JIIMC June 2016.cdr ORIGINAL ARTICLE ABSTRACT Objective: To determine the frequency of internet addiction among medical students and its effects on their academic performance. Study Design: Cross sectional comparative study. th Place and Duration of Study: The study was conducted at Army Medical College, Rawalpindi from 5 January to th 15 May 2015. Materials and Methods: Data collection tool was a closed ended, self-administered questionnaire, 'Young's Internet Addiction Test'. Duly filled questionnaires were returned by 322 MBBS students. The 'Young's Internet Addiction Questionnaire' consists of 20 items with responses on a 5 point Likert scale. The total score which ranged from 20 to 100 was categorised into mild (normal), moderate (problem) and severe internet addiction. Scores ≤ 49 were classified as normal, 50-79 as moderate, and 80-100 as severe internet addiction. Academic nd performance of the students was measured as the percent marks obtained in 2 professional MBBS examination. Students with marks 50 and above were declared as 'pass' and below 50 as 'fail'. Data was analysed using SPSS version 22. Simple linear regression was applied to determine the effect of internet addiction on academic performance. Results: There were 175 male and 147 female students in the study with mean age of 19.27±1.01 years. Two hundred and sixty-eight (83.2%) students were in normal category, 52 (16.1%) in moderate and 2 (0.6%) in severe category. There was significant difference in the proportion of students who passed or failed the exam in the two categories (normal vs moderate + serious) being low pass and high fail in 'moderate+serious' categories (p=0.02). The mean internet addiction score was negatively correlated with academic performance (p=0.01). Conclusion: Excessive internet usage by medical students may lead to internet addiction which may adversely affect their academic performance. Key Words: Computer, Internet Addiction, Young's Internet Addiction Test. tremendous amount of information available on internet which is just a click away. It is horrible for a today's student to think of the academic/research activities without internet. Internet has connected the people from fields of science and education all 2 over the world. Accomplishment of academic goals has become extremely easy in today's technology 3 enabled epoch. Amount of information available on internet is greater than present in world's largest libraries and with just a single click one can have 4 access to the huge databases. However, internet is a double edged sword; its appropriate use can undoubtedly facilitate the academic process like a magic wand whereas inappropriate use can wreak 5 havoc. Inventors of the internet would have never thought that internet usage could also have a downside, named as bad as 'addiction'. Internet addiction is defined as “inability to stop internet overuse, tendency to perceive offline time as meaningless, excessive irritation and ag gression during Introduction Information technology revolution of present era is primarily based upon internet. It has permeated into our lives to such an extent that life without internet seems meaningless. Every walk of life, education, research, business, military etc and even day to day 1 chores are heavily dependent on internet. There is Effect of Internet Addiction on Academic Performance of Medical Students 1 2 3 4 Muhammad Alamgir Khan , Ahsan Ahmad Alvi , Faizania Shabbir , Tasif Ahmed Rajput JIIMC 2016 Vol. 11, No.2 Correspondence: Prof Dr. Muhammad Alamgir Khan Department of Physiology Army Medical College, Rawalpindi E-mail: docalamgir@gmail.com 1 Department of Physiology Army Medical College, Rawalpindi 2 Department of Pathology Islamic International Medical College Riphah International University, Islamabad 3 Department of Physiology Rawalpindi Medical College, Rawalpindi 4 Department of Pharmacology Shifa College of Pharmaceutical Sciences Shifa Tameer- e- Millat University, Islamabd Funding Source: NIL ; Conflict of Interest: NIL Received: Feb 01, 2016; Revised: Mar 20, 2016 Accepted: May 25, 2016 48 Internet Addiction and Medical Students 49 Data collection tool was a closed ended, self- administered questionnaire, 'Young's Internet Addiction Test' which was developed by Young in 1998. The questionnaire is fully validated with high 17 reliability index. The questionnaire was distributed to 350 students of different classes of MBBS however, duly filled questionnaire were returned by 322 students at a response rate of 92%. The 'Young's Internet Addiction Questionnaire' consists of 20 items with responses on a 5 point Likert scale. The total score which ranged from 20 to 100 was categorised into mild (normal), moderate (problem) and severe internet addiction. Scores ≤ 49 were classified as normal, 50-79 as moderate, and 80-100 as severe internet addiction. Academic performance of the students was measured as the percent marks obtained in 2nd professional MBBS examination. Students with marks 50 and above were declared as 'pass' and below 50 as 'fail'. Data was analysed using SPSS version 22. Mean and standard deviation was calculated for numerical variables like age of participants, marks obtained in professional exam, total Likert scale scores whereas frequency and percentage for categorical variables like gender and categories of each item of the questionnaire. Simple linear regression was applied to determine the effect of internet addiction on academic performance. Reliability was determined through internal consistency by applying Cronbach's Alpha test. The