Scandinavian Journal of Public Health, 2007; 35: 95103

ORIGINAL ARTICLE

Orientations in adolescent use of information and communication technology: A digital divide by sociodemographic background, educational career, and health

LEENA K. KOIVUSILTA1, TOMI P. LINTONEN2 & ARJA H. RIMPELA3

IASM (Institutions and Social Mechanisms) Consortium and Department of Social Policy, FIN-20014 University of Turku, Finland, 2Tampere School of Public Health and University of Tampere Centre for Advanced Study, University of Tampere, Finland, and 3Tampere School of Public Health, University of Tampere, Finland
1

Abstract Aims: The role of information and communication technology (ICT) in adolescents lives was studied, with emphasis on whether there exists a digital divide based on sociodemographic background, educational career, and health. The assumption was that some groups of adolescents use ICT more so that their information utilization skills improve (computer use), while others use it primarily for entertainment (digital gaming, contacting friends by mobile phone). Methods: Data were collected by mailed survey from a nationally representative sample of 12- to 18-year-olds (n57,292; response 70%) in 2001 and analysed using ANOVA. Results: Computer use was most frequent among adolescents whose fathers had higher education or socioeconomic status, who came from nuclear families, and who continued studies after compulsory education. Digital gaming was associated with poor school achievement and attending vocational rather than upper secondary school. Mobile phone use was frequent among adolescents whose fathers had lower education or socioeconomic status, who came from non-nuclear families, and whose educational prospects were poor. Intensive use of each ICT form, especially of mobile phones, was associated with health problems. High social position, nuclear family, and a successful educational career signified good health in general, independently of the diverse usage of ICT. Conclusions: There exists a digital divide among adolescents: orientation to computer use is more common in educated well-off families while digital gaming and mobile phone use accumulate at the opposite end of the spectrum. Poorest health was reported by mobile phone users. High social background and success at school signify better health, independently of the ways of using ICT.

Key Words: Adolescence, digital divide, educational career, health, ICT, sociodemographic background

Introduction The interactive information and communication technologies (ICT; computers, the Internet, mobile phones, digital games) have changed the everyday life of adolescents worldwide. In Finland, all young people have access to a mobile phone, and most of them to a computer and the Internet [1]. Considering positive health effects, ICT may act as a mediator of health-related information and learning of health-related skills, and offer a potential to influence adolescents cognitive and social development [2]. By contrast, negative effects include increases in aggressive behaviour encouraged by

violent games [3], game or Internet addiction [4], and violation of interpersonal relationships [3] with related mental health problems [5]. Difficulties in time management may cause problems in schoolwork, daytime tiredness, and stress symptoms. Among the physical effects of ICT is an increased risk of musculoskeletal problems [6]. The health effects of ICT may be indirect and less immediate. Health risks diminish if health-compromising behaviours (e.g. smoking) are exchanged for less detrimental ones (e.g. mobile phone use) [7]. On the other hand, interactive media may displace health-enhancing practices, such as participation in

Correspondence: Leena K. Koivusilta, IASM, FIN-20014 University of Turku, Finland. Tel: +358-2-333 8896. E-mail: leena.koivusilta@utu.fi (Accepted 19 June 2006) ISSN 1403-4948 print/ISSN 1651-1905 online/07/010095-9 # 2007 Taylor & Francis DOI: 10.1080/14034940600868721

