The Journal of School Nursing2023, Vol. 39(3) 206–218© The Author(s) 2020Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/1059840520946378journals.sagepub.com/home/jsn
The aim of this study was to identify the prevalence of media addiction and its associated factors in elementary school children based on the problem behavior theory. This cross-sectional study was a secondary data analysis using national data from the 10th Panel Study on Korean Children 2017, which included 1,078 families of third-grade students (8–9 years of age). Descriptive statistics were used to examine the prevalence of media addiction, and logistic regression analysis was conducted to identify factors associated with media addiction. Prevalence of media addiction was 22.91% in this sample. Media addiction was significantly associated with general characteristics (gender, education level of mother, and time spent without parents), socialization (media use time), factors in the personal system (happiness), and factors in the perceived-environment system (parenting style). More comprehensive, tailored education may prevent elementary school children’s media addiction. In addition, parents should participate in media addiction education with their children.
Keywords
media addiction, panel study on Korean children, problem behavior theory, elementary school children, school nursing
Media addiction—the excessive use of digital media through smartphone or personal computer (PC)—is a condition that, owing to withdrawal and tolerance, causes difficulty in performing daily activities (Khang et al., 2013; Park & Noh, 2019); it has been recognized as a health problem for children since 2013. Media use has become a major part of daily life, and people have become increasingly dependent on its convenience (Kwon, Lee, et al., 2013; Lee & Ogbolu, 2018; Park et al., 2013). However, the excessive use of media causes adverse effects on users who gradually become addicted to it (Arefin et al., 2018). Media addiction is no longer just a problem for adults, as children can easily access media as well and they use it as a toy (Park & Park, 2014). A study of Asian countries with relatively high prevalence of media addiction (Korea, China, Japan, Hong Kong, Malaysia, and the Philippines) reported that most Asian countries have a higher societal penetration rate of media devices in children (41%–84%; Mak et al., 2014) compared to the United States (46%; Ma, 2018). In particular, the user penetration rate for Korean children was 84%, the highest among Asian countries (Mak et al., 2014). Further, the prevalence of media addiction in children varies among countries, with Asia showing a higher rate (around 5%–21%) than Europe (10%; Cha & Seo, 2018; Chang et al., 2019; Lopez-Fernandez et al., 2014; Mak et al., 2014). Korea has the highest prevalence of media addiction in children at 31% (Cha & Seo, 2018). This might be due to Korea being known as a powerhouse of information technology (IT; Lee & Joshi, 2015), and consequently, many Korean children are more likely to be exposed to media devices from a very early age. In fact, 72.8% of Korean children aged 3–5 use media devices (Korea Internet & Security Agency, 2012). The high rate of media device penetration and the prevalence of media addiction among Korean children indicate that urgent intervention is needed.
School-aged children born in the late 2000s are called “digital natives” (Prensky, 2001). Digital natives are naturally exposed to a variety of media from early childhood, become familiar with such devices, and can easily interact with them (Cho et al., 2016; Zevenbergen, 2007). Exposure to media at an early age is more likely to result in media addiction in children and can cause behavioral difficulties (Divan et al., 2012; Park & Park, 2014). Media addiction leads to a range of physical, psychological, and social problems in children. Physical problems include visual impairments, lack of brain development, musculoskeletal problems, and obesity (Haug et al., 2015; Park & Park, 2014; Yang et al., 2017). Psychological problems include stress, anxiety, depression, suicidal ideation, and attention deficit hyperactivity disorder (Haug et al., 2015; Kim et al., 2019; Park et al., 2013). Social problems include negative interpersonal relationship formation, delayed social development, and poor school adjustment (Celikkalp et al., 2020; Heo & Lee, 2018).
