Associations of Personality Traits with Internet Addiction: A Cross-Cultural Meta-Analysis with a Multilingual Approach.

With a novel multilingual approach, this cross-cultural meta-analysis study investigated the associations between personality traits and Internet addiction. Articles were identified and retrieved by searching through general and language-specific databases, and thereafter reviewed for inclusion based on the selection criteria. Random effects models with the Hartung-Knapp-Sidik-Jonkman method were used to examine the associations of Internet addiction with seven personality traits: Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism, Psychoticism, and Lie (OCEAN-PL). Forest plots with summary statistics were produced to inspect the between-study heterogeneity. Subgroup analysis was performed to further determine the contributions of moderators (geographic region, population subgroup, scales for assessing personality traits and Internet addiction, and language of publication) to the observed between-study heterogeneity. Funnel plots and Egger's test were used to detect possible small-study effects. A sample of 34,438 participants from 37 studies (24 from Asia) were included for data analysis. The major languages of publications of the selected articles were English and Asian languages. According to the pooled results, Internet addiction was associated positively with Neuroticism and Psychoticism, but negatively with Conscientiousness, Extraversion, Agreeableness, and Lie. Geographic region and language of publication significantly moderated the associations of Internet addiction with Agreeableness and Neuroticism, and Openness and Extraversion, respectively. No significant small-study effect was present for all OCEAN-PL personality traits, except Neuroticism. In conclusion, the Internet addiction group is relatively more neurotic and psychotic, and less conscientious, extraverted, agreeable, and untruthful than the nonaddiction group. A multilingual approach is useful for improving the search strategies for systematic reviews, cross-cultural meta-analyses in particular.

Crosscultural Measurement Invariance of the Internet Addiction Test-Revised (IAT-R) Among Japanese and Filipino University Students.

This study investigated the measurement equivalence of the Internet Addiction Test-Revised (IAT-R) among university students. In the Asian College Health Assessment (ACHA), 200 Japanese and 348 Filipino university students completed a survey in 2016-2017 school year. Multiple-group confirmatory factor analysis was performed to examine the three hierarchical levels (configural, metric, and scalar) of measurement invariance. A first-order three-factor model with three domains, namely "Excessive Use, Lack of Control, and Neglect Work," "Anticipation and Salient," and "Neglect Social Life," emerged. The fit indices were 0.958 for comparative fit index (CFI) and 0.025 (0.017-0.034) for root mean square error of approximation (RMSEA) (confidence interval [90% CI]) in Japanese sample; and 0.962 for CFI and 0.068 (0.053-0.088) for RMSEA (90% CI) in Filipino sample. All three levels of measurement invariance between the two samples were established, with ΔCFI and ΔRMSEA not exceeding -0.01 and 0.015, respectively, for each increasing stringent level. The results indicated the measurement equivalence of IAT-R for assessing Internet addiction risks across cultural groups.

Development and Differential Item Functioning of the Internet Addiction Test-Revised (IAT-R): An Item Response Theory Approach.

This study developed and investigated the differential item functioning (DIF) of the Internet Addiction Test-Revised (IAT-R) with an item response theory approach. In the Asian College Health Assessment (ACHA), 1,072 university students completed a survey in 2016-2017 school year. Confirmatory factor analysis models with robust maximum likelihood and diagonal weighted least square estimation methods were used to evaluate the construct validity of the 20-item IAT-R. Graded response model was used to produce categorical characteristic curves (CCCs), test characteristic curves (TCCs), item information function (IIF) curves, and test information function (TIF) curves for detecting DIF of the polytomous responses. Furthermore, DIF between genders was examined by ordinal logistic regression and Monte Carlo simulations. A first-order three-factor model was the most parsimonious model with normed fit index (NFI) of 0.915, non-normed fit index (NNFI) of 0.927, comparative fit index (CFI) of 0.937, and root mean square error of approximation (RMSEA) of 0.050. The emerged factors included Excessive Use and Neglect Work, Anticipation and Lack of Control, as well as Neglect Social Life and Salience. CCCs, TCCs, IIFs, and TIFs showed that all items were sensitive at moderate-to-high trait values. No nonuniform scale-level DIF relating to gender was determined. Under no DIF, the thresholds for proportional beta change exhibited a fairly steady trend (below 0.10) across items. In conclusion, IAT-R is a valid measurement scale of Internet addiction with measurement equivalence between genders being established.