96

L. K. Koivusilta et al. 12-, 14-, 16-, and 18-year-old Finns, using a selfadministered structured mailed questionnaire (Adolescent Health and Lifestyle Survey), with two reminders to non-respondents. Sample size was 10,360 and number of respondents 7,292. Response rates varied between 53% and 72% in boys and between 76% and 82% in girls. The ethical committee of the Department of Public Health at the University of Helsinki accepted the study protocol. Variables Three ICT forms were measured by asking time spent daily on: (1) computer for e-mail, writing, surfing; (2) playing digital games; (3) mobile phone for phoning, text messages, games. The response alternatives were transformed into a time-base by assigning them the following values not at all50, occasionally50.1, less than an hour50.5, 13 hours52, 45 hours54.5, w5 hours56 (theoretical maximum). Social background: (1) fathers/guardians education: high (12 years or more), middle (approximately 9 11 years), low (approximately 9 years or less); (2) fathers/guardians socioeconomic status (SES) was encoded from an open-ended question of primary occupation according to Status Classification, Statistics Finland: high (entrepreneur, upper whitecollar employee), middle (lower white-collar employee), low (blue-collar employee or other); (3) family type: nuclear (living with both parents/foster parents), other. Social position variable was formed combining fathers/guardians educational level and SES (Cronbachs alpha50.64). Respondents with a high value for both or a high value for one and a middle value for the other were categorized into high social position (27%). Respondents with a low level for both were categorized into low social position (40%). All others were categorized into middle social position (33%). Educational career: (1) school achievement (12- to 14-year-olds); students subjective assessment of his/ her relative position in class based on preceding endof-term school report: good (combines much better/ slightly better than average), average, poor (combines slightly poorer/much poorer); (2) school status and type of school (16- to 18-year-olds; at 16 compulsory education is finished) had the categories: not in school, vocational school, upper secondary school. To study all ages combined, a variable educational career was formed describing hypothesized educational prospects in adulthood. Categories were good prospects (good school achievement/attending upper secondary school),

physical exercise, and, consequently, increase risk of weight gain [3,8]. There is evidence that intensive computer usage contributes to overweight in adolescents [9]. Being associated with health-compromising behaviours some forms of ICT constitute part of a health-endangering lifestyle, e.g. the intensity of mobile phone use increases along with an increase in tobacco and alcohol use [10]. While longitudinal studies on health consequences of ICT are non-existent, cross-sectional studies are useful for exploring connections between health and ICT usage. The health and lifestyle effects of ICT may contribute to health and welfare differences between population groups, particularly if ICT use divides adolescents into educational careers leading to different social positions. Although the number of adolescents with computer access is increasing, family capabilities for diverse ICT forms and usage to benefit child development differ. ICT-based entertainment is more common in lower-income and educational purposes in higher-income households [3]. Altogether, ICT contains the potential to either help adolescents live healthier in more secure societal positions, or to promote social exclusion and poor health. The unequal access to and use of the diverse forms of ICT supporting healthy intellectual, social and physical development has been claimed to lead to a digital divide [3]. This cross-sectional study looks for signs of a digital divide among 12- to 18-year-old Finns. Digital divide here means that some adolescents use ICT in ways offering multiple opportunities to utilize information and develop skills, while others use it mainly for entertainment such as gaming and contacting friends. The following questions are addressed: 1. 2. 3. 4. What is the relationship between adolescents social background and form of ICT? What is the relationship between adolescents educational career and form of ICT? What is the relationship between adolescents health and form of ICT? Does ICT mediate the relationship between social background/educational career and health?

Material and methods Participants Data were collected in 2001 from a nationally representative sample based on birth dates of

Orientations in adolescent use of ICT average (average school achievement/attending vocational school), and poor (poor school achievement/not in school). Health: (1) self-rated health: very good, quite good, average or poor (combines average/rather poor/very poor); (2) daily health complaints during the preceding six months; a sum-index of experiencing daily stomach aches, tension/nervousness, irritability/outbursts of anger, trouble falling asleep/waking at night, headache, trembling of hands, feeling tired/ weak, feeling dizzy: none, one, at least two; (3) depression: a positive answer to two questions asking whether during preceding month respondent had often felt (a) blue, depressed or hopeless, (b) nothing interests or brings pleasure [11]; (4) categories for daytime tiredness during the past month were: (2 days/week (combines categories: not at all, less than once a week, on 12 days/week), on 35 days/week, almost daily. A combined variable health was formed to study research question 4. Four item variables were recoded: self-rated health 0 (very good/quite good), 1 (average/poor); health complaints 0 (none), 1 (at least one); depression 0 (no), 1 (yes); daytime tiredness 0 (at most 12 times/week), 1 (at least 3 5 times/a week). The re-coded variables were summarized (Cronbachs alpha50.626) to give a combined health variable with the range 0 (good)4 (poor). Statistical methods The age (grouped into 1214, and 1618) and gender differences in ICT use were tested using chisquared tests. One-way ANOVA was used to study differences in (arithmetic) mean scores between the categories of social background, educational career, and health. This was done for each ICT form, separately. One-way ANOVA was performed to determine the mean scores differences of the combined health variable between categories indicating social position, educational career, and family type. ICT forms were then individually included in multi-way ANOVA containing the variables social position and educational career, and family type. For this purpose, the use of each ICT form was categorized as Occasional/no use, Less than one hour, At least one hour. All dependent variables (ICT variables and combined health variable) were square-root transformed into normal distributions. Levenes test was applied to test equality of error variance of the dependent variable across groups. Tukeys or Tamhanes (differing variances) test was used for

97

multiple comparisons. Only means differing at the 5% level are mentioned in the results. ANOVA was performed using the GLM procedure in SPSS 12.0 for Windows.