The risk of addiction is of particular concern for schoolaged children because health habits formed in the school years affect health conditions in adulthood (Kwon et al., 2015); therefore, it is important to develop healthy media habits at a young age. Furthermore, elementary school children are very vulnerable to media addiction, considering that they have access to media devices at a young age and are less likely to be organized and restrained than adults and adolescents (Eisenberg et al., 2014; Vazsonyi & Huang, 2010). Therefore, elementary school is a critical time to form healthy lifestyles (Kwon et al., 2015) and the most effective period to prevent media addiction in adolescence and adulthood (Kim et al., 2014). Most previous studies, however, tended to address media addiction in adolescents and adults (Arefin et al., 2018; Haug et al., 2015; Lopez-Fernandez et al., 2014; Mak et al., 2014; Xin et al., 2018); only a few studies have been conducted with younger children (Hulya & Orsal, 2018; Lee & Ogbolu, 2018; Lee & Cho, 2015). Those studies were conducted in limited arenas with convenience and/or small samples with limited generalizability (Hulya & Orsal, 2018; Lee & Ogbolu, 2018; Lee & Cho, 2015). Therefore, it is necessary to identify the current status of media addiction and its related factors more broadly in order to develop health promotion strategies for all school-aged children. This study aimed to identify the prevalence of media addiction and associated factors in elementary school children by using nationwide survey data from the 10th Panel Study on Korean Children (PSKC).
Problem behavior theory (PBT; Jessor & Jessor, 1977) serves as the framework for this study. PBT is a psychosocial theory that describes the process of human behavior as affected by demographic social structure, socialization, the personal system, and the perceived-environment system (Jessor & Jessor, 1977). Previous studies have used the model to explain and predict behavioral problems of the youth (Jessor, 1991; Mobley & Chun, 2013). In this respect, the theory can be applied and extended to identify associated factors of media addiction in children and adolescents (Lee & Ogbolu, 2018; Lee & Kim, 2018). We hypothesized that demographic social structure (type of family and monthly income of family), socialization (smartphone ownership and media use time), the personal system (self-esteem and happiness), and the perceived-environment system (peer attachment and parenting style) would all affect the behavior system (media addiction; see Figure 1).
This was a cross-sectional and correlational study with secondary data analysis using the 10th PSKC (Korea Institute of Child Care and Education [KICCE], 2018a).
The primary data were obtained from the 10th PSKC conducted by the KICCE (2018b), a national policy research agency, in 2017. The aim of this survey was to establish a nationwide database of Korean children’s development and related factors such as family and community environments (KICCE, 2016). The PSKC has collected data annually since 2008 using stratified multistage sampling to reduce sampling bias (KICCE, 2016). The primary sampling unit was nationwide hospitals with more than 500 births per year (KICCE, 2016). The secondary sampling unit was households with children born between April and July 2008. The PSKC collected data from 2,150 families at baseline (KICCE, 2016). The 10th PSKC was conducted with a total of 1,484 families from July 3 to December 31, 2017; maintenance rate was 69% compared to the baseline, and the children were in third grade (aged 8–9 years) at elementary schools (KICCE, 2018b). The investigators trained by the KICCE visited the sampled families and conducted surveys via questionnaires and interviews with the mother, father, and children (KICCE, 2018b). A web-based questionnaire was sent to the children’s teachers for completion (KICCE, 2018b). The 10th PSKC collected comprehensive data on the characteristics of family, parents, children, family resources, local community, childcare services, and childcare policies (KICCE, 2018b).
Media addiction is likely to be perceived as socially negative; therefore, it can be difficult to involve participants in research on this topic. Thus, it was fortuitous that we could conduct secondary data analysis using nationally representative data from the PSKC to examine media addiction in children.
The secondary data analysis included 1,484 families at first. Eligible families (children and both their mother and father) were those who participated in the 10th PSKC, and both children and parents responded to the panel study. To clarify the factors related to media addiction in elementary school children, we excluded families who (1) did not report important general characteristics (type of family, monthly income of family, smartphone ownership, and media use time) or (2) did not report major variables (media addiction, self-esteem, happiness, peer attachment, and parenting style); data with even one of the variables missing were excluded; 406 families’ data were excluded, and a total of 1,078 families were included in the final data (see Figure 2).
We collected basic data on characteristics of children, parents, and family. Children’s characteristics included gender, siblings, ownership of smartphone, and usage time; characteristics of parents were age, employment status, and education level; and characteristics of family included type of family, family income, time without parents (how many hours during the day children spent time alone or with siblings but without parents or adult caregivers). Children reported on self-esteem, happiness, and peer attachment, and their mothers reported on media addiction and general family characteristics. Both mothers and fathers reported on parenting style.
