© Mary Ann Liebert, Inc. DOI: 10.1089/cpb.2006.9948
Family Factors of Internet Addiction and Substance
Use Experience in Taiwanese Adolescents
JU-YU YEN, M.D.,1,2 CHENG-FANG YEN, M.D. Ph.D.,1,3 CHENG-CHUNG CHEN, M.D. Ph.D.,3,4 SUE-HUEI CHEN, Ph.D.,5
and CHIH-HUNG KO, M.D.1,6
ABSTRACT
The aim of the study is to examine the differences in the diversity of family factors between adolescents with and without Internet addiction and substance use experience. A total of 3662 students (2328 boys and 1334 girls) were recruited from seven junior high schools, six senior high schools, and four vocational high schools in southern Taiwan. Internet addiction and substance experience were classified according to the score of Chen Internet Addiction Scale Questionnaires for Experience of Substance use. The family factors assessed included per-ceived family satisfaction, family economic status, parents’ marriage status, care-givers, the frequency of intra-family conflict, families’ habitual alcohol use, and perceived parents’ or care givers’ attitude toward adolescents’ substance use. This study demonstrated that the char-acteristics of higher parent-adolescent conflict, habitual alcohol use of siblings, perceived par-ents’ positive attitude to adolescent substance use, and lower family function could be used develop a predictive model for Internet addiction in the multiple logistic regression analysis. The former three family factors were also sufficient in themselves to develop a predictive model for substance use experience. The results revealed that adolescent Internet addiction and substance use experience shared similar family factors, which indicate that Internet ad-diction and substance use should be considered in the group of behavioral problem syn-dromes. A family-based preventive approach for Internet addiction and substance use should be introduced for adolescents with negative family factors.
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INTRODUCTION
U
SE OF THEINTERNETcontinues to rapidly spread.It has become a popular academic and enter-tainment tool of adolescents around the world. Ado-lescents are encouraged to utilize the Internet to en-hance school performance and competitiveness; however, heavy use has several negative
conse-quences. Internet addiction is one of the most seri-ous problems.1–3Adolescents who are addicted to
the Internet also usually suffer from problems in their daily routine, school performance, family re-lationships, and mood.4–6It is important, therefore,
for mental health professionals to develop inter-ventional strategies for preventing Internet addic-tion among adolescents. Hence, it is necessary to
ex-1Department of Psychiatry, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
2Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 3Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
4Jsyr-Huey Mental Hospital, Kaousiung Jen-I’s Home, Kaohsiung, Taiwan. 5Department of Psychology, National Taiwan University, Taipei, Taiwan.
amine both protective and risk factors for Internet addiction in adolescents, in order to develop such preventative strategies.
Since the family plays a central role in adoles-cents’ socialization,7family factors are reported to
be one of the major risk factors of adolescent sub-stance use.8Adolescent substance use was found to
be associated with broken parenting,9,10
parent-ado-lescent and intra-family conflicts,11,12 accepting
at-titudes of parents toward substance use of adoles-cents,13,14and parental alcohol or tobacco use in the
home.8,15 Poor family function has also been
re-ported to correlate with Internet addiction in ado-lescents.16
However, to date, no report has focused on the association between adolescent Internet addiction and a diversity of family characteristics. Family-based preventive intervention has great promise in prevention of adolescent substance use.17If
adoles-cent Internet addiction and substance use share the same family factors, the family-based approach could become implemented as a solution for Inter-net addiction.
Thus, the aim of this study was to determine the association of Internet addiction and substance use experience with family-correlated factors including family economic status, parental marriage status, caregivers, the frequency of intra-family conflict, family habitual alcohol use, and perceived parental or caregiver attitudes toward adolescent substance use in Taiwanese adolescents.