Results Computer use was somewhat more frequent among boys than girls, particularly the 16- to 18-year-olds (Table I), and so were digital games. Girls used mobile phones more than boys. The gender difference is much less marked in computer use than games or mobile phones. The statistical test of age differences by gender revealed that computer use was clearly more frequent among older boys than younger boys (pv0.001), the difference being less visible among girls (p50.012). Both younger boys (pv0.001) and younger girls (pv0.001) played digital games more than older boys and girls. Mobile phone use increased with age in both genders (pv0.001). Social background Children whose fathers/guardians education was high or middle level used computers more than children whose fathers/guardians had a low level of education (Table II). Children of high SES used computers more than other children. Those living with both parents used computers more than children not living with both parents. Children of academically educated fathers played games less than children whose fathers had middlelevel education (see Table II). No differences existed according to fathers/guardians SES or family type. Mobile phone use differed according to fathers/ guardians education, SES and family type (see Table II). In multiple comparisons, mobile phones were used less by children with high SES, highly educated fathers, and nuclear family homes compared with children from lower socioeconomic backgrounds, fathers with low education, and other family types, respectively. Educational career Computer use was not statistically significantly associated with school achievement (see Table II). Those who continued education used computers more than those not continuing education at age 16 or 18. Both school variables were significantly associated with game playing (see Table II). Adolescents with good or average school achievement played more

98

L. K. Koivusilta et al.

Table I. Daily use of various forms of ICT (%) among boys and girls aged 12, 14, 16, and 18 years. 12 and 14 years ICT form Computer for e-mail, writing and surfing Not at all Occasionally Less than one hour 13 hours 45 hours Over 5 hours Total% n Playing digital games Not at all Occasionally Less than one hour 13 hours 45 hours Over 5 hours Total% n Mobile phone Not at all Occasionally Less than one hour 13 hours 45 hours Over 5 hours Total% n Boys Girls 16 and 18 years Boys Girls Total

20 42 25 11 1 1 100 1,509

15 52 22 10 1 100 1,816 pv0.001 27 49 16 8 0 0 100 1,824 pv0.001 12 34 38 12 2 2 100 1,786 pv0.001

16 40 23 18 2 1 100 1,585

13 57 20 9 1 0 100 2,051 pv0.001 49 41 7 3 0 0 100 2,036 pv0.001 3 34 50 11 1 1 100 2,011 pv0.001

16 49 22 12 1 0 100 6961

4 18 21 47 7 3 100 1,512

12 36 18 29 3 2 100 1,576

25 37 15 20 2 1 100 6948

22 41 29 6 1 1 100 1,500

8 43 39 9 1 0 100 1,568

11 38 40 9 1 1 100 6965

than those with poor achievement. Adolescents attending upper secondary schools played less than the other two groups. Frequency of mobile phone use differed by both school variables: better achievement meant less frequent mobile phone use (see Table II). The 16to 18-year-olds attending upper secondary schools used mobile phones less than adolescents attending vocational schools or not attending school. Health No statistically significant differences in computer use existed between the self-rated health and daily health complaints categories (Table III). Depressed adolescents used computers more than the nondepressed. Adolescents experiencing daytime tiredness at maximum two days a week used computers less than those experiencing tiredness more often. In the whole material, playing digital games was more common in adolescents with very good health compared with those in good health, in adolescents

without daily health complaints compared with those having at least one health complaint, and among the non-depressed compared with the depressed (see Table III). The less often adolescents felt daytime tiredness, the more often they played digital games. Separate one-way ANOVA was accomplished for every health indicator in each age-gender category (1214/male, 1214/female, 1618/male, 1618/female). Separate analyses were performed, because none of the girls played for 45 hours/day (see Table I). Genders also differed in their perceptions of health [12]. Group differences in multiple comparisons existed only in perceived health, among younger and older boys, and among older girls. Among younger boys, those with very good (pv0.001) or good health (p50.022) played less than those with average/ poor health. Among older boys, and older girls, those with very good health played less than those with average/poor health (p50.034 and p50.004, respectively). No group differences existed