Media addiction. Media addiction was measured using the Korean Scale for Internet Addiction (K-Scale), which was developed by the National Information Society Agency (NIA, 2011) and revised by the KICCE; the word “internet” was modified to “PC/smartphone” (KICCE, 2017a). The “use of PC and smartphone” in this scale means all activities using a media device, such as games, social network service (SNS), watching videos, and using the internet (KICCE, 2017a). The KICCE’s (2017a) K-Scale consists of 15 items across four domains: disturbance of adaptive functions (five items), withdrawal (four items), tolerance (four items), and virtual world orientation (two items). Media addiction items are rated on a 4-point Likert-type scale, ranging from 1 (not very) to 4 (very), and total scores range from 15 to 60. A higher score indicates a higher level or excessive use of media by children from the mother’s perspective. Based on the standard scores of media addiction, individuals can be classified into a general user group, potential-risk user group, and high-risk user group (NIA, 2011). Individuals who score 30 or more or obtain high scores in all categories (exceeding 14 in disturbance of adaptive functions, 12 in withdrawal, and 11 in tolerance) were included in the high-risk user group. Individuals scoring 28–29 in total or high scores in at least one category (exceeding 13 in disturbance of adaptive functions, 11 in withdrawal, or 10 in tolerance) were included in the potential-risk user group (NIA, 2011). Cronbach’s a of the scale in this study was .84.
Self-esteem. Children’s self-esteem was measured using five items rated on a 4-point Likert-type scale with 1 (strongly disagree) to 4 (strongly agree); total scores range from 5 to 20. This scale was developed by Rosenberg (1965), revised by the Center for Longitudinal Studies (CLS, 2012), and translated into Korean by the KICCE (2015b). Higher scores indicate higher levels of self-esteem. For the present study, Cronbach’s α was .75.
Happiness. To measure children’s happiness, the CLS’s (2012) Happiness Scale was used. This scale, developed by the CLS and translated into Korean by the KICCE (2015a), consists of six items rated on a 4-point Likert-type scale with a total score ranging from 6 to 24. Higher scores denote higher levels of happiness in general life. Cronbach’s a was .74 in this study.
Peer attachment. Children’s peer attachment was assessed using nine items rated on a 4-point Likert-type scale. This scale, developed by Armsden and Greenberg (1987) and revised by the National Youth Policy Institute (NYPI, 2012), includes three domains: communication (three items), trust (three items), and alienation (three items). The total score ranged from 9 to 36; higher scores denote higher peer attachment. In this study, Cronbach’s α was .69.
Parenting style. Parenting style was measured using the Parenting Styles and Dimensions Questionnaire (PSDQ), originally developed by Robinson et al. (1995) and translated into Korean by the KICCE (2017b). The PSDQ consists of 62 items with three domains measured on a 5-point Likert-type scale: authoritative (27 items; total score ranging from 27 to 135), authoritarian (20 items; total score ranging from 20 to 100), and permissive (15 items; total score ranging from 15 to 75). Score results provide a measure of each parenting style with no specific classification of a predominant parenting style. Cronbach’s α in this study was .63–.91 for mothers and 0.62–0.92 for fathers.
According to the user guidelines, PSKC is a complex sample design that requires the application of weights to reflect the sample design for data analysis (KICCE, 2016). The KICCE provided a weighted value so that the surveyed sample represented general Koreans (KICCE, 2016). First, descriptive statistics were performed to examine general characteristics, including the prevalence of media addiction, using means, standard deviations (SDs), and weighted percentages. Second, a χ2 test and independent t test were conducted to identify the differences in media addiction according to general characteristics and main variables (self-esteem, happiness, peer attachment, and parenting style) between the no-risk and risk groups, with the risk group including those in the potential- and high-risk categories. Third, a logistic regression analysis was performed to identify the factors associated with media addiction. It is not generally clear how to apply weights to complicated estimates such as a logistic regression, and a weighted estimate makes it more difficult to evaluate standard errors (Gelman, 2007); thus, we chose not to apply weighted values in the logistic regression analysis. All statistical analyses were performed using SPSS Version 25.0 with the significance level set at .05, two-tailed.
The 10th PSKC was officially approved by the institutional review board (IRB) of KICCE (Approval No. 220996-17a620-HR-004). The 10th PSKC was designed to protect privacy for participants through anonymity and voluntary participation. To conduct the secondary data analysis study, exemption from ethical review was obtained from the IRB of Yonsei University Health System (IRB approval number: Y- 2019-0121). As this was a secondary analysis, no informed consent was needed from the participants.