METHODS
A total of 3662 students (2328 boys and 1334 girls) were recruited from seven junior high schools, six senior high schools, and four vocational high schools in southern Taiwan. Two classes were ran-domly selected from each grade of these schools. All students in selected classes were invited to complete the questionnaire anonymously after informed con-sent was obtained. The Chen Internet Addiction Scale (CIAS)18was used to determine participant
In-ternet addiction. The CIAS contains 26 items on a four-point Likert scale that assesses the severity of Internet-related problems. The internal reliability of the scale and the sub-scales in the original study range from 0.79 to 0.93.18 Based on diagnostic
in-terviews assessing for criteria of Internet addiction,2
the 63/64 cut-off point of CIAS had been deter-mined to classify Internet addiction in adolescents with good diagnostic accuracy (87.6%).19
Partici-pants who scored higher than 63 on the CIAS were classified as Internet addicts. The Questionnaire for
Experience of Substance Use (Q-ESU) was used to assess whether participants habitually used tobacco, alcohol, and/or betel nut, and whether they had ever used cannabis, amphetamines, glue, heroin, ec-stasy, or ketamine.20The participants with positive
responses to the above questions were classified as the substance use group.
Participants completed the Family APGAR Index (APGAR) to measure the level of satisfaction with various family functions. This index was originally developed by Smilkstein21 and was translated into
Chinese by Chau et al.22 The five-point response
scales range from “never” to “always.” High scores indicate a good family function. Participants also completed questionnaires that assess demographic and family characteristics, including gender, age, family economic status, parents’ marriage status, caregivers, the frequency of parental-adolescent and inter-parental conflict, family habitual alcohol use, and perceived parents’ or caregivers’ attitudes to-ward adolescent substance use.
Statistical analysis
Those who did not complete all measures—CIAS, Q-ESU, and APGAR—were excluded. Under con-trol of gender, age, and school, we analyzed the as-sociation between Internet addiction and every fam-ily factor with logistic regression. The age, gender, and school factors were entered into the logistic re-gression models first. Then, the indicated family fac-tor was entered, and the significance of prediction was determined. The significant family predictors were selected to conduct the multiple stepwise lo-gistic regression analyses. The association between family factors and adolescent substance use was an-alyzed in the same way. A p-value less than 0.05 was considered significant.
RESULTS
A total of 3480 (95.0%) participants (2189 boys and 1291 girls) completed all questionnaires, and these data were entered into the final statistical analyses. Demographic data are shown in Table 1. The mean age of the participants was 15.47 1.65 years old. Among them, 20.7% were classified as the Internet addiction group, and 9.1% were classified as the substance use group.
The results of analyses for the association be-tween Internet addiction and family factors by lo-gistic regression under control of age, gender, and school are shown in Table 2. The results indicated that the adolescents with Internet addiction were
more likely to not be raised by parents, to have high parent-adolescent and inter-parental conflict, to have parents and siblings with habitual alcohol use, to have lower APGAR scores, and to perceive pos-itive parental attitudes toward adolescent smoking, alcohol, and substance use.
The family factors that were significantly associ-ated with Internet addiction were further fitted into the multiple logistic regression analysis, and the re-sults are shown in Table 3. High parent-adolescent conflict was the most significant predictor since it was the first predictor entering the regression model. Other significant predictors included low APGAR score, sibling habitual alcohol use, and per-ceived positive parental attitudes toward adolescent substance use.
The result of regression analysis for substance use experience shown in Table 2 demonstrates that lower economic status, separated or divorced par-ents, not cared for by parpar-ents, high parent-adoles-cent conflict, high inter-parental conflict, habitual alcohol use of father, mother, and siblings, and per-ceived positive parental attitudes toward adolescent smoking, alcohol, and substance use predicted a high chance of substance experience significantly. Additionally, the APGAR score predicted a lower chance of substance use.
The family factors that were significantly associ-ated with substance use experience were further fit-ted into the multiple logistic regression analysis (Table 3). Habitual alcohol use of siblings was the most significant predictor, since it was the first pre-dictor entering the regression model. The other sig-nificant predictors included perceived positive parental attitudes toward adolescent substance use and high parent-adolescent conflict.
DISCUSSION
This study revealed that higher parent-adolescent conflict, habitual alcohol use of siblings, perceived positive parental attitudes toward adolescent sub-stance use, and lower family functioning could be used to develop a predictive model for Internet ad-diction in the multiple logistic regression analysis. The former three family factors were also sufficient in themselves to develop a predictive model for sub-stance use experience. The results demonstrated that adolescent Internet addiction and substance use experience share similar family factors.