Orientations in adolescent use of ICT

99

Table II. Orientations in use of ICT among 12- to 18-year-old Finns: Daily use in minutes (square-root transformation) according to social background and educational career of adolescents, test of between-subjects effects in one-way ANOVA. Computer for email, writing, and surfing Social background Fathers education High Middle Low Fathers SES High Middle Low Family type Nuclear Other Educational career School achievement (at ages 12, 14) Good Average Poor School status and type of school (at ages 16, 18) Upper secondary Vocational Not in school NS5not significant. p Mean value v0.001 0.59 0.55 0.49 v0.001 0.57 0.51 0.47 v0.001 0.53 0.48 NS 0.50 0.48 0.49 v0.001 0.56 0.57 0.40

Playing digital games p Mean value 0.026 0.54 0.60 0.57 NS 0.56 0.59 0.59 NS 0.58 0.59

Mobile phone p Mean value v0.001 0.54 0.55 0.61 0 .002 0.56 0.61 0.60 v0.001 0.57 0.65

v0.001 0.67 0.71 0.82 v0.001 0.41 0.55 0.50

v0.001 0.50 0.60 0.70 v0.001 0.57 0.67 0.71

according to daily health complaints, depression or daytime tiredness. Mobile phone use was strongly associated with health (see Table III). The poorer the self-rated

health, the more frequent was the mobile phone use. The more daily health complaints and daytime tiredness adolescents had, the more frequently they used mobile phones. Depressed

Table III. Orientations in use of ICT among 12- to 18-year-old Finns: Daily use in minutes (square-root transformation) according to health status, test of between-subjects effects in one-way ANOVA. Computer for e-mail, writing, and surfing Health status Self-rated health Very good Quite good Average or poor Daily health complaints None One At least two Depression No Yes Daytime tiredness ( 2 days/week 35 days/week Every day NS5not significant. p Mean value NS 0.50 0.51 0.54 0.047 0.51 0.54 0.53 v0.001 0.51 0.56 v0.001 0.50 0.54 0.56

Playing digital games p Mean value v0.001 0.63 0.55 0.58 v0.001 0.60 0.52 0.51 v0.001 0.61 0.47 v0.001 0.61 0.53 0.47

Mobile phone p Mean value v0.001 0.54 0.60 0.66 v0.001 0.56 0.65 0.71 v0.001 0.57 0.70 v0.001 0.56 0.61 0.72

100

L. K. Koivusilta et al. All forms of ICT were significantly associated with health status. Regarding group differences, occasional or non-use of computer was related to better health than use of at least one hour daily. Adolescents playing games occasionally or never were in better health than those playing more. For mobile phones, the difference between the extreme values was especially large: health was better with lower use.

adolescents used mobile phones more than the non-depressed. ICT as mediator between health and social background and educational career There were no statistically significant interactions between social position, family type, and educational career variable combinations. The differences in the health variable between the categories of social position, family type, and educational career showed significance in one-way ANOVAs (Table IV). The multiple comparisons of group means showed that high social position, nuclear family, and good/ average educational career signified good health; low position, non-nuclear family, and poor educational career signified poor health. In a multi-way ANOVA, including all independent variables, differences between family type and educational career categories were significant but differences between the social position categories were of borderline significance. ICT forms were entered, one at a time, into multiway analyses of variance, including social position and educational career. No statistically significant interactions existed between ICT forms and other independent variables. Inclusion of computer use in the model diminished the statistical significance of social position to near the 5% significance level (Table V). Including the other ICT forms, social position became insignificant but the changes in the mean differences between categories were only slightly affected. Family type and educational career retained their high statistical significance.

Discussion A digital divide among adolescents was observed in this study. Adolescents with better health, higher socioeconomic background, and educational career with better social prospects in adulthood more often exploited ICT forms that improved their information utilization skills, whereas entertainment use of ICT accumulated at the opposite end of the spectrum.