Among all participants, 17.71% were classified as high-risk users, and 5.20% were potential-risk users. Based on previous studies of media addiction in children (Lee & Lee, 2017; Lee & Ogbolu, 2018), we categorized groups as the no-risk group and the risk group (combining potential- and high-risk categories). In total, 22.91% of children were risky users of media addiction (Table 1).
All general characteristics of children, mother, father, and family showed significant statistical differences between the risk and no-risk groups (all p values < .001). The proportion of girls (51.07%) was higher in the no-risk group, while that of boys (61.52%) was higher in the risk group (χ2 = 3810.90, p < .001). The majority of children in both the risk (86.94%) and no-risk groups (90.64%) had siblings (χ2 = 896.32, p < .001). Among mothers, 49.68% were 40 years or older in the risk group and 51.24% in the no-risk group (χ2 = 57.92, p < .001). In contrast, a higher proportion of fathers aged 40 years or older were reported in the risk group (77.48%) compared to the no-risk group (75.96%; χ2 = 77.07, p < .001). The proportion of employed mothers in the risk group (55.28%) was higher than that in the no-risk group (50.61%; χ2 = 523.98, p < .001). Over one fifth of mothers in the no-risk (22.70%) and 35.55% of mothers in the risk groups were high school graduates or below (χ2 = 7492.14, p < .001). The proportion of fathers who were high school graduates or below was higher in the risk group (31.18%) than in the no-risk group (25.40%; χ2 = 3658.05, p < .001). Regarding the family variable, the majority of children in both groups (no-risk group; 89.52%, risk group; 81.03%) spent less than 2 hr a day without their parents (χ2 = 4004.36, p < .001; Table 2).
Table 3 presents the differences in media addiction according to the main PBT variables between the no-risk and the risk group. All the differences in the main variables were statistically significant (all p values <.001). In the demographicsocial system, the no-risk and risk group rates for smartphone ownership were 68.75% and 73.20%, respectively (χ2 = 565.48, p < .001). Larger differences were identified in media use time; most of the no-risk group (80.15%) used media for less than 2 hr a day, but 45.53% of the risk group used media for more than 2 hr a day (χ2 = 20735.78, p < .001). In the personality system, the no-risk group had higher levels of self-esteem (t = 48.32, p < .001) and happiness (t = 75.35, p < .001) compared with the risk group. In the perceived-environment system, levels of peer attachment in the norisk group were higher than in the risk group (t = 47.32, p < .001). Authoritative parenting style was higher in the no-risk group (mothers: t = 145.23, p < .001; fathers: t = 87.06, p < .001). Authoritarian (mothers: t = –155.75, p < .001; fathers: t = –91.31, p < .001) and permissive (mothers: t = –214.04, p < .001; fathers: t = –91.54, p < .001) parenting styles were higher in the risk group.
The logistic regression model revealed factors associated with media addiction in third-grade children (Table 4). The Cox and Snell R2 and Nagelkerke R2 values, which indicate the goodness of fit of the model (Walker & Smith, 2016), were .206 and .309, respectively. Significant general characteristic factors associated with media addiction in the children were gender, mother’s education level, and the time spent without parents during the day. The adjusted odds ratio (aOR) for media addiction was significantly lower in girls than boys (aOR = 0.572; 95% CI [0.407, 0.804]). Children whose mothers graduated from university were at significantly lower risk of being addicted to media than children with mothers who had a high school education or less (aOR = 0.529; 95% CI [0.321, 0.873]). In the case of children who spent time without parents for 2–4 hr per day, the aOR for media addiction was significantly higher than for children who were alone for less than 2 hr (aOR = 1.729; 95% CI [1.073, 2.787]).
Media use time, happiness, and family’s parenting style were significantly associated with risky use of media. In the PBT demographic-social system, none of the factors were statistically significant. In terms of personality, as children’s happiness scores increased, the aOR for media addiction was significantly lower (aOR = 0.922; 95% CI [0.851, 0.999]). In terms of the perceived-environment system, as mother’s authoritarian (aOR = 1.044; 95% CI [1.020, 1.067]) and permissive (aOR = 1.139; 95% CI [1.089, 1.191]) parenting style scores increased, the aOR for media addiction of children increased as well. On the other hand, as father’s authoritative parenting style scores increased, the aOR for risky use of media decreased (aOR = 0.981; 95% CI [0.965, 0.997]).
