Investigating the relationship between internet addiction and academic achievement of medical students. Iranian Journal of Health, Safety and Environment

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Iranian Journal of Health, Safety & Environment, Vol.3, No.2, pp.528-534
528
Investigating the Relationship Between Internet Addiction and Academic
Achievement of Medical Students (2013)
Rita Motidost Komleh1, Agha Fatemeh Hosseini2, Ladan Fata3,4, Fakhrossadat Mirhosseini5,6, Shoaleh
Bigdeli 7,8*
1) Department of Medical Education Faculty of Medicine, Center for Educational Research in Medical Sciences (CERMS), Iran
University of Medical Sciences (IUMS), Tehran, Iran.
2) Department of Biostatistics, Faculty of Public Health, Iran University of Medical Sciences(IUMS), Tehran, Iran.
3) Center for Educational Research in Medical Sciences (CERMS), Tehran, Iran
4) Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
5) Department of Anesthesia, Faculty of Allied Health Sciences, Kashan University of Medical Sciences, Kashan, Iran
6) Department of Medical Education, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
7) Center for Educational Research in Medical Sciences (CERMS) Iran university of medical sciences, Tehran, Iran
8) Department of Medical Education, Faculty of Medicine, Iran, University of Medical Sciences (IUMS), Tehran, Iran.
*Author for Correspondence: sbigdeli@alumni.sfu.ca
Received: 16 Apr. 2015, Revised: 25 Jul. 2015, Accepted: 15 Aug. 2015
ABSTRACT
Intensive use of the internet can be associated with negative psychological consequences and behavioral
changes. These consequences affect different aspects of life including physical, mental and spiritual
health and academic performance of the students as users. In this regard, this study is an attempt to
determine the rate of internet addiction and its relationship to academic achievement among medical
students of basic sciences studying at Tehran University of Medical Sciences.
In this cross-sectional study, a sample size of 417 participants had been selected by stratified random
sampling. To collect data a demographic questionnaire and a Farsi version of Young Internet Addiction
Test was used. Descriptive statistics (frequency distribution, frequency Percent, mean and standard
deviation) and inferential statistics (Pearson correlation test, chi-square and t-test) were used to analyze
data.
57 out of 417 participants of the study (15.2%) had internet addiction. There was a significant relationship
between time spent on the internet (p≤0.001) and number of failed credits in the semester prior to the
study (P≤0.02 and r=-0.136). Internet addiction was not significantly associated with sex, age, age of the
first internet use, parental education and academic achievement. By medical students of basic sciences
internet addiction had no significant relationship with academic achievement; however, to study the
effects of Internet addiction on other aspects of medical students' life is suggested.
Keywords: Internet Addiction, Academic Achievement, Medical Students
INTRODUCTION
Internet as a growing phenomenon is almost
accessible everywhere; therefore, because of its
easy availability, the amazing number of users is
on the rise. [1] Easy internet access and its
worldly spread have affected all aspects of
human life. Shield quoting McLuhan, believes
that the world has become a global village in
which everyone has the ability to communicate
with others and has easy access to the latest
news and world events [2] There are many uses
for the internet and it has numerous advantages
not ignoring the disadvantages. Meanwhile,
internet overuse and misuse leads to undesirable
consequences for the individual health and leads
to negative behavioral changes [3].
In the virtual world, addictive use of the internet
is a new hidden phenomenon which is not
known by many users [3-4]. Internet addiction
was introduced by Goldberg is pathological
obsessive use of the internet that is manifested
by isolation symptoms including depression,
loneliness, anxiety and lack of self-confidence.
This phenomenon adversely affects physical,

Rita Motidost Komleh et al., Investigating the Relationship Between Internet Addiction…
529
mental and spiritual health of individuals and
leads to negative consequences on the society
[5].
A wide body of research has been reported on
the positive and negative effects of Internet use.
Sanders reported an inverse association between
Internet use and family relationships among
adolescents (low communication with mother
and friends) [3]. According to Young, highly
educated people are more at risk of Internet
addiction [6]. Scherer found that students
addicted to Internet who are mainly males
(72%), use it 11 hours per week [7]. According
to Kubey et al. using internet for entertainment
is associated with serious damages to personal
performance, academic problems, sense of
loneliness and sleep disorders [1].Nastizaee
(2009) in University of Sistan and Baluchestan,
Iran found that internet addicts are more prone
to health risk factors than regular users (P≤0.01);
moreover, depression and anxiety are more
common among them [3]. According to Dargahi,
Internet addiction is more prevalent among
adolescents of 15-19 years of age, and singles
who commonly use the Internet at school and
home [8].
