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The Internet is no longer merely an infrastructure; it has become an unlimited space for information exchange, social networking, and the development of cyber behaviours [1]. It is a network of networks that consists of private, public, academic, business and government networks of local to global scope that is linked by a broad array of electronic and optical networking technologies. By the advent of the internet, our earth has reduced and has attained the form of a global village [2]. It has brought people closer together by enabling various forms of interpersonal communication, notably e-mail, instant messaging, video conferencing, and social networking. In a very short period, it has become difficult for most of us to imagine a world without instant and continuous access to the internet [3].

According to a report published in 30^th June 2014, the world’s Internet user base was around 3 billion, in which approx. 1.4 billion users are from Asia. The higher IA, i.e., 45.7% is from Asian countries (Indians are the highest users in Asia). There has been an explosive growth of Internet usage worldwide and this is expected to continue with its use becoming an integral part of everyday life. The Internet provides tremendous educational benefits; however, excessive Internet use can lead to negative outcomes such as poor school performance and social isolation [4].

The concept of IA, which was first used by Goldberg in 1995, has recently turned out to be a phenomenon. This phenomenon is defined through various terms such as “net addiction”, “online addiction”, “IA disorder”, “pathologic internet use” and “cyber disorder” [5]. Young [6] linked excessive internet use most closely to pathological gambling, a disorder of impulse control in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and adapted the DSM-IV criteria to relate to internet use in the IA Test (IAT).

Healthy internet use is the use of the internet for an expressed purpose in a reasonable amount of time without cognitive or behavioral discomfort whereas problematic internet use or IA is a psychiatric condition that involves maladaptive thoughts and pathological behaviour. Now it is difficult to estimate how widespread this IA in adolescents is. The major symptoms of IA include 1) preoccupation with the internet, 2) withdrawal symptoms – restless or irritability including a feeling of anger, tension, depression when the computer is inaccessible, 3) repeated unsuccessful effort to control, cut back or stop internet and so on.

Although people in all segments of the society use the Internet, especially adolescents are the most frequent users and thus more vulnerable to IA [7]. The most part of this attraction is due to their development stage and they have less ability to control their enthusiasm for Internet activities. Adolescence is a period of the lifecycle when individuals are managing multiple and complex developmental tasks. These involve significant changes in biological, physical, social, psychological, emotional, and community-relatedness domains [8]. It is also the most volatile and unstructured and the most mouldable phase [9] in which they look for and experience different identities, social and emotional relationships, academic and working careers, and entertainment outlets [10]. In addition, the availability of internet on the mobiles and the computer/laptops makes them access the internet very easily, thus there is a chance of IA.

Now there is a flood of social networking sites. In the emerging era, adolescents have been exposed more than ever to the internet. Psychiatrists say they receive more than five to six cases of psychological problems caused by the overuse of internet almost every day. The problems include lack of attention or focus, difficulty in processing real-time information, anxiety, and mood swings. It leads to irregular sleeping habits, which can cause other health problems [11]. It may still remain a matter of debate whether IA has impacts on adolescence or not [9]? There are an urgent needs and emergencies to sensitise both students and parents about the negative effects of IA. Parents and guardians should pay proper attention about what their children are doing on the internet?

Young [6] conducted the IAT with 987 adolescents where it was found that those with excessive use internet had high scores on anxiety, depression, and anxiety depression. The result also revealed that there is no significant relationship between IA and the hours of use. Another similar studies [1,12-20] revealed that IA is growing problems. The highest ranked online activities were watching videos, frequent chat rooms, social networking, playing games etc. The internet dependents delayed their regular work to spend their time online, lost sleep due to late-night logins and felt life would be boring without the internet.

Some of the studies [4,21-24] investigated the level of IA and factors associated with IA. Some studies [9,10,25-34] assessed the impacts of IA on daily lives. The relations of IA to socio-educational characteristics, demographic characteristics, and internet usage patterns and adolescents behaviour were evaluated.

This study feels the need to assess IA and its impact on academic performances, family and social life on adolescence. The Modified form of IAT developed by Young [6] has been used to assess the level of IA. We have also developed the structured questionnaire to assess the impact of IA on adolescents.

• To assess the level of IA among adolescents studying in selected high schools.

• To assess the impact of IA among adolescents studying in selected high schools.

• To find out the correlation between the level of IA and its impact on adolescents studying in selected high schools.

• To find out the association between levels of IA among adolescents studying in selected high schools and their selected demographic variables.

• To find out the association between the impact of IA among adolescents studying in selected high schools and their selected demographic variables.

The conceptual framework of the study has been developed based on Roy’s Adaptation Model (Figure 1). The tool consisted of a baseline (demographic) proforma, a modified form of IAT and a structured questionnaire developed during this study, was used to assess the level of IA and its impact among high school adolescents. The tool was submitted to 14 experts (2 Psychologist, 2 psychiatric nursing, 9 Paediatric Nursing and 1 medical officer of primary health centre). They suggested some revisions and finally, the tool was reframed (see the supplement section for the final tool).

Figure 1: Modified conceptual framework based on Roy’s Adaptation Model.