This study used Korean national survey data and research variables adopted from the PBT to provide important information about the prevalence of media addiction and its associated factors in elementary school children. Consistent with the PBT that framed this study, socialization (media use time), the personal system (happiness), and the perceivedenvironment system (parenting style) were associated with the behavior system (media addiction). Socialization (media use time) was the strongest associated factor for children’s media addiction. In contrast, the demographic-social structure (type of family and monthly income of family) was not a significant factor in this study. This result may reflect that most modern family types are nuclear, and with the change from extended to nuclear family type, the impact of family structure on the behavior system (media addiction) may be weaker than in the past. Further, the average monthly income of this sample was about 5.3 million KRW (about US$4,290), which is high compared to all Korean households (which average about 4.7 million KRW, or US$3,800; Korean Statistical Information Service, 2020). The fact that we did not have access to a range of family income may be a limitation in identifying its significance as an associated factor of media addiction. However, because a previous study (Brown et al., 2011) reported that family income was associated with children’s media addiction, it is necessary to clarify the role of family income in future studies.
In our study, the prevalence of high-risk users and potential-risk users among all the participants was 17.71% and 5.20%, respectively; that is, 22.91% of children were classified as at-risk users of media. Considering that 6.7% of Korea’s school-aged children were addicted to media in 2014 (Lee, 2014), children’s media addiction seems to have increased rapidly in recent years. Even though owing to differences in definition and measurement of media addiction among countries, it is not easy to make direct comparisons, the current prevalence (22.91%) in Korea is very high compared to that reported in other Asian countries (13%–15.2%), 10% in Britain, and 16% in Europe overall (Chang et al., 2019; Gallimberti et al., 2016; Lopez-Fernandez et al., 2014; Takahashi et al., 2018). The national IT infrastructure could be affecting the seriousness of media addiction among Korean children (Lee & Lee, 2017); Koreans have media devices with high-speed internet connections, and there are many public places where Wi-Fi services are free of charge (Lee & Lee, 2017). With media devices, children can access the internet at any time, in any place, and they can download and use any application. In this environment, media could be even more highly addictive for children at this mental and physical developmental stage (Park & Park, 2014).
We also found that 17.71% of children were in the highrisk media user group. Compared to the prevalence of high risk in adolescents (5%) and adults (6%; Jo et al., 2018) in a previous Korean study, the rate of children at risk of media addiction is extremely high. The Korean government has focused on the severity of media addiction in adolescents and tried to tackle this problem (Cha & Seo, 2018). Considering our data, more age-specific education programs should be implemented for developmentally susceptible children to prevent media addiction (Zheng et al., 2019). Currently, health education in Korea’s elementary, middle, and high schools only includes sex education, drug abuse prevention, mental health, and first aid; no regular education on media use has been provided to date (Song & Kang, 2016). Health education could be broadened so that a media addiction prevention program led by school nurses is incorporated into the elementary schools’ regular curriculum.
Significant factors associated with media addiction in third graders were gender, mother’s education level, time spent without parents, media use time, happiness, and parenting style. In this study, a higher proportion of media addiction was found among boys than girls. This result is consistent with the finding of previous studies of school-aged children (Chen et al., 2015; Li et al., 2014). However, in a recent study of adolescents, there was a higher proportion of females addicted to media (Kim et al., 2019). The different results found between the study of children and adolescents may be due to age-related activities and patterns of media use (Lee & Kim, 2018; Takahashi et al., 2018). Teenage girls are likely to spend more time on media messaging, surfing websites, and SNSs than teenage boys (Roberts et al., 2014). Younger school-aged children are more likely to use game software than other age groups ( Kim, 2018), and boys spend more time playing games than do girls (Ustinavičienė et al., 2016). In other words, elementary school boys and teenage girls showed high prevalence of media addiction (Takahashi et al., 2018). Therefore, when planning an education program to prevent media addiction for school-aged children, genderand age-specific patterns of media use should be considered.
