Preschool Exposure to Online Games and Internet Gaming Disorder in Adolescents: A Cohort Study

Hyunsuk Jeong, Hyeon Woo Yim, Seung-Yup Lee, Hae Kook Lee, Marc N Potenza, Yunmi Shin, Hyunsuk Jeong, Hyeon Woo Yim, Seung-Yup Lee, Hae Kook Lee, Marc N Potenza, Yunmi Shin

Abstract

Objectives: Although considerable evidence has already been collected on the effects of early initiation of drug/alcohol consumption on addictive behaviors in adolescents, little is known about the impact of early exposure to online games during preschool ages on the risk of internet gaming disorder (IGD). We evaluated the effects of exposure to online games before entering elementary school on IGD occurrence during the secondary school years using a community-based longitudinal study. Methods: Data from 1,760 adolescents (seventh grade), who were recruited from the iCURE study and followed for 2 years, were analyzed. A high risk of IGD (HRIGD) was assessed by the Internet Game Use Elicited Symptom Screen, a self-reported questionnaire based on the fifth version of DSM-5 IGD criteria. Early exposure to online gaming was defined as when adolescents played online games during their preschool years. A multivariate generalized-estimating-equation model was applied to examine the independent risk factor of the occurrence of HRIGD during the 2-year follow-up period. Results: As compared with the later-exposure group, those with early exposure to online games showed an ~1.7-fold greater incidence of HRIGD over the 2-year follow-ups after adjusting for potential confounders including baseline IGD scores (adjusted relative risk:1.69; 95%confidence interval:1.08-2.66). Pre-specified sensitivity analyses showed that the results were robust. Conclusion: Exposure to online gaming during the preschool years increases the likelihood of occurrence of HRIGD in adolescence. Restricting exposure to online games during the preschool years should be examined as a way to reduce the risk of IGD in adolescents. Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT02415322.

Keywords: adolescents; cohort; internet gaming disorder; online game; preschool.

Conflict of interest statement

MP has consulted for and advised Opiant Pharmaceuticals, Idorsia Pharmaceuticals, AXA, Game Day Data, and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; has received research support from the Mohegan Sun Casino, the Connecticut Council on Problem Gambling, and the National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Jeong, Yim, Lee, Lee, Potenza and Shin.

Figures

Figure 1
Figure 1
Flow diagram of inclusion and exclusion criteria for the data analysis. *Sensitivity analysis set to evaluate effect of cumulative risk of early exposure to online game on HRIGD. †Main analysis set to evaluate the effect of early exposure to online game on incidence of HRIGD. ‡Sensitivity analysis set to evaluate effect of early exposure to online game on incidence of HRIGD among game users at baseline.
Figure 2
Figure 2
Incidence of HRIGD in the early- and later-exposure groups at 12 and 24 months of follow-up. HRIGD, high risk of internet gaming disorder.

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