Socioeconomic background Access to computers depends on socioeconomic factors [1]. Adolescents from high socioeconomic families used computers more than adolescents from lower socio-economic families. High socioeconomic families may not only have the economic resources for acquiring computers, but may also create a particular cultural environment for their use. The importance of family type may partly be explained by economic factors: two-parent families can afford better computer equipment.

Table IV. Differences in health (combined indicator, square-root transformation) according to social position, family type, and educational career among 12- to 18-year-old Finns, tests of between-subjects effects in one-way and multi-way ANOVA. Health (combined variable)a One-way ANOVA Social background/Educational career Social position High Middle Low Family type Nuclear Other Educational career Good Average Poor
a

Multi-way ANOVA Marginal mean p value 0.058 0.73 0.74 0.78

Mean

p value v0.001

0.76 0.80 0.87 v0.001 0.73 0.89 v0.001 0.64 0.68 0.86

v0.001 0.68 0.83 v0.001 0.69 0.70 0.86

Small values indicate good health.

Orientations in adolescent use of ICT

101

Table V. Differences in health (combined indicator, square-root transformation)a according to social background, educational career, and ICT type among 12- to 18-year-old Finns, tests of between-subjects effects in multi-way ANOVA.b Model5social background variables + computer use Social background Social position High Middle Low Family type Nuclear Other Educational career Good Average Poor ICT type Computer for e-mail, writing, and surfing Occasional or no use Less than one hour At least one hour Playing digital games Occasional or no use Less than one hour At least one hour Mobile phone Occasional or no use Less than one hour At least one hour
a

Model5social background variables + digital games p Mean value NS 0.68 0.70 0.73 v0.001 0.64 0.77 v0.001 0.63 0.66 0.81

Model5social background variables + mobile phone use p Mean value NS 0.77 0.79 0.82 v0 .001 0.73 0.86 v0.001 0.75 0.75 0.89

p Mean value 0.049 0.75 0.77 0.81 v0.001 0.73 0.85 v0.001 0.72 0.73 0.88

v0.001 0.74 0.70 0.89

v0.001 0.82 0.63 0.66

v0.001 0.68 0.76 0.94

Small values indicate good health. bSeparate models for each ICT type. The variable is not included in the model.

With easier access to computers in their workplaces, highly educated parents are more likely to socialize their children into the world of modern information technology. Education is often mentioned as among the most important reasons for purchasing a home computer [13] and connecting it to the Internet [14]. Knowledge of foreign languages together with motivation and information skills provides a convenient habitat for versatile computer use. Children from other backgrounds may face more obstacles because of lack of equipment and lower self-confidence in the computerized world. Digital gaming was less straightforwardly associated with socioeconomic background than computer use. Being a multifaceted phenomenon that incorporates various subtypes according to preferences and needs [15] possibly crossing over class boundaries, game playing may be supposed to level off class-based influences on adolescent lifestyles. This may apply especially to boys, for whom gaming is more important than for girls and an important form of social interaction [16].

Mobile phone use was more frequent in low socioeconomic families and non-nuclear families. In Finland where both parents labour market participation is high, mobile phones offer a means of keeping in contact with children. Parents also contribute to payment of bills. Such remote parenting is especially important for one-parent families [17]. Educational career Adolescents on their way towards higher educational levels in adulthood favoured computers. Computer availability has been associated with higher test scores in school, even after controlling for family income and social capital [18]. Larger educational gains are achieved by children of higher socioeconomic families than of lower socioeconomic families [13,18]. Self-confidence obtained by being a skilled computer user may also contribute to educational achievement and social status among peers [19]. Encouraging children to use computers