Nademi in a study on Mashhad university
students found that 77% of the study participants
are at risk of Internet addiction and in 14% of
their internet dependency affected their
academic performance. In addition, internet
addiction was significantly more prevalent in
male students than females [5]. According to
Moeedfar et al., Internet addicts suffer school
and work failure [1]. Ahmadi in a study on the
4342 high school students found that 22.2% of
them were internet addicts, most of whom were
males, and indicated that there was a significant
relationship between internet addiction, sex and
education of parents (P≤0.001) [9].
However, Namazi et al. reported no significant
relationship between Internet use and depression
among users [3]. Accordingly, Miltiadou
believed that self confidence in internet users is
higher [10].Wheeler et al. believed that internet
use enhances creative thinking and social
communications in the users [1]. Zare and
Kadivar also found that Internet users are more
creative and self-efficient than non-users [12].
Alavi quoted by Kim, et al. in their studies on
Internet addiction and its psychological
outcomes reported no psycho-logical symptoms
for Internet addiction [1]. Global research on
Internet addiction shows controversial findings,
and since to the best of our knowledge no study
has been done on the relationship of Internet
addiction and academic achievement of Iranian
medical students of basic sciences, this study is
an attempt to investigate this phenomenon
among medical students of Tehran University of
Medical Sciences.
MATERIALS AND METHODS
This applied cross-sectional study was carried
out to determine the rate of internet addiction
and its relationship to academic achievement of
medical students of basic sciences of Tehran
University of Medical Sciences (Hemmat and
Poursina Campuses, 2013). Considering the
95% confidence level, 90% power and
correlation coefficient (r=0.28) of similar studies
[1-5], and an estimated design effect of 1.5,
minimum sample size was estimated 315. Each
semester was defined as a stratum and samples
were selected by stratified random sampling.
Finally, the sample size reached to 417 (Table
1).
Table 1. Distribution of the semester of undergraduate
medical students of Basic Sciences studying at Tehran
University of Medical Sciences
Semester
Count
Percent
3
90
21.6
4
221
53.0
5
106
25.4
Total
417
100
Data were collected using a questionnaire
including demographic information and Farsi
version of Young Internet Addiction Test [1],
Demographics included: age, sex, marital status,
place of residence, Grade Point Average (GPA)
of the two consecutive previous academic
semesters, GPA of the last high school year,
level of education of parents, daytime hours of
internet use and age of the first Internet use.
Farsi version of Internet Addiction Test (Young,
1998, translated and validated by Alavi, 2010)
was used for the purposes of the study and its
permission to use was secured from Sinai
Cognitive Behavioral Research Institute, Tehran,
Iran.

Iranian Journal of Health, Safety & Environment, Vol.3, No.2, pp.528-534
530
The reliability and validity of the Farsi version
of this 21-items five-point likert-scale question-
naire were confirmed by Alavi in a cross-
sectional survey on 233 internet users studying
at Isfahan university (internal consistency 0.82,
external validity 0.79 ). In his study, the
correlation coefficient was significant (P≤0.05)
[13]. Moreover, face and content validity of this
version was examined by 5 psychologists and 5
educationalists (n= 10) and the modified Farsi
version was used to gather data. Test-retest
reliability of the questionnaire was confirmed by
10 students with a one week lapse. The
reliability of the questionnaire was confirmed
according to the Pearson correlation coefficient
(r=0.87). The research project was approved by
the university research committee and school of
graduate studies. The questionnaire was
distributed among participants of the study while
the researcher was available on the site for more
clarifications. Moreover, since criteria for GPA
was participants' disclosure, they were
encouraged to mention their scores as correct as
possible while it was emphasized that their
scores will be kept confidential. In addition, they
were announced that in case that they are
interested to know the results of the study they
can contact the researcher present at the site
(RMK) through her email address.