We found that habitual alcohol use of siblings sig-nificantly predicted Internet addiction and sub-TABLE1. DEMOGRAPHICDATA, INTERNETADDICTION, AND
SUBSTANCEUSEEXPERIENCE OFPARTICIPANTS (n 3480)
n (%) Mean SD Age, years 15.47 1.65 Gender Male 2189 62.9 Female 1291 37.1 Level of education
Junior high school 1443 41.5 Senior high school 1120 32.2 Vocational high school 917 26.4 Grade Grade 7 489 14.1 Grade 8 511 14.7 Grade 9 443 12.7 Grade 10 681 19.6 Grade 11 547 15.7 Grade 12 809 23.2 Internet addiction Yes 721 20.7 No 2759 79.3
Substance use experience
Yes 316 9.1
stance use experience of adolescents. Correspond-ing to the results of a previous study,23 sibling
al-cohol use has a greater association with adolescent substance use than parent alcohol use in this study. Additionally, a similar association was found be-tween sibling alcohol use and Internet addiction in this study. Although social learning theory was uti-lized to explain the association between sibling and adolescent alcohol use,24it could not explain the
as-sociation between sibling alcohol use and adoles-cent Internet addiction. Sibling alcohol use may be a result of poor family function; however, the ha-bitual alcohol use of a sibling significantly predicted
adolescent Internet addiction even after controlling for family function in the multiple regression model. Aside from family environmental factors, factors of other dimensions—including genetic factors ac-counting for an addiction-prone personality and co-morbid psychiatric disorders—ought to be consid-ered as underlying mechanisms deserving of further research.
High parent-adolescent conflict predicted Inter-net addiction and substance use in adolescents in this study. Ary et al.25 have reported that families
with higher conflict have lower levels of parent-child involvement, which would result in inade-TABLE2. LOGISTICREGRESSIONANALYSIS FOR THE FAMILYPREDICTORS FORINTERNETADDICTION AND
SUBSTANCEEXPERIENCE INADOLESCENTS UNDERCONTROL OFGENDER, AGE, ANDSCHOOL
Internet addiction Substance use
Wald 2 OR 95% CI Wald 2 OR 95% CI
APGAR score 53.41*** 0.92 0.90–0.94 20.43*** 0.93 0.90–0.96 Lower economic status 0.49 1.07 0.89–1.28 5.94* 1.36 1.06–1.73 Separated or divorced parents 1.75 1.16 0.93–1.45 10.66** 1.61 1.21–2.14 Not cared for by parents 6.29* 1.35 1.07–1.70 4.47* 1.41 1.03–1.93 High parent-adolescent conflict 69.36*** 2.75 2.17–3.49 39.83*** 2.66 1.96–3.60 High inter-parental conflict 31.72*** 1.99 1.57–2.53 24.68*** 2.20 1.61–3.00 Habitual alcohol use of father 9.70** 1.32 1.11–1.57 15.26*** 1.62 1.27–2.06 Habitual alcohol use of mother 6.99** 1.56 1.12–2.18 45.71*** 3.58 2.47–5.18 Habitual alcohol use of siblings 27.68*** 1.83 1.46–2.30 140.16*** 5.04 3.86–6.59 Perceived positive parental attitude 6.84** 1.67 1.14–2.44 34.12*** 3.46 2.28–5.25
to adolescent smoking
Perceived positive parental attitude 5.08* 1.36 1.04–1.77 36.65*** 2.61 1.91–3.56 to adolescent alcohol use
Perceived positive parental attitude 13.16*** 2.35 1.48–3.72 55.55*** 6.25 3.86–10.1 to adolescent substance use
*p 0.05. **p 0.01. ***p 0.001.
TABLE3. MULTIPLELOGISTICREGRESSIONANALYSIS FOR THEFAMILYPREDICTOR OF INTERNETADDICTION ANDSUBSTANCE EXPERIENCE UNDERCONTROL OFGENDER, AGE, ANDSCHOOL
Internet addiction Substance use
Wald 2 AOR 95% CI Wald 2 AOR 95% CI
High parent-adolescent conflict 29.92*** 2.21 1.67–2.94 16.71*** 2.17 1.50–3.14 APGAR 22.85*** 0.94 0.91–0.96 — — — Habitual alcohol use of siblings 12.82*** 1.58 1.23–2.03 104.11*** 4.65 3.46–6.24 Perceived positive parental attitude 5.68* 1.93 1.12–3.31 17.86*** 3.79 2.04–7.04
to adolescent substance use *p 0.05.