This study found that higher education levels among mothers were negatively associated with media addiction in children: If mothers were university graduates, their children were less likely to be addicted to media compared to mothers with a high school education or less. A previous study also suggests that the mother’s education level was associated with decreased media addiction in children (Toker & Baturay, 2016). Furthermore, higher educated mothers spend more time with their children (Guryan et al., 2008), which gives them more opportunities to control their children’s media use appropriately. However, Hulya and Orsal (2018) found that children’s media addiction was not related to their mothers’ education levels. To resolve these contradictory findings, more research regarding the relationship between media addiction and mother’s education is needed. Although fathers’ education levels were not significant in the present research, future studies should also consider fathers’ characteristics and how they relate to media use in children.
Time spent without parents was also a factor associated with media addiction in children. As children spent more time without parents, they were more likely to be addicted to media. About 70% of children use media without the supervision of parents, and insufficient monitoring can lead to children’s problematic media use (Wang et al., 2011). Thus, parents should supervise their children’s media use and establish rules for media use at home to guide their children.
Consistent with previous studies (Lee & Kim, 2018; Li et al., 2014), we found that media use time was a statistically significant contributor to media addiction in elementary school children. Children who used media for more than 2 hr a day were more likely to be addicted to it. The American Academy of Pediatrics recommended limiting children’s total media use to 2 hr or less per day (Gentile et al., 2004). Therefore, parents should follow this guideline when establishing a screen time rule for their children.
Children’s happiness was a factor associated with media addiction; the happier the children were, the less likely they were to display risky use of media. This result is consistent with the finding of previous studies (Akın, 2012; Hull et al., 2013) that happiness is a negative predictor of media addiction. Positive psychology principles such as happiness are associated with less media addiction; thus, if children are happy, excessive use of media is less likely to occur (Hull et al., 2013). When media use meets children’s important needs for “entertainment and leisure,” “emotional coping: releasing stress,” and “excitement and challenge seeking” (Wan & Chiou, 2006), media addiction may occur because children spend most of their time on media rather than on other activities (Toker & Baturay, 2016). Thus, to prevent media addiction, parents and teachers should try to find leisure activities that can replace media and increase children’s happiness.
Parenting style was an important factor in risk of media addiction among third-grade children: Mothers’ authoritarian or permissive parenting styles contributed to decreased media addiction in children, while fathers’ authoritative parenting style was negatively related to children’s media addiction. This finding is consistent with previous studies that authoritative parents respect children’s autonomy, provide consistency, and establish clear rules (Abedini et al., 2012; Park & Park, 2014; Valcke et al., 2010). Authoritative parents do not limit every behavior but expect their children to be responsible and live in a self-regulated way; for that reason, their children can develop the ability to control themselves and use media properly (Valcke et al., 2010). Authoritarian parenting is a rigorous way of raising children to follow rules without explanation (Park & Park, 2014). Permissive parenting is inconsistent; parents give in to what their children ask and follow their ideas and will (Park & Park, 2014; Valcke et al., 2010). Authoritarian and permissive parents can affect children’s media addiction by evoking negative emotions such as anxiety and depression (Wei & Kendall, 2014). Thus, when parents establish rules for children’s media use, they should try to be authoritative rather than authoritarian or permissive.
Early intervention is needed to prevent the development of media addiction in children (Mak et al., 2014). School-aged children are vulnerable to media addiction; they can use media devices easily as they are less likely to be restrained (Eisenberg et al., 2014; Vazsonyi & Huang, 2010). Efforts from parents and educational institutions are required to reduce media addiction, and programs based on school and parent participation are effective in preventing media addiction in children (Apisitwasana et al., 2018). Schools should guide children’s media activities to help them develop good media habits (Li et al., 2014). Parents who also participate in such education programs will know how to monitor and manage their children’s media use (Mak et al., 2014).
School nurses play a significant role as key contacts and health care professionals for school-aged children within the education system. This study suggests important implications for school nurses in organizing and providing education programs for preventing children’s risky media use.