alpha value was set at 0.05. Results There were 175 male and 147 female students in the study with mean age of 19.27±1.01 years. Table I illustrates frequency and percentage of students falling in each category of internet addiction i.e. normal, moderate and serious. Table II shows cross tabulation of internet addiction categories (moderate + severe) with exam outcome status (pass/fail). The two variables are associated as indicated by the p-value (0.02). Table III shows overall mean score of the instrument along with mean academic performance in terms of percent marks in professional examination. The table also shows significant and inverse correlation between the two variables (r=-0.13, p=0.01). Table IV shows parameters of simple linear regression for prediction of academic performance from internet addiction scores. Academic performance can significantly be 6 deprivation”. It is also described as internet d e p e n d e n c e , p at h o l o g i ca l i nte r n et u s e o r 7 compulsive internet use. Internet addiction can be compared to other types of addictions regarding 8 risks and consequences. It is especially prevalent in college/university students and can accompany or 9 herald other psychiatric disorders. The user feels himself unable to refrain from the use of internet and 'carried away' with it resulting in wastage of time and energy. This leads to substantial deterioration in p e r f o r m a n c e , h e a l t h a n d i n t e r p e r s o n a l relationships. The students are trapped in a vicious cycle which may lead to extremely adverse 10 outcomes. They find refuge in internet and tend to 11 elope from reality. Internet addiction has evolved as a major public health issue in the recent years and has gained attention of the researchers all over the 12 world. Internet in the form of smart phones and tablets has 13 become an integral part of every student's life. Although a small fraction of students use internet for educational activities in a controlled way, however, a large percentage just keep wasting time by visiting 14 'non-educational' sites. Research has shown that proportion of time a student spends on internet for educational purpose versus non-educational activity 15 could significantly determine his success. College students, being young and psychologically immature are naturally vulnerable to internet addiction, hence it is the responsibility of society, institutions, teachers and parents to adopt measure which can 16 keep the youth away from this nuisance. There is debate about advantages and disadvantages of internet usage among young students as the research data regarding internet addiction in students and its effects on their academic performance is scant. Hence, the current study was planned to determine the frequency of internet addiction among medical students and its effects on their academic performance. Materials and Methods This cross sectional study was conducted at Army Medical College, Rawalpindi from January to May 2015. The study was commenced after getting formal approval from Ethical review committee of Army Medical College. Non-probability convenience sampling was used to include medical students in the study after getting the written informed consent. JIIMC 2016 Vol. 11, No.2 Internet Addiction and Medical Students 50 same finding is supported when the data was analysed by converting total internet score into the three categories i.e. normal, problem and serious according to 'Young's Internet Addiction' test guidelines. The results revealed that over 80% students were in normal category whereas about 17% had some degree of internet addiction. Academic performance of the students was significantly and negatively correlated with total internet addiction score. This means, the more the students were nearer to internet addiction on the scale, the less was their academic performance as reflected by their marks in the professional examination. When the data were analysed by considering the frequency of students within each category who passed and failed the examination, almost similar picture was seen. Ninety-four percent students in 'normal' category passed the exam and 6% failed whereas about 85% in 'problem plus serious' category passed the exam and 15% failed. The difference in proportion of students who passed or failed the exam in each category was found significant. After analysing the data from multiple perspectives, tests of statistical significance revealed that low academic performance was not by chance but due to the variable under study that is internet addiction. All these factors acting jointly push the students away from books leading to poor academic performance. Stavropoulos V and colleagues conducted a study to recognizing internet addiction, prevalence and re l a t i o n s h i p t o a c a d e m i c a c h i e v e m e n t i n adolescents enrolled in urban and rural Greek high 18 schools. They also used 'Young's Internet Addiction' questionnaire and found a frequency of 3.1% for seriously addicted students. They found that internet addiction had negative correlation with academic performance as was the finding in our study. However, the frequency of severe internet addiction, they found was higher as compared to our study (0.6%). This may be due to the fact that study conducted by Stavropoulos had a larger sample size as compared to ours (2090 vs 322). The other reason may be that a large percentage of our students especially boys reside in hostels where internet is not provided. Akhtar carried out a study to determine internet addiction in university