The collected data were analyzed by descriptive
statistics (frequency distribution, frequency
percent, mean and standard deviation) and
inferential statistics (Pearson correlation
coefficient and Chi-square). In this study,
internet addiction was an independent variable
which was measured on the basis of the sum of
the scores with the cut-off point of 44 (estimated
by Young Internet Addiction Test). It must be
emphasized that the score of each participant
obtained from the test is the criterion to detect
internet addiction rather than the time spent on
the internet, and the academic achievement
criterion was the average GPA for two
consecutive semesters prior to the study and
high school diploma.
RESULTS
Most of the study participants were studying at
the 4th semester of medical school (53%), 58%
of which were female and 42% male. More than
50% of the participants were located in the age
group of 21-22 years (51.9%). The participants
were living in personal residences or dorms,
53.5% and 46.5%, respectively. Most of the
participants (96.4%) were single and 31.2% of
them spent 1 to 1.99 hours per day on the
internet. 61.5% of the participants reported a
history of internet use since they were 10-14
years. Overall, the study participants mean age
of the first internet use was 12 years and 6
months. GPA of the 80% of the participants at
their final year of high school was 19-20.
Demographic characteristics of the participants
are presented in Table 2. (Table 2)
15.2% out of 417 participants of the study had
internet addiction; in other words, they got
greater than 44 score from internet addiction
questionnaire. From those studied in the third,
the fourth, and the fifth academic semesters,
internet addiction was reported 16.5%, 14.9%
and 14.8%, respectively.
In students with GPA of 11-13.99, 14-16.99 and
17 and above in a semester prior to the study,
internet addiction was 26.1%, 16.2% and,
12.5%, respectively. Chi-square did not show a
significant relationship between sex and Internet
addiction (P≥0.05) and between study semester
and Internet addiction.
Pearson correlation coefficient showed no
significant linear relationship between Internet
addiction and the previous semester GPA ) r=-
0.085, p=0.10). Similarly, chi-square showed no
significant relationship between Internet
addiction and the previous semester GPA
(P=0.217). In students with a cumulative GPA
of 11-13.99, 14 to 16.99, and17 and above in the
two consecutive semesters prior to the study,
7.1%, 15.5%, and 17.6% had internet addiction,
respectively. Pearson correlation coefficient,
showed no significant linear relationship
between Internet addiction and the mean average
of the previous semesters GPA (P=0.37 and r=-
0.048). Similarly, chi-square showed no
significant relationship between Internet
addiction and the GPA of the two consecutive
semesters prior to the time of the study.
(P=0.579).
According to the GPA of students in the final
year of high school, those in the group scored
lower than 17, 17-18.99 and 19-20, 14.3, 10 and
16.8%, were internet addicts.

Rita Motidost Komleh et al., Investigating the Relationship Between Internet Addiction…
531
Table 2. Demographic characteristics of students
Pearson correlation coefficient, showed no
significant linear relationship between Internet
addiction and GPA of the last high school year
(P=0.25, r= - 0.060). Chi-square showed no
significant relationship between Internet
addiction and last year of the high school GPA
(P=0.417).
In the age group of 25 and above, and 21-22
years 16.7% and 16.2% of the students were
internet addict, respectively. Pearson correlation
coefficient (P=0.62, r= -0.025) showed no
significant linear relationship between Internet
addiction and age. Chi-square showed no
significant relationship between Internet
addiction and age (P=0.415).
From those students who had access to the
Internet at their residence, 15.6% were internet
addict. Chi-square showed no significant
relationship between internet access at the
students' place of residence and internet
addiction (P=0.347).
In students who passed all their courses in a
semester prior to the study, internet addiction
was 13.9%., while this rate was 24.4% in those
who failed all their courses. However, it has no
statistical significant relationship.
On the contrary, chi-square showed a significant
relationship between the number of failed credits
in the semester prior to the study and internet
addiction (P=0.02). It means that Internet
addiction in those who failed in less than 3
credits was 44.4% and in those who failed in 3
or more credits was 12.5% (negative correlation)
(Table 3).