Applications of machine learning in addiction studies: A systematic review.

This study aims to provide a systematic review of the applications of machine learning methods in addiction research. In this study, multiple searches on MEDLINE, Embase and the Cochrane Database of Systematic Reviews were performed. 23 full-text articles were assessed and 17 articles met the inclusion criteria for the final review. The selected studies covered mainly substance addiction (N = 14, 82.4%), including smoking (N = 4), alcohol drinking (N = 3), as well as uses of cocaine (N = 4), opioids (N = 1), and multiple substances (N = 2). Other studies were non-substance addiction (N = 3, 17.6%), including gambling (N = 2) and internet gaming (N = 1). There were eight cross-sectional, seven cohort, one non-randomized controlled, and one crossover trial studies. Majority of the studies employed supervised learning (N = 13), and others employed unsupervised learning (N = 2) and reinforcement learning (N = 2). Among the supervised learning studies, five studies used ensemble learning methods or multiple algorithm comparisons, six used regression, and two used classification. The two included reinforcement learning studies used the direct methods. These results suggest that machine learning methods, particularly supervised learning are increasingly used in addiction psychiatry for informing medical decisions.

Mediating Effect of Internet Addiction on the Association between Resilience and Depression among Korean University Students: A Structural Equation Modeling Approach.

OBJECTIVE: This study examined the mediating role of internet addiction in the association between psychological resilience and depressive symptoms. METHODS: 837 Korean university students completed a survey with items of demographic information, Connor-Davidson Resilience Scale (CD-RISC), Internet Addiction Test (IAT), and Patient Health Questionnaire (PHQ-9) in 2015. The complex associations among psychological resilience, internet addiction, and depressive symptoms were delineated using structural equation models. RESULTS: In the most parsimonious model, the total effect and indirect effect of resilience on depressive symptoms via internet addiction, were statistically significant. The goodness of fit of the measurement model was satisfactory with fit indices, normed fit index (NFI) of 0.990, non-normed fit index (NNFI) of 0.997, comparative fit index (CFI) of 0.998, root mean square error (RMSEA) of 0.018 (90%CI=0.001-0.034); and Akaike Information Criterion (AIC) of -21.049. CONCLUSION: The association between psychological resilience and depressive symptoms was mediated by internet addiction in Korean university students. Enhancement of resilience programs could help prevent internet addiction and reduce the related depression risks.

Cross-cultural adaptation and psychometric properties of the Korean Scale for Internet Addiction (K-Scale) in Japanese high school students.

The Korean Scale for Internet Addiction (K-Scale) was developed in Korea for assessing addictive internet behaviors. This study aims to adopt K-Scale and examine its psychometric properties in Japanese adolescents. In 2014, 589 (36.0% boys) high school students (Grade 10-12) from Japan completed a survey, including items of Japanese versions of K-Scale and Smartphone Scale for Smartphone Addiction (S-Scale). Model fit indices of the original four-factor structure, three-factor structure obtained from exploratory factor analysis, and improved two-factor structure of K-Scale were computed using confirmatory factor analysis, with internal reliability of included items reported. The convergent validity of K-Scale was tested against self-rated internet addiction, and S-Scale using multiple regression models. The results showed that a second-order two-factor 13-item structure was the most parsimonious model (NFI=0.919, NNFI=0.935, CFI=0.949, and RMSEA=0.05) with good internal reliability (Cronbach's alpha=0.87). The two factors revealed were "Disturbance of Adaptation and Life Orientation" and "Withdrawal and Tolerance". Moreover, the correlation between internet user classifications defined by K-Scale and self-rating was significant. K-Scale total score was significantly and positively associated with S-Scale total (adjusted R2=0.440) and subscale scores (adjusted R2=0.439). In conclusion, K-Scale is a valid and reliable assessment scale of internet addiction for Japanese high school students after modifications.