students and its 19 effects on academic performance. The scale predicted from internet addiction score as is evident from the p-value (0.016). Value of Cronbach alpha was 0.90 reflecting high reliability. Table I: Frequency of different categories of internet addic�on among the students (N=322) Table II: Frequency and percentage of students with different categories of internet addic�on (N=322) Table III: Correla�on between internet addic�on score and academic performance (N=322) Table IV: Simple linear regression analysis of internet addic�on as predictor of academic performance (N=322) Discussion The average internet addiction score of our study (scale average) is about 38 which almost corresponds to 'occasional' category of the Likert Scale. The total internet addiction score ranges from 20 to 100 whereby 20 relates with almost no usage of internet and 100 relates with total internet addiction. The scale average of our study reflects that the use of internet by medical students is occasional and it is overall much away from internet addiction. The JIIMC 2016 Vol. 11, No.2 Internet Addiction and Medical Students 51 6. Widyanto L, Griffiths M. Internet addiction: a critical review. Internat J Ment Health Addict. 2006; 4: 31-51. 7. Young KS. Internet addiction: a new clinical phenomenon and its consequences. Am Behav Sci. 2004; 48: 402-15. 8. Griffiths MD, Kuss DJ, Billieux J, Pontes HM. The evolution of Internet addiction: A global perspective. Addict Behav. 2016; 53: 193-5. 9. Wu JY, Ko HC, Lane HY. Personality Disorders in Female and Male College Students With Internet Addiction. J Nerv Ment Dis. 2016. 10. Wallace P. Internet addiction disorder and youth: There are growing concerns about compulsive online activity and that this could impede students' performance and social lives. EMBO Rep. 2014; 15: 12-6. 11. Ghamari F, Mohammadbeigi A, Mohammadsalehi N, Hashiani AA. Internet addiction and modeling its risk factors in medical students, iran. Indian J Psychol Med. 2011; 33: 158-62. 12. Coniglio MA, Muni V, Giammanco G, Pignato S. Excessive Internet use and Internet addiction: emerging public health issues. Ig Sanita Pubbl. 2007; 63: 127-36. 13. Choi SW, Kim DJ, Choi JS, Ahn H, Choi EJ, Song WY, et al. Comparison of risk and protective factors associated with smartphone addiction and Internet addiction. J Behav Addict. 2015; 4: 308-14. 14. Fernandez Villa T, Alguacil Ojeda J, Almaraz Gomez A, Cancela Carral JM, Delgado- Rodriguez M, Garcia-Martin M, et al. Problematic Internet Use in University Students: associated factors and differences of gender. Adicciones. 2015; 27: 265-75. 15. Li Y, Zhang X, Lu F, Zhang Q, Wang Y. Internet addiction among elementary and middle school students in China: a nationally representative sample study. Cyberpsychol Behav Soc Netw. 2014; 17: 111-6. 16. Van Rooij AJ, Prause N. A critical review of "Internet addiction" criteria with suggestions for the future. J Behav Addict. 2014; 3: 203-13. 17. Young KS. Internet addiction: The emergence of a new clinical disorder. CyberPsychology & Behavior. 1998; 1: 237- 44. 18. Stavropoulos V, Alexandraki K, Motti-Stefanidi F. Recognizing internet addiction: prevalence and relationship to academic achievement in adolescents enrolled in urban and rural Greek high schools. J Adolesc. 2013; 36: 565-76. 19. Akhter N. Relationship between Internet Addiction and Academic Performance among University Undergraduates. Educ Res Rev. 2013; 8: 1793-6. average of her study was 39.23 and she reported that internet addiction scores were negatively and significantly correlated with grade point average of the students (r=-0.130, p=0.039). The results reported by Akhtar were comparable to our study. Excessive usage of internet in students leads to internet addiction due to which they cannot spend enough quality time on studies. They lose capacity to concentrate and focus on studies due to late night internet sessions. Even they sacrifice extracurricular activities for internet due to which they remain aloof and their mental and physical health deteriorate. Academic performance of a student depends not only upon his mental/physical health but also the degree of his time/self-management. To extrapolate the findings on to the general population, multicenter studies need to be conducted with a large sample size that is representative of the general population to draw reliable parametric inferences. Conclusion Excessive internet usage by medical students may lead to internet addiction which may adversely affect their academic performance. Parents/teachers need to take preemptive measures to avoid this and to remain vigilant especially for students whose academic performance is persistently low as internet addiction may be one of the reasons. REFERENCES 1. Bhat M. Internet revolution. Br Dent J. 2007; 202: 645. 2. Jia R. Computer playfulness, Internet dependency and their relationships with online activity types and student academic performance. J Behav Addict. 2012; 1: 74-7. 3. Chen SY, Tzeng JY. College female and male heavy internet users' profiles of practices and their academic grades and psychosocial adjustment. Cyberpsychol Behav Soc Netw. 2010; 13: 257-62. 4. Tao D, Demiris G, Graves RS, Sievert M. Transition from in library use of resources to outside library use: the impact of the Internet on information seeking behavior of medical students and faculty. AMIA Annu Symp Proc. 2003:1027. 5. Gray NJ. Health information on the internet--a double- edged sword? J Adolesc Health. 2008; 42: 432-3. JIIMC 2016 Vol. 11, No.2 Internet Addiction and Medical Students