had moderate internet addiction which shows that the Internet can create frequent problems and have significant impact on their life.

The classifications of internet addiction described by many authors[14],[15] have shown various divisions in severe internet addiction. Those include disruption in day-to-day life in terms of preoccupied with the Internet; increased amounts of time in order to achieve satisfaction; failed efforts to manage, cut back, or discontinue internet use; mood variation when attempting to cut down or stop internet use; and overtime usage of the Internet.

Similar to the classical series of drug addiction – abuse, dependence, tolerance and addiction, internet addiction also goes through these touchy areas. The excess use of internet affects interpersonal, physical, psychological, behavioral(interference in role functioning) and educational areas. The presence of these effects can be single or multiple based on the extent of internet use. The physical impact of internet addiction can presurface long before the occurrence of a psychological impact. These physical somatization disorders can be present in moderate internet addiction and can act as a pointer toward the initiation of psychological effects.[16]

In our study, we found that 71% of students (mild 107 [54%] and moderate 34 [17%]) had internet addiction. The finding is comparable with the prevalence of 58.8% from a study done among medical students in Maharashtra, India,[17] and 56.6% from a study done among college students from South India.[18] In another study, Sharma et al.[19] reported 42.7% prevalence of internet addiction among professional college students in India. There are studies[20],[21] which showed lower prevalence of internet addiction. This higher prevalence in our study may be due to increased usage of the Internet for educational purposes among these students and decline in recreational activities.

In our study, we found that males were more addicted than females. This finding is consistent with many studies.[17],[18],[19],[22] This finding can be due to the fact that males more frequently use the Internet and have chance to recharge more often. This leads to more addiction among them. In our study, we found that those who had mobile/tablet for internet usage had increased internet addiction. This can be due to the handiness of the device and ease to use at any time. This finding is similar to other studies.[17],[23]

Our study found that internet addiction leads to eye strain, backache, appetite change, sleep initiation trouble, and decreased sleep. These physical problems are due to overusage of internet, reduction in change of posture while using the Internet, and sympathetic stimulation due to increased concentration on a particular object. These findings are similar to those of many studies.[16],[24],[25]

We cannot advice a person to stop using the Internet completely like in normal drug, alcohol, or tobacco addiction because of its double-faced manner. Even though it will not create any withdrawal symptoms in general, complete avoidance will be hardship in these days of technology. Conscious reduction of usage from the part of person is needed here. Getting a hobby which involves more face-to-face interaction can be done. The person can be deviated toward extracurricular activities such as arts and sports. Setting up time limits for usage, opening up opportunities for creative ideas, and creating awareness about the effects of addiction can be implemented.

To get a generalized status, the study should have been extended to more group of students and colleges. The age range should have been widened to include and exclude various factors associated with the addiction. The probability of social desirability bias cannot be overruled in this study. Qualitative components would have added up an in-depth effect to the study. Involvement of parents or teachers to assess the effects (positive or negative) of the Internet would have created more valid data.

  Conclusion Top

In our study, we found that 71% of students (mild 107 [54%] and moderate 34 [17%]) had internet addiction. This shows that the Internet is having prominent place in the life of these people. Hence, the Internet can create frequent troubles in their life physically, psychologically, economically, and socially, thus dismantling the state of health.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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Correspondence Address:
Neethu George,
Department of Community Medicine, Dhanalakshmi Srinivasan Medical College, Perambalur - 621 212, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/INJMS.INJMS_26_19


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4]


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