Nutritional Epidemiology of Antenatal Smoking Cessation Among Japanese Women.

This study compared the nutritional status before pregnancy, as well as dietary profiles and biomarkers during first trimester, between never-smokers and antenatal quitters among Japanese women. One hundred fifty pregnant women (79 never-smokers and 71 antenatal quitters) from two obstetrics and gynecology clinics were recruited in Japan. Subjects' prepregnancy nutritional status was indicated by their body mass index (BMI). In the first trimester, their dietary profiles were assessed by the Brief Diet-History Questionnaire (BDHQ) and pregnancy outcomes were screened by biomarker tests. Generalized linear regression was used to examine the differences of energy-adjusted dietary intakes and biomarker results between the two smoking groups, with adjustment of maternal age, BMI, gestation week, and parity. The results showed that antenatal quitters were more likely to have a prepregnancy underweight status than never-smokers. During the first trimester, antenatal quitters had significantly higher intakes of unsaturated fatty acids and antioxidants (vegetable lipids and isoflavone), and lower intakes of total cholesterol than never-smokers. Moreover, antenatal quitters had a significantly higher level of serum homocysteine (6.36 nmol/mL vs 4.88 nmol/mL) than never-smokers. In conclusion, antenatal quitters are more likely to have a poor nutritional status before pregnancy than never-smokers. Quitting smoking before pregnancy and having a good nutritional profile during the trimester may not sufficiently reverse the adverse effects of former smoking behaviors on pregnancy outcomes.

Gender differences in the association between cohabitation with parents and stress among married adults: A propensity score-matched analysis from the Korean National Health and Nutrition Examination Survey (KNHANES).

This study examined the gender-specific associations between cohabitation with parents and stress using an econometric approach. A total of 13,565 (41.7% men and 58.3% women) Korean adults aged 20-59 years from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008 to 2011 were pooled. They reported their gender, age, marital status, education level, employment status, income, home ownership, and cohabitation status with their parents. The association of living with parents and stress, as well as the gender difference in the association, was investigated using propensity score matching and the average treatment effect on the treated. Adults with higher education and income, not owning a house, or living in larger cities were less likely to live with parents. Stress was associated with having children and participating in the labor market for both married men and women. Moreover, living with parents was a protective factor for stress among husbands, but a risk factor for wives in Korea. Gender differences existed in the association between cohabitation with parents and stress. Greater stress was related to cohabiting with parents and working for married women.

Prediction of vehicle crashes by drivers' characteristics and past traffic violations in Korea using a zero-inflated negative binomial model.

AIMS: Traffic safety is a significant public health challenge, and vehicle crashes account for the majority of injuries. This study aims to identify whether drivers' characteristics and past traffic violations may predict vehicle crashes in Korea. METHODS: A total of 500,000 drivers were randomly selected from the 11.6 million driver records of the Ministry of Land, Transport and Maritime Affairs in Korea. Records of traffic crashes were obtained from the archives of the Korea Insurance Development Institute. After matching the past violation history for the period 2004-2005 with the number of crashes in year 2006, a total of 488,139 observations were used for the analysis. Zero-inflated negative binomial model was used to determine the incident risk ratio (IRR) of vehicle crashes by past violations of individual drivers. The included covariates were driver's age, gender, district of residence, vehicle choice, and driving experience. RESULTS: Drivers violating (1) a hit-and-run or drunk driving regulation at least once and (2) a signal, central line, or speed regulation more than once had a higher risk of a vehicle crash with respective IRRs of 1.06 and 1.15. Furthermore, female gender, a younger age, fewer years of driving experience, and middle-sized vehicles were all significantly associated with a higher likelihood of vehicle crashes. CONCLUSIONS: Drivers' demographic characteristics and past traffic violations could predict vehicle crashes in Korea. Greater resources should be assigned to the provision of traffic safety education programs for the high-risk driver groups.