First, school nurses should pay more attention to children who are addicted to media. School nurses should monitor and identify children’s media use and addiction status regularly through questionnaires and the application of relevant scales. We suggest the use of the K-Scale, which has been identified for diagnosis of internet gaming disorder (Zheng et al., 2019), and the Smartphone Addiction Scale Short Version (SAS-SV; Kwon, Kim, et al., 2013), which is a validated scale in South Korea published in English (Kwon, Kim, et al., 2013); the SAS-SV has been translated into many languages (French, Spanish, Japanese, Brazilian, and Portuguese) and is internationally regarded as valid (Lopez-Fernandez, 2017; Mescollotto et al., 2019; Tateno et al., 2019). In addition, school nurses may be able to counsel children at risk of media addiction to lead them to use media properly. In order to provide professional counseling to children, school nurses should complete education on counseling methods, attitudes, and functions. Government-level support and efforts are also needed to create an environment for school nurses to provide these services.
Second, school nurses should provide comprehensive and tailored programs to prevent the risk of media addiction. In developing educational programs, school nurses should include comprehensive contents (strategies for appropriate media use, how to prevent media addiction) and tailored contents (including gender, age, and family-specific factors). School nurses should recognize different patterns of media use between boys and girls, consider age-specific media use patterns, and be aware of family factors associated with media addiction, such as the mothers’ education level and time spent without parents or caregivers.
Third, school nurses should provide media addiction prevention programs that parents can participate in with their children. Parents need to recognize the severity of media addiction in school-aged children and limit media use to 2 hr or less a day; school nurses can teach parents how to establish rules for media use with their children. School nurses can also emphasize a variety of leisure activities that families can enjoy together to improve children’s happiness.
This study has three limitations. First, in the PSKC, the media addiction variable was first measured in 2017; thus, only cross-sectional data analysis was possible based on the latest data. Therefore, it is recommended that longitudinal studies be conducted in the future to identify causal relationships more clearly among variables.
Second, Cronbach’s α for the original scale of peer attachment was .72–.91 (Armsden & Greenberg, 1987), but in this study, it was 0.69. Armsden and Greenberg (1987) originally developed the tool to measure the peer attachment of adolescents and young adults (aged 16 –25 years); therefore, some items may have been difficult for elementary school children to understand accurately. In particular, NYPI (2012) revised the (alienation) item “I wish I had different friends” in the Korean version to “Do you want to make other friends instead of your current friends?” Cronbach’s a excluding this item was .75. Therefore, in future research, investigators must provide a detailed explanation to help children understand the item when using the tool for measuring peer attachment.
Third, the children who participated in this study were all in third grade; therefore, research results should not be generalized to all school-aged children. We suggest future studies include school-aged children of various ages.
The prevalence of media addiction among elementary school children in this Korean sample was 22.91%. The significant factors associated with media addiction were gender, mothers’ education levels, time spent without parents, media use time, happiness, and parenting style. Our findings suggest that more attention should be paid to elementary school children in terms of media use, and comprehensive, tailored programs involving parents and schools should be created to mitigate the risk of media addiction. A key role for school nurses is outlined.
Eunjeong Bae, Eun Kyoung Choi, and Heejung Kim contributed to conception, design, acquisition, analysis, or interpretation; drafted the manuscript; critically revised the manuscript; gave final approval; and agreed to be accountable for all aspects of work ensuring integrity and accuracy. Hyejung Lee contributed to conception, design, acquisition, analysis, or interpretation; critically revised the manuscript; gave final approval; and agreed to be accountable for all aspects of work ensuring integrity and accuracy.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This study was supported by Chijung Sim scholarship of the College of Nursing of Yonsei University in 2019.
Eunjeong Bae, RN, MSN, PhD student https://orcid.org/0000-0003-1583-8933
Eun Kyoung Choi, PhD, RN, CPNP https://orcid.org/0000-0003-4622-2437
Heejung Kim, PhD, RN, GNP-BC https://orcid.org/0000-0003-3719-0111
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Eunjeong Bae, RN, MSN, is a PhD student, College of Nursing, Yonsei University Graduate School, Seoul, South Korea.
Eun Kyoung Choi, PhD, RN, CPNP, is an Assistant Professor, College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.
Hyejung Lee, PhD, RN, is an Associate Professor, College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.
Heejung Kim, PhD, RN, GNP-BC, is an Assistant Professor, College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.
1 College of Nursing, Graduate School, Yonsei University, Seoul, Republic of Korea
2 College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
Corresponding Author:Eun Kyoung Choi, PhD, RN, CPNP, College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemungu, Seoul 03722, Republic of Korea.Email: ekchoi@yuhs.ac
