Elsevier

Public Health

Volume 132, March 2016, Pages 60-63
Public Health

Short Communication
Association between internet addiction and high-risk sexual attitudes in Chinese university students from Hong Kong and Macau

https://doi.org/10.1016/j.puhe.2015.11.009Get rights and content

Highlights

  • Exploration of internet addiction in the largest population of internet users: Chinese adolescents.

  • Internet addiction was correlated with high-risk sexual attitudes and past sexual experience in adolescents.

  • Increasing information in this understudied area of health-risk behaviors may improve adolescent health programs.

Introduction

Internet addiction (IA), defined as a psychological dependence on the internet, is characterized by severe psychosocial problems related to excessive time spent online. The negative health impacts of excessive internet use have been well documented internationally, particularly in East Asia where internet use is nearly ubiquitous among adolescents. Previous studies in the region have noted that heavy internet use is associated with mood disorders, such as depression,1 and various adverse health outcomes, such as poor sleep quality1, 2 and lower levels of physical activity.2 However, researchers in the region have not investigated the association between heavy internet use and sexuality, especially among university-aged populations. University is a critical developmental period for most Chinese adolescents as it is seen as a life stage of greater autonomy from their parents, when long-lasting behaviour patterns often form. As in other parts of the world, the internet is likely to be the most common source of information on sexual topics among people of this age group. Frequent exposure to uncensored sexual content may also be influential in shaping adolescent sexual attitudes, and thereby eventual sexual behaviours. Moreover, interactive social networking websites offer unlimited, around-the-clock opportunities to connect with potential romantic partners. Adolescents possessing very open sexual attitudes, faced with a vast array of online sexual content, and possessing poor decision-making skills may exhibit a higher likelihood of sexual risk behaviours. Although the 641 million Chinese internet users represent the largest absolute number of users in the world and 21.9% of the worldwide total,3 there is currently little information on the correlation between IA and sexual attitudes and behaviours among Chinese adolescents, as the majority of studies have been conducted on Western populations. The results of this study may be useful for university health intervention programmes in the region.

All students matriculating at one of the eight universities in Hong Kong or one of the four universities in Macau were mailed, at random, with one of two versions of a health questionnaire in 2011; this was to be returned at a compulsory health examination. The questionnaires were anonymous in order to moderate any social desirability biases. The sexual health questionnaire used in this study was completed by 1510 individuals [646 males and 864 females, mean age 18.7 (standard deviation 0.9) years; response rate >81.0% across both sites]. The sociodemographic characteristics of the sample did not differ markedly from other universities in the area. The questionnaires asked students their age, sex, place of birth, household income level, religious affiliation and parental education level. Students also completed a negative body image scale4 (Cronbach's α = 0.76) and a 16-item brief sexual attitudes scale (Cronbach's α = 0.67).5 This instrument was composed of four sexual attitude subscales: (1) permissiveness (acceptance of casual sexuality, e.g. ‘Casual sex is acceptable’); (2) birth control acceptance (e.g. ‘Birth control is part of responsible sexuality’); (3) communion (idealistic sexuality, e.g. ‘Sex is usually an intensive, almost overwhelming experience’); and (4) instrumentality (sex as a biological need, e.g. ‘Sex is primarily a bodily function, like eating’). As no published recommended cut-offs are available, the normally distributed summative subscale and global scale scores were recoded into three levels (score < interquartile range (IQR), score within IQR and score > IQR). Higher scores (score > IQR) for these four subscales reflected greater permissiveness of casual sex, stronger endorsement of contraceptive use, stronger inclination for intensive sexual experiences and greater preference for enjoying physical aspects of sex. The study used the eight-item short version of Young's Internet Addiction Test (IAT)6 which has been validated in Chinese adolescents.7 Five or more affirmative responses indicated IA.6

Unadjusted logistic regression was conducted initially to determine whether the sexual attitudes subscales, global sexual attitudes scale and past sexual experience were significantly associated with IA. Sociodemographic variables and body image score were subsequently included as potential confounders in the adjusted logistic regression analysis if they demonstrated a statistical association with IA (P < 0.20). Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (CI) are shown in Table 1. Items asking respondents about perceived influence of parents, siblings, peers and mass media on their sexual behaviours were compared between IA and non-IA groups using Chi-squared test or Fisher's exact test. All analyses were conducted using Statistical Package for the Social Sciences Version 20.0 (IBM Corp., Armonk, NY, USA) with α = 0.05.

Section snippets

Associations between internet addiction and sexual attitudes and behaviours

Approximately one in 50 students (1.9%) met the stringent Young's criteria for IA. Preliminary analysis showed that no sociodemographic factors, other than being born outside of Hong Kong/Macau/Mainland China, were significantly associated with IA (39.3% of IA students vs 18.9% of non-IA students were foreign-born; P = 0.007). Male sex showed a marginally significant association with IA (60.7% in IA students vs 42.7% in non-IA students; P = 0.06).

In the unadjusted analyses, IA was significantly

Associations between internet addiction and exposure to online sexual content, and perceptions of influence of mass media on sexual behaviours

In the month preceding the survey, IA students averaged 238 min online each day, and 60.0% had searched for sex-related information, 31.4% had engaged in sex-related chatting and 50.0% had watched streaming pornographic videos in the previous month; corresponding figures for non-IA students were 168 min/day, 31.6%, 12.1% and 24.2%, respectively (P < 0.001).

When asked to rate the influence of four factors (parents, siblings, peers, mass media) on teen sexual behaviours, only mass media

Implications for sexual behaviour research and regional university health promotion

Previous research in adolescents has shown strong associations between perceived peer sexual norms and eventual sexual behaviours. A systematic review of 69 primary studies of American adolescents noted that the belief that most peers were sexually active and perceived peer approval of sex predicted sexual risk behaviours consistently in this age group.8 Frequent exposure to explicit online sexual content, particularly from interactive social networking websites, may thereby indirectly

Acknowledgements

The authors wish to thank the students who participated in the study, and the university health service workers for their assistance with data collection.

Ethical approval

Ethical approval was obtained from the sponsoring university's institutional review board.

Funding

The study was funded by internal funding of the sponsoring university.

Competing interests

None declared.

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