Table 3. Frequency distribution of Internet addiction based
on the number of failed credits in the last semester of
medical students of Basic Sciences Tehran University of
Medical Sciences
Sum
Addicted
Without
Addiction
Internet
Addiction
Number
of failed
credits in the
previous semester
Percent
Number
Percent
Number
Percent
Number
failed
100
18
44.4
8
55.6
10
<3
100
24
12.5
3
87.5
21
≥3
100
42
26.2
11
73.8
31
Sum
P=0.020, df=1 , =5.430
Chi-square test
In those who used the Internet for less than one
hour a day, Internet addiction was 6.1%; and for
those who spend 5 hours or more a day on the
Internet it was 36.1%. Chi-square showed a
significant relationship between Internet
addiction and time spent on the Internet
(P≤0.001) (Table 4).
243(%58.4)
Woman
Gender
1.
173(%41.6)
Man
21.01±1.46
mean± SD
Age (years)
2.
402(%96.4)
Single
Marital status
3.
15(%3.6)
Married
90(%21.6)
Term 3
Semester
4.
221(%53)
Term 4
106(%25.2)
Term 5
222(%53.5)
Dorm
Residence
status
5.
193(%46.5)
Private house
%96.2
Yes
Internet use at
place of
residence
6.
%88
Yes
Using the
Internet at the
University
7.
%57.1
Yes
Internet use in
places other
than the home
and university
8.
2.84±3.81
mean± SD
Daily time
spent on
surfing the
Internet
(hours)
9.
12.51±2.82
mean± SD
Age of first
contact with
the Internet
10.
44(%10.7)
Yes
Employment
11.
16.29±1.54
mean± SD
GPA (last
semester)
12.
16.32±1.39
mean± SD
Last two
consecutivese
mesters GPA
13.
19.17±0.98
mean± SD
GPA (Last
year of high
school)
14.
43(%11.1)
Less than
high school
diploma
Mother
Parental
education
15.
146(%37.6)
Diploma and
Advanced
Diploma
199(%51.3)
Bachelor's
degree or
higher
25(%6.5)
Less than
high school
diploma
Father
103(%26.5)
Diploma and
Advanced
Diploma
259(%67)
Bachelor's
degree or
higher
336(%87.8)
Yes
Successful
passed course
credits(previou
s semester)
16.
3.13±1.69
mean± SD
Number of
failed course
credits
17.

Iranian Journal of Health, Safety & Environment, Vol.3, No.2, pp.528-534
532
Table 4. Frequency distribution of Internet addiction based
on daily time spent on the internet among Medical Students
of basic sciences in Tehran University of Medical Sciences
Sum
Addicted
Without
Addiction
Internet
Addiction
Daily time
to use the
internet
(Hour)
Percent
Number
Percent
Number
Percent
Number
100
33
6.1
2
93.9
31
1
100
100
3
3
97
97
1-1.99
100
89
19.1
17
80.9
72
2-2.99
100
44
25
11
75
33
3-3.99
100
21
28.6
6
71.4
15
4-4.99
100
36
36.1
13
63.9
23
≥5
100
323
16.1
52
83.9
271
Total
P<0.001 , df=5 , =31.432
Chi-square test
The highest internet addiction rate was seen in
those who had their first contact with the
internet between 5 and 9 years of age (17.8%).
Chi-square showed no significant relationship
between age of the first contact with the internet
and Internet addiction. (P=0.786)
In this study, there was no significant elationship
between parental education and Internet
addiction (mother p=0.752 and father p=0357).
Internet addiction was the lowest in those whose
mothers and fathers were under diploma (10.5%
and 4.3% respectively) that was inconsistent
with findings of Ahmadi [9].
DISCUSSION
57 out of 417 participants of the study (15.2%)
were internet addicts. There was a significant
relationship between internet addiction and
duration of internet use (P≤0.001). However,
there was no significant relationship between
sex, age, age of the first Internet use, academic
achievement and parental education with
internet addiction.
From 417 participants of the study, 15.2%
(n=57) had internet addiction. This rate was
similar to the studies of Alavi, et al. [1],
Anderson[14], Dargahi [8], and Solhi et al. [15]
that may be due to the increasing use of the
internet in the youth and university students and
their similar characteristics. The results show
that 15.9% of females and 14.1% of males were
addicted to the Internet. Chi-square showed no
significant relationship between sex and internet
addiction (P=0.62), which is consistent with the
results of Bullen Pat et al. who mentioned equal
chances of Internet addiction between men and
women [1], but it is inconsistent with the results
of Anderson [14], Nademi et al. [5], Cengiz
[16], Kuss et al. [17] and Solhi et al. [15] who
found more prevalence of internet addiction in
men than women, in other words a significant
relationship between sex and Internet addiction.