The pilot study was conducted at St. Ann’s High School, Derebail in a north block and Sacred Heart High School, Mangalore in a south block from 20/01/2016 to 23/01/2016. The data were collected from 10 students from the north block and 10 students from the south block high schools. The above-mentioned tool was applied. We found the tool to be valid, reliable and feasible. Hence, we decided to conduct further research. We randomly selected two English medium high schools, one from the south block, St. Lawrence High School and one from the north block, St. Joseph High School. From the selected High Schools any one section from each 8^th, 9^th and 10^th standard were selected randomly and students from each were selected by proportionate random sampling (see Figure 2 for detailed information of sampling process). 200 adolescents were selected by multistage random sampling technique. The data collection period was from 01/02/2016 to 26/02/2016.

Figure 2: Schematic representation of multi stage random sampling.

The data were analysed using descriptive and inferential statistics. Karl Pearson’s correlation coefficient test was used to find out the correlation between the level of IA and its impact on adolescents. Chisquare test was used to find the association between the IA with their demographic variables. The hypotheses were tested at 0.05 level of significance:

H₀₁: No significant correlation between the level of IA and its impact.

H₁: Significant correlation between the level of IA and its impact.

H₀₂: No significant association between level of IA and their selected demographic variables.

H₂: Significant association between level of IA and their selected demographic variables.

H₀₃: No significant association between impacts of IA and their selected demographic variables.

H₃: Significant association between impacts of IA and their selected demographic variables.

The level of IA and impacts of IA are shown in Figure 3. The study revealed that 70.5% were normal users, 23% had a mild IA, 6% had a moderate addiction, and 0.5% had a severe addiction. The study also revealed that 73% had a mild impact, 16.5% had a moderate impact, 10.5% had no impact while none had a significant impact due to IA.

Figure 3: The level of IA (left) and impacts due to IA (right).

The scatter diagram of the level of IA and its impact is shown in Figure 4. There is a positive correlation between the level of IA and its impact among high school student with r=0.678 and P=0.000. The null hypothesis (H₀₁) was rejected and the research hypothesis (H₁) was accepted at 0.05 level of significance. This revealed that the level of IA was correlated with impact due to IA.

Figure 4: Relationship between the level of IA and its impact.

The association between the level of IA and their selected demographic variables are shown in Table 1.

Table 1: Chi-square values showing the association between the level of IA among high school students and their selected demographic variables.

The study revealed that there was a significant association between IA among adolescents studying in selected high schools with some of their selected demographic variables, viz., age, class, number of siblings and occupation of father of high school students and the null hypothesis (H₀₂) was rejected. Whereas no significant association was found with rest of variables, viz., gender, religion, types of family, presently residing, place of residency, education of father, education of mother, occupation of mother and mode of internet access. And the null hypothesis (H₀₂) was accepted.

The association between the impact due to IA and their selected demographic variables are shown in Table 2.

Table 2: Chi-square values showing the association between the impact due to IA among high school students and their selected demographic variables.

The study showed that there was a significant association between impact due to IA with some of their selected demographic variables, viz., gender, age, class, presently residing, and occupation of father of the high schools students and the null hypothesis (H₀₃) was rejected. Whereas no significant association was found in remaining demographic variables ,viz., religion, types of family, number of siblings, place of residency, education of father, education of mother, occupation of mother and mode of internet access and the null hypothesis (H₀₃) was accepted.

This study presents the descriptive assessment of the level of IA among adolescents. A case study of English medium high schools in Mangalore was conducted. The tool consisted of a baseline proforma, a modified form of IAT and a structured questionnaire developed during this study. The study revealed that 70.5% were normal users, 23% had a mild addiction, 6% had a moderate addiction, and 0.5% had a severe addiction. The study also revealed that 73% have “Mild impact”, 16.5% have “Moderate impact”, 10.5% have “No impact” and none of them has “significant impact” due to IA. The study showed that there is a significant correlation between IA and its impact among adolescent.

We found that there was a significant association between IA among adolescents with some of their demographic variables, viz., age, class, number of siblings and occupation of father. Whereas no significant association was found with other demographic variables, viz., gender, religion, types of family, presently residing, place of residency, education of father, education of mother, occupation of mother and mode of internet access.

Similarly, we also found that there was a significant association between the impact of IA with some of their demographic variables, viz., gender, age, class, presently residing, and occupation of father. Whereas no significant association was found in other demographic variables, viz., religion, types of family, number of siblings, place of residency, education of father, education of mother, occupation of mother and mode of internet access.

The findings of the study have implications in the field of nursing education, nursing practice, nursing administration and nursing research. Nurses get the unique opportunity to shape and develop healthy cognitions and positive self-regard among the adolescents. Immediate actions are to be taken to have a long-lasting impact on adolescents. This study recommends the need for the professional to function more effectively among the adolescents in order to mould them into productive, fruitful citizens for the country. This study serves as a valuable reference material and pathway for future investigation. The findings of the study would help to expand the scientific body of professional knowledge upon which further researchers can be conducted.

We would like to thank Mr. Rabi Shankar Talchabhadel for his constructive inputs for improving the manuscript.