Mediating effects of body composition between physical activity and body esteem in Hong Kong adolescents: a structural equation modeling approach.

This study investigated the mediating role of body mass index (BMI) in the relationship between physical activity and body esteem in adolescents. Nine hundred and five Hong Kong Chinese students aged 12-18 years participated in a cross-sectional study in 2007. Students' BMI was computed as an indicator of their body composition. Their physical activity level and body esteem were examined using the Physical Activity Rating for Children and Youth (PARCY) and Body Esteem Scale (BES), respectively. Structural equation modelling was used to investigate the mediating effects of BMI and physical activity in predicting body esteem, with stratification by sex. The overall fit of the hypothesized models was satisfactory in boys (NFI = 0.94; NNFI = 0.88; CFI = 0.95; RMSEA = 0.07) and girls (NFI = 0.89; NNFI = 0.77; CFI = 0.91; RMSEA = 0.11). When BMI was considered as a mediator, higher physical activity had a significant negative total effect on body esteem in boys, but not in girls. The indirect effect of higher physical activity on body esteem via BMI was positive in boys, but negative in girls. CONCLUSIONS: Regular physical activity may help overweight adolescents, especially boys, improve their body esteem. Kinesiologists and health professionals could explore the use of physical activity prescriptions for weight management, aiming at body esteem improvement in community health programs for adolescents. WHAT IS KNOWN: Among Western adolescents, negative body esteem is more pervasive in girls than in boys. There are consistent findings of the association between higher body mass index and lower body esteem in adolescents, but the association between physical activity and body esteem are equivocal. WHAT IS NEW: A negative association between body mass index and body esteem was found in both Hong Kong adolescent boys and girls. The indirect effect of physical activity on body esteem via body mass index was positive in Hong Kong adolescent boys, but negative in girls.

Measurement Invariance of the Internet Addiction Test Among Hong Kong, Japanese, and Malaysian Adolescents.

There has been increased research examining the psychometric properties on the Internet Addiction Test (IAT) in different populations. This population-based study examined the psychometric properties and measurement invariance of the IAT in adolescents from three Asian countries. In the Asian Adolescent Risk Behavior Survey (AARBS), 2,535 secondary school students (55.9% girls) aged 12-18 years from Hong Kong (n=844), Japan (n=744), and Malaysia (n=947) completed a survey in 2012-2013 school year. A nested hierarchy of hypotheses concerning the IAT cross-country invariance was tested using multigroup confirmatory factor analyses. Replicating past findings in Hong Kong adolescents, the construct of the IAT is best represented by a second-order three-factor structure in Malaysian and Japanese adolescents. Configural, metric, scalar, and partial strict factorial invariance was established across the three samples. No cross-country differences on Internet addiction were detected at the latent mean level. This study provided empirical support for the IAT as a reliable and factorially stable instrument, and valid to be used across Asian adolescent populations.

Internet Addiction and Psychosocial Maladjustment: Avoidant Coping and Coping Inflexibility as Psychological Mechanisms.

This 6 month prospective study systematically tested some multivariate models that advanced the understanding of the psychological mechanisms underlying Internet addiction and psychosocial maladjustment. On the basis of previous theories, avoidant coping and coping inflexibility were proposed as underlying mechanisms. Participants were 271 Chinese undergraduates (75% women, Mage=20.49) who took part in both phases of this study. Structural equation modeling was performed to obtain the best fit models for both the cross-sectional and the prospective data. The cross-sectional model testing revealed statistically significant mediating effects for both avoidant coping (ß=0.149 [95% CI 0.071-0.226], p=0.002) and coping flexibility (ß=0.048 [95% CI 0.013-0.081], p=0.032). The prospective model testing further showed that avoidant coping mediated the relationship between Internet addiction and Time 2 psychosocial maladjustment (ß=0.141 [95% CI 0.065-0.216], p=0.005), as well as that between coping flexibility and Time 2 psychosocial maladjustment (ß=-0.096 [95% CI -0.161 to -0.031], p=0.015). This study was the first to establish theory-driven models, which unveiled an inflexible, avoidant coping style as psychological mechanisms that explained the link between Internet addiction and psychosocial maladjustment.