102

L. K. Koivusilta et al. ICT usage and socioeconomic health differences In this study, the effects of various ICT forms, social background, and educational career on health were mainly independent of each other. Taking account of every studied form of ICT usage weakened the connection between adolescent health and fathers social position. Instead, family type and adolescents educational career were associated with health independently of ICT usage. Family type and educational career, thus, seem to be more straightforwardly connected with adolescent health, while the connection of familys social position is mediated by ICT usage. This mediating role is more obvious for digital games and mobile phone usage than for computer usage. Adolescents appear to be drifting towards different trajectories of ICT usage in terms of gaining different health management tools. Thus, the diverse usage incorporates a potential of increasing socioeconomic health differences when todays children become adults. Interactive media have proved their usefulness in providing information on, for example, nutrition, exercise, and smoking [8], offering tools for helping children to cope with their chronic health conditions [26], helping young people personalize information, assess risks, and make health decisions in a hypothetical yet realistic situation [27], or in presenting social opportunities for those unable to attend school due to disabilities. The question of whether these opportunities are utilized in society to benefit the vulnerable groups as well needs to be addressed in the social and health policy agenda. Acknowledgements Financial support was obtained from the Health Promotion Research Programme of the Academy of Finland, the Ministry of Social Affairs and Health, the Juho Vainio Foundation, and the Lehto Foundation. The authors would like to thank Mr Lasse Pere for data management and Mrs Marja Vajaranta for revising the language. References
[1] Nordic Council of Ministers, Statistics Denmark, Statistics Finland, Statistics Iceland, Statistics Norway, Statistics Sweden. Nordic Information Society Statistics. Helsinki: Yliopistopaino; 2002 [cited 2005 March 30]. Available at: http://www.tilastokeskus.fi/tk/yr/tietoyhteiskunta/nordic_iss_ 02.pdf [2] Wartella EA, Lee JH, Caplovitz AG. Children interactive media. Research Compendium Update. Markle Foundation, 2002 [cited 2005 March 30]. Available at: http://www.markle.org/resources/reports_and_publications/research_archives/ imc_reports.php

for educational purposes would represent a form of transmission of upper and middle-class values, socalled cultural capital, which is a major factor in educational success [20]. Consequently, ICT, as a necessary resource in the modern information society, might become a factor contributing to educational inequality and divide between young people. Health Computer use may develop skills for later life yet appears to consume adolescents health resources. Reduced well-being with feelings of loneliness and depression as a consequence of spending much time on the Internet has been reported earlier [5], although with ambiguous results [3]. The mental load connected even with pleasant activities in ICT surroundings may add to physiological stress reactions [21]. Depression related to spending much time using computers may indicate problematic use of the Internet or Internet addiction [4,22]. Game players consisted mostly of the youngest respondents, and of boys, who generally tend to experience fewer health complaints than girls [12]. The pictures obtained from analysing all respondents together and from analysing agegender categories were different. When considering all respondents, game playing adolescents frequently seemed healthier than those playing less, yet in subcategories they perceived their health as worse. This discrepancy might be caused by a statistical flaw due to the small number of girls playing digital games. Furthermore, it is possible that for some youth groups game playing is beneficial to health. Fun and pleasure may offer an outlet for depression and a feeling of personal power [23]. The imaginary world, where the player is able to experience things otherwise impossible, may be especially appealing for adolescents not satisfied with their well-being [15]. Mobile phone use differed from the other forms of ICT use. Their greater use was typical of adolescents who appeared less fortunate in every aspect. Health problems among excessive mobile phone users were more typical of girls than boys. Previous studies suggest that frequent mobile phone use is strongly associated with addictive behaviours [10]. It may be hypothesized to form part of a street-oriented lifestyle [24]. Easy contact with friends spending a mobile leisure makes the mobile phone extremely important. Not being continuously reachable, living off-line could indicate shutting oneself off from social life [17]. Mobile phones seem to have a potential for becoming addictive [25].