Chi-square showed no significant relationship
between Internet addiction and measures of
academic achievement in one or two consecutive
semesters prior to the study and the last high
school year GPA,which was not consistent with
Young who reported an intensive decline in the
scores [4]. The findings of this study were not
consistent with Pirzadeh who reported 8.4%
educational decline in University of Payam
Noor, Isfahan due to the Internet use [18].
However, the findings of this study are
consistent with the results of Miltiadou who
believed that internet use will increase self-
confidence in students, and findings of Wheeler
et al. who believed that Internet usage will
reinforce creative thinking and improves social
interactions, and findings of Zare Zadeh and
Kadivar who believed that Internet users are
more creative and self-efficient than non-users
[3,0,11.12]. In this study, internet addiction rate
was 13.9% for the students who passed all their
course credits in a semester prior to the study.
Although there was no significant relationship
between passing the courses in the semester
prior to the study and Internet addiction
(P=0.066), chi-square test showed a significant
relationship between number of failed courses in
the semester prior to the study and internet
addiction (P=0.02). Therefore, internet addiction
rate among those who failed in less than 3
credits was 44.4%, and was 12.5% in those who
failed in 3 credits or more, which may be due to
ever-increasing use of the Internet among
university students. In addition, type of course
credit (theoretical or applied) may be the
determining factor. In this study there was a
significant relationship between Internet
addiction and time spent on the Internet
(P=0.001). In those who spent less than one hour
a day on the Internet, addiction rate was 6.1%
and in those who spent more than 5 hours a day
on the Internet the rate was 36.1%, which were
more than the rates reported by Solhi et al. who

Rita Motidost Komleh et al., Investigating the Relationship Between Internet Addiction…
533
mentioned that internet addiction (internet usage
more than 3 hours a day) was seen in 18% of
students in their study [15].
The results of this study showed that the
participants spent more time on the internet than
those participated in Young study, in which
Internet addicts spend 8 to 40 hours a week on
the internet [4]. All these findings indicate the
growing use of the Internet over the past few
years. In most studies, internet addiction was
more prevalent in the age group of 15-19 and
20-29 among high school and university
students [1, 8,16, 17]. In this study, There
majority of Internet addicts were 25 years and
above, and 21-22 years, respectively (16.7%
and 16.2%) which was consistent with Solhi et
al. who found most internet addicts in age
group of 19 to 25 years old [15]. In this study,
15.5% of singles were Internet addicts and 7.7%
of married students had internet addiction;
however, there was no significant relationship
between marital status and Internet addiction
which was similar to Dargahi Study [8]. In this
study, the highest level of internet addiction was
seen in those who had their first contact with
the internet between 5-9 years of age (17.8%);
however, there was no significant relationship
between the first age of internet use and internet
addiction (P=0.786), which was inconsistent
with the results of Ni et al. [19].
CONCLUSION
Since to the best of our knowledge this is the
first study conducted on the internet addiction of
medical students of basic sciences, although no
significant relationship was found between their
Internet addiction and academic achievement, it
is recommended that further studies be
conducted on this relationship with other aspects
of medical students' life and mental health in a
larger scale to detect probable risk factors. In
addition, due to the importance of the issue, it is
suggested that at the time of university entrance
all students complete internet addiction
questionnaire and it be filled out periodically or
in longitudinal studies so that internet addiction
be diagnosed as soon as possible and necessary
measures taken to improve undesirable mental
and physical consequences of internet addiction.
ETHICAL ISSUES
To perform the study, ethical permission of the
research committee of the university and informed
consent of the participants were secured.
CONFLICT OF INTEREST
Authors have no conflict of interest.
AUTHORS CONTRIBUTION
The paper is part of a Master’s thesis. Author 1 was
contributed as MSc
student, author 5 was thesis supervisor. Other authors
collaborated as the supervisory committee.
FUNDING /SUPPORTING
The study had no financial support.
ACKNOWLEDGMENT
The authors are grateful to Educational officials of
Tehran University of Medical Sciences (two
campuses at the time of the merger) and students who
participated in this study.
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