Sociodemographic Differences in the Association Between Obesity and Stress: A Propensity Score-Matched Analysis from the Korean National Health and Nutrition Examination Survey (KNHANES).

Few population-based studies have used an econometric approach to understand the association between two cancer risk factors, obesity and stress. This study investigated sociodemographic differences in the association between obesity and stress among Korean adults (6,546 men and 8,473 women). Data were drawn from the Korean National Health and Nutrition Examination Survey for 2008, 2009, and 2010. Ordered logistic regression models and propensity score matching methods were used to examine the associations between obesity and stress, stratified by gender and age groups. In women, the stress level of the obese group was found to be 27.6% higher than the nonobese group in the ordered logistic regression; the obesity effect on stress was statistically significant in the propensity score-matched analysis. Corresponding evidence for the effect of obesity on stress was lacking among men. Participants who were young, well-educated, and working were more likely to report stress. In Korea, obesity causes stress in women but not in men. Young women are susceptible to a disproportionate level of stress. More cancer prevention programs targeting young and obese women are encouraged in developed Asian countries.

Ethnic differences in suicide behavior in Singapore.

This study examined the ethnic differences in stressors, risk, and protective factors among people who attempted suicide in Singapore. A retrospective chart review of 626 attempted suicide cases at a hospital in Singapore between 2004 and 2006 collected information on diagnosis according to DSM-IV-TR criteria. Chi-square tests was used to compare the sociodemographic characteristics, stressors, risk factors, and protective factors among Chinese, Malay, Indian, and other ethnic groups. Logistic regression was used to determine the odds ratios of having two or more stressors, risk factors, or protective factors for the four ethnic groups. Women were more likely than men to attempt suicide, although they also were more likely to have two or more suicide protective factors than men. In general, older people were more likely to have two or more suicide risk factors than the younger groups. Ethnic differences were found in history of psychiatric illnesses and unemployment among the risk factors, and for most of the protective factors, but none of the stressors. Indians were more likely to have two or more protective factors than were Chinese (OR of 7.74, 95% CI [1.04, 8.72]. Future suicide prevention programs should target young adults and strengthen the protective factors among different ethnic groups.

Divergent pathways to influence: Cognition and behavior differentially mediate the effects of optimism on physical and mental quality of life in Chinese university students.

Previous research has indicated that both cognitive and behavioral variables mediate the positive effect of optimism on quality of life; yet few attempts have been made to accommodate these constructs into a single explanatory framework. Adopting Fredrickson's broaden-and-build perspective, we examined the relationships between optimism, self-rated health, resilience, exercise, and quality of life in 365 Chinese university students using path analysis. For physical quality of life, a two-stage model, in which the effects of optimism were sequentially mediated by cognitive and behavioral variables, provided the best fit. A one-stage model, with full mediation by cognitive variables, provided the best fit for mental quality of life. This suggests that optimism influences physical and mental quality of life via different pathways.

Epidemiology of internet behaviors and addiction among adolescents in six Asian countries.

Internet addiction has become a serious behavioral health problem in Asia. However, there are no up-to-date country comparisons. The Asian Adolescent Risk Behavior Survey (AARBS) screens and compares the prevalence of Internet behaviors and addiction in adolescents in six Asian countries. A total of 5,366 adolescents aged 12-18 years were recruited from six Asian countries: China, Hong Kong, Japan, South Korea, Malaysia, and the Philippines. Participants completed a structured questionnaire on their Internet use in the 2012-2013 school year. Internet addiction was assessed using the Internet Addiction Test (IAT) and the Revised Chen Internet Addiction Scale (CIAS-R). The variations in Internet behaviors and addiction across countries were examined. The overall prevalence of smartphone ownership is 62%, ranging from 41% in China to 84% in South Korea. Moreover, participation in online gaming ranges from 11% in China to 39% in Japan. Hong Kong has the highest number of adolescents reporting daily or above Internet use (68%). Internet addiction is highest in the Philippines, according to both the IAT (5%) and the CIAS-R (21%). Internet addictive behavior is common among adolescents in Asian countries. Problematic Internet use is prevalent and characterized by risky cyberbehaviors.