Orientations in adolescent use of ICT

[3] Wartella E, OKeefe B, Scantlin R. Growing up with interactive media: What we know and what we dont know about the impact of new media on children. An executive summary of a report to the Markle Foundation. Markle Foundation, 2000 [cited 2005 March 30]. Available at: http://swandive.securesites.net/downloadable_ assets/cimcompendium_execsummary.pdf [4] Kaltiala-Heino RK, Lintonen T, Rimpela A. Internet addiction? Potentially problematic use of the Internet in a population of 1218-year-old adolescents. Addict Res Theory 2004;12:8996. [5] Kraut R, Patterson M, Lundmark V, Kiesler S, Mukopadhyay T, Scherlis W. Internet paradox: A social technology that reduces social involvement and psychological well-being? Am Psychol 1998;53:10171031. [6] Hakala PT, Rimpela A, Saarni L, Salminen JJ. Frequent computer-related activities increase the risk for neck shoulder and low back pain in adolescents. Submitted. [7] Charlton A, Bates C. Decline in teenage cigarette smoking with rise in mobile phone ownership: hypothesis. Br Med J 2000;321:1155. [8] Borzekowski DLG, Rickert VI. Adolescents, the Internet, and health issues of access and content. J Appl Dev Psychol 2001;22:4959. [9] Kautiainen S, Koivusilta L, Lintonen T, Virtanen S, Rimpela A. Use of information and communication technol ogy and prevalence of overweight and obesity among adolescents. Int J Obes, in press. [10] Koivusilta L, Lintonen T, Rimpela A. Intensity of mobile phone use and addictive behaviours: How is information and communication technology connected to health-related lifestyle in adolescence? J Adolesc 2005;28:3547. [11] Whooley MA, Avins AL, Miranda J, Browner WS. Casefinding instruments for depression: Two questions are as good as many. J Gen Intern Med 1997;12:43945. [12] Sweeting H, West P. Sex differences in health at ages 11, 13 and 15. Soc Sci Med 2003;56:319. [13] Giacquinta JB, Lane PA. Fifty-one families with computers: A study of childrens academic use of microcomputers at home. Educ Technol Res Dev 1990;38:2737. [14] Turow J. The Internet and the family: The view from the parents, the view from the press (Report No.27). Philadelphia, PA: Annenberg Public Policy Center of the University of Pennsylvania; 1997 [cited 2005 March 30]. Available at: http://www.appcpenn.org/ [15] Ermi L, Mayra F. Power and control of games: children as the actors of game cultures. In: Copier M, Raessens J,

103

[16]

[17]

[18] [19]

[20] [21]

[22]

[23]

[24]

[25] [26]

[27]

editors. Level up digital games Research Conference 2003 Proceedings;2003:23445. University of Utrecht [cited 2005 March 30]. Available at: http://www.uta.fi/hyper/gamelab/ Ermi_Mayra_Power_and_Control_of_Games.pdf Orleans M, Laney MC. Childrens computer use in the home: isolation or socialisation. Soc Sci Comp Rev 2000;18:5672. Coogan K, Kangas S. Nuoret ja kommunikaatioakrobatia, 1618-vuotiaiden nuorten kannykka- ja internetkulttuurit. (The young and the communications acrobatics, mobile phone and Internet cultures among 1618-year-olds). Nuorisotutkimusverkosto ja Elisa Communications. Elisa tutkimuskeskus. Raportti 158, 2001 [cited 2005 March 30]. Available at: http://www.alli.fi/nuorisotutkimus/julkaisut/ akrobatia.pdf Rocheleau B. Computer use by school-age children: trends, patterns, and predictors. J Educ Comp Res 1995;12:117. Hopkins M. The value of information technology for children with emotional and behavioural difficulties. Maladjustment and Therapeutic Education 1991;9:14351. Bourdieu P, Passeron JC. Reproduction in education, society and culture. London: Sage Publications; 1977. Lundberg U, Melin B, Evans GW, Holmberg L. Physiological deactivation after two contrasting tasks at a video display terminal: Learning vs. repetitive data entry. Ergonomics 1993;36:60111. Shapira NA, Goldsmith TD, Keck PE Jr, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic Internet use. J Affect Disord 2000;57:26772. Jones G. Killing Monsters: Why Children need fantasy, super heroes, and make-believe violence. New York: Basic Books; 2002. West P, Sweeting H. Lost souls and rebels: a challenge to the assumption that low self-esteem and unhealthy lifestyles are related. Health Educ 1997;97:1617. Dobson R. Text messaging is spoiling teenagers sleep. Br Med J 2003;327:582. Bearison D, Brown R. Case Studies of the STARBRIGHT Explorer Series. Los Angeles, CA: STARBRIGHT Foundation; 2000 [cited 2005 March 30]. Available at: http://www.starbright.org/projects/hes/research.html Lieberman DA. Interactive video games for health promotion: Effects of knowledge, self-efficacy, social support, and health. In: Street RL, Gold WR, Mannings T, editors. Health promotion and interactive technology: Theoretical applications and future directions. Mahwah, NJ: Lawrence Erlbaum; 1997. p 10320.