quate parental monitoring, which would predict, in turn, adolescents being predisposed to Internet ad-diction. Furthermore, the social control theory sug-gests that, when adolescents are close to their par-ents, they feel obligated to act in non-deviant ways to please their parents.26,27 Thus, adolescents with
higher conflict with parents would refuse to con-form to the supervision of parents, including rules set for Internet use. Also, lacking support from par-ents, those adolescents seek social support from the interacting experiences on the Internet.28
Unfortu-nately, heavy Internet use by adolescents usually re-sults in further conflict with their parents, which may make the problem of adolescent Internet ad-diction more difficult to resolve.
Inadequate parental supervision and discipline are usually a strong predictor of adolescent sub-stance use.25,29The present study demonstrates that
perceived positive parental attitudes toward sub-stance use predicts adolescent subsub-stance use and In-ternet addiction. Perceived positive parental atti-tudes toward substance use have been reported to be associated with adolescent substance use.30,31
Positive parental attitudes toward substance use represents ineffective family supervision, guidance, and discipline. According to social control theory, all adolescents have the impulse to act on their de-sires, but pro-social controls provided by families and other social institutions enable them to exert re-straint.32Internet activities usually provide the
plea-sure of control, interactive activity, and perceived fluidity of identity for adolescents.33Without
effec-tive supervision and discipline in the family, ado-lescents usually have difficulty controlling time spent in ongoing online activities, such as online role-playing games.
Problem drinking, marijuana use, delinquent be-haviors, and precocious sexual intercourse have been grouped as a syndrome of problem behaviors in adolescents.34,35The social context model of the
development of antisocial behavior has been re-ported to explain this problem behavior syn-drome.36 The model suggests that ineffective
parental discipline and supervision, and poor intra-family relationships are the first steps in the devel-opment of problematic behaviors.36 According to
the results of the present study, adolescent Internet addiction and substance use were proved to share similar family factors, including habitual alcohol use of siblings, perceived positive parental attitudes toward substance use, and conflict with parents. Thus, the results of this study would suggest that adolescent Internet addiction may be one form of problem behaviors. However, further research to compare other social contexts of Internet addiction
with those of other problem behaviors is necessary to validate this hypothesis.
The family-based approach has been reported to improve family function and decrease behavioral problems of children.17Since adolescent Internet
ad-diction shares the same family factors with sub-stance use, the concept of family-based intervention for substance abuse might be utilized for Internet addiction. Based on the results of this study and pre-vious reports of the family-based approach,17 we
suggest that family-based prevention should in-clude skills training for parents to improve com-munication skills in helping adolescents to develop social skills, helping family members reduce mal-adaptive family function, fostering skills for healthy family interactions, and effective family monitoring and discipline focusing on Internet addiction and substance use.
Our results should be interpreted in the light of several limitations. Firstly, societal restrictions on substance use may make adolescents unwilling to admit substance use even in anonymous question-naires. Secondly, the cross-sectional research design of the present study could not confirm causal rela-tionships of Internet addiction and substance use with family factors. Thirdly, lacking information from parents, assessment of family factors was based only on adolescents’ reports.
CONCLUSION
This study examined the association between adolescent Internet addiction and a variety of fam-ily factors based on empirical research. It demon-strated that parent-adolescent conflict, lower family function, habitual alcohol use of sibling, and per-ceived positive parental attitudes toward adolescent substance use predicted adolescent Internet addic-tion. We found that Internet addiction and sub-stance use in adolescents shared similar associated family factors, which indicate that Internet addic-tion and substance use might be included in the group of behavioral problems syndrome. A family-based preventive approach for Internet addiction and substance use should be implemented for ado-lescents with negative family factors.
ACKNOWLEDGMENTS
This study was supported by a grant of Kaohsi-ung Medical University ChKaohsi-ung-Ho Memorial Hos-pital (kmhk-93-004).
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Address reprint requests to:
Dr. Chih-Hung Ko Department of Psychiatry Kaohsiung Medical University 100 Tzyou 1st Rd.
Kaohsiung City, Taiwan 807 E-mail: cyberko@seed.net.tw