Prevalence and correlates of video and internet gaming addiction among Hong Kong adolescents: a pilot study.

This pilot study investigated the patterns of video and internet gaming habits and the prevalence and correlates of gaming addiction in Hong Kong adolescents. A total of 503 students were recruited from two secondary schools. Addictive behaviors of video and internet gaming were assessed using the Game Addiction Scale. Risk factors for gaming addiction were examined using logistical regression. An overwhelming majority of the subjects (94%) reported using video or internet games, with one in six (15.6%) identified as having a gaming addiction. The risk for gaming addiction was significantly higher among boys, those with poor academic performance, and those who preferred multiplayer online games. Gaming addiction was significantly associated with the average time spent gaming per week, frequency of spending money on gaming, period of spending money on gaming, perceived family disharmony, and having more close friends. These results suggest that effective educational and preventative programs or strategies are needed.

The association between internet addiction and psychiatric co-morbidity: a meta-analysis.

BACKGROUND: This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature. METHODS: Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR). RESULTS: Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001). CONCLUSIONS: IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.

Psychometric properties of the Revised Chen Internet Addiction Scale (CIAS-R) in Chinese adolescents.

The Revised Chen Internet Addiction Scale (CIAS-R) was developed to assess Internet addiction in Chinese populations, but its psychometric properties in adolescents have not been examined. This study aimed to evaluate the factor structure and psychometric properties of CIAS-R in Hong Kong Chinese adolescents. 860 Grade 7 to 13 students (38 % boys) completed the CIAS-R, the Young's Internet Addiction Test (IAT), and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in a survey. The prevalence of Internet addiction as assessed by CIAS-R was 18 %. High internal consistency and inter-item correlations were reported for the CIAS-R. Results from the confirmatory factor analysis suggested a four-factor structure of Compulsive Use and Withdrawal, Tolerance, Interpersonal and Health-related Problems, and Time Management Problems. Moreover, results of hierarchical multiple regression supported the incremental validity of the CIAS-R to predict mental health outcomes beyond the effects of demographic differences and self-reported time spent online. The CIAS is a reliable and valid measure of internet addiction problems in Hong Kong adolescents. Future study is warranted to validate the cutoffs of the CIAS-R for identification of adolescents with Internet use problems who may have mental health needs.

Longitudinal relations of perceived availability of neighborhood sport facilities with physical activity in adolescents: an analysis of potential moderators.

BACKGROUND: Little is known about the longitudinal relations of environment attributes and leisure-time physical activity (PA) in adolescents, and the moderating effects of individual characteristics. This study examined the longitudinal association of the perceived availability of neighborhood sport facilities with leisure-time PA, and the potential moderating effects of age, past PA behavior, and weight status in adolescents. METHODS: Among 20,933 follow-up subjects (60.9% of 34,369 baseline subjects), 9993 from 32 Hong Kong secondary schools were successfully matched with baseline (mean duration 16 months; SD 1.7) and had complete information. At baseline and follow-up, respondents reported their leisure-time PA, weight, height, and the presence of sport facilities in the neighborhood. RESULTS: Increased perceived availability of sport facilities from baseline to follow-up predicted more leisure-time PA at follow-up (ß = 1.029; 95% CI: 1.0111.047) overall. This effect was modified by baseline PA, with a significant effect observed only among those who had engaged in leisure-time PA more than 3 times a week. CONCLUSIONS: Increasing awareness of neighborhood sport facilities or building more such facilities may help active adolescents maintain or increase their leisure-time PA. However, more comprehensive multilevel interventions that aim at enhancing potential social, personal, and environmental PA-related factors may be needed to motivate inactive adolescents.