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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Exploring the Risk Factors Associated with Video Game Addiction among Adolescent School Children in Chennai District, Tamil Nadu, India: A Cross-sectional Study
Correspondence Address :
BN Surya,
Chettinad Health City, Rajiv Gandhi Salai, Kelambakkam, Chengalpattu District, Chennai-603103, Tamil Nadu, India.
E-mail: suryauk4@gmail.com
Introduction: Video game addiction has emerged as a significant concern among adolescent children in recent years. With the widespread availability of technology and the increasing popularity of video games, a substantial number of adolescents are displaying addictive behaviours.
Aim: To estimate the prevalence of video game addiction among adolescent school children in Chennai, Tamilnadu, India and find out the various risk factors associated with it.
Materials and Methods: A cross-sectional study was conducted at the Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu, Chennai, Tamil Nadu, India among 300 school children aged 10-17 years from four private schools in Chennai, Tamil Nadu, India from February 2023 to June 2023. Data collection involved the Gaming Addiction Scale for Adolescents (GASA) and a pretested semistructured questionnaire. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0.
Results: The study revealed that approximately 31.7% of the participants had video game addiction. Categorical variables were analysed using the Chi-square test, with a significance level of p<0.05. Bivariate logistic regression was utilised to determine unadjusted odds ratios, and variables with p<0.05 were included in the multivariate model to calculate adjusted odds ratios and construct 95% confidence intervals.
Conclusion: Video game addiction among adolescent school children is a significant issue with multiple associated risk factors. By promoting awareness, encouraging healthy coping mechanisms, and fostering balanced lifestyles, we can effectively address video game addiction and enhance the well-being of adolescent school children.
Anger, Sedentary behaviour, Sleep deprivation, Technology addiction
The role of technology in our daily lives has significantly increased in recent years, with video games becoming a popular form of entertainment. The World Health Organisation (WHO) has included “Gaming Disorders (GD)” in the list of mental health conditions in the 11th Revision of the International Classification of Diseases (ICD-11 (1)). According to World Health Organisation (WHO), GD is characterised by impaired control over gaming, giving gaming increasing priority over other activities to the extent that it supersedes other interests and daily activities, and persisting in gaming despite negative consequences (2).
Video game addiction has raised concerns among adolescent school children in recent times. The proliferation of high-tech gaming devices like smartphones, gaming consoles, and tablets, along with the widespread availability of affordable internet access, has made gaming more appealing, addictive, convenient, and cost-effective. Consequently, video game addiction has become a significant worry among adolescent school children, impacting their physical health, mental well-being, academic performance, and social interactions (3).
The impact of video game addiction on adolescents is multifaceted. Excessive gaming can lead to sedentary lifestyles, contributing to physical health issues such as obesity, musculoskeletal problems, and sleep disturbances. Additionally, the immersive nature of video games can negatively affect mental health, increasing stress, anxiety, depression, and overall well-being decline (4). Academic performance may suffer due to decreased focus, reduced study time, and poor time management skills. Excessive gaming can also disrupt social interactions, leading to isolation, relationship difficulties, and reduced participation in real-world activities.
Understanding the risk factors associated with video game addiction among adolescent school children is crucial for developing effective preventive measures and intervention strategies. Various personal, environmental, game-related, and socio-cultural factors contribute to the development and maintenance of addictive behaviours. Personal factors may include underlying psychological issues, impulsivity, and poor coping mechanisms. Environmental factors, such as video game accessibility, parental influence, and peer pressure, significantly affect adolescents’ gaming behaviours (5).
Game-related factors, such as design features and in-game purchases, can increase the addictive potential of video games. Moreover, socio-cultural factors, including cultural norms, attitudes, and media influence, contribute to the prevalence of video game addiction among adolescents (6). However, there is a lack of literature on video game addiction and potential risk factors associated with it among adolescent children in India.
A cross-sectional study was conducted at the Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu, Chennai, Tamil Nadu, India from February 2023 to June 2023 among 300 school children aged 10-17 years from four private schools in Chennai, Tamil Nadu, India. Children studying in middle school, secondary school, and higher secondary school in Chennai were included as study participants. Ethical clearance for the present study was obtained from the Institutional Human Ethics Committee on Human Subjects (Approval No: 002/SBMC/IHEC/2021/1641).
Inclusion criteria: Children aged 10-17 years studying in grades 6th to 12th were included in the study.
Exclusion criteria: Children under treatment for any known psychiatric illness were excluded.
Sample size calculation: Based on a study by Goswami V and Singh DR, the prevalence of gaming addiction was found to be 24.5% among school children (7). Using this prevalence value and applying it in the formula Z2PQ/L2, where Z=1.96 (95% CI), P=24.5, Q=75.5, and the absolute precision (L) was set at 5%, the required sample size was calculated as 284 and rounded-off to 300 (n=300).
Study Procedure
Out of the 15 zones in Chennai (8), four zones were randomly selected using the lottery method, and one school from each zone was chosen from the school database using the same method. A list of students studying in grades 6th to 12th in the four schools was obtained. Each sample unit meeting the inclusion criteria was selected using simple random sampling until the required sample size of 300 was achieved.
The principals of each school were personally met, and all study details, including the purpose and confidentiality of the study participants, were explained. After obtaining permission from the school authorities, a parent-teacher meeting was organised to explain the study details and objectives to the parents. Written informed consent was obtained from each parent, and written or oral assent was obtained from their children depending on their age.
Data was collected through personal interviews with eligible participants using a pretested semistructured questionnaire. The questionnaire was developed after rigorous pilot testing and included questions related to socio-demographic details, gaming patterns, and various physical, psychological, and social health factors associated with gaming. Data collection from children was done in the presence of their parents, allowing them to seek help if needed.
A pilot study involving 30 children was conducted using the semistructured questionnaire, and based on the responses and feedback received, the questions were modified. The internal validity of the questionnaire was analysed using reliability analysis, with a Cronbach’s alpha of 0.82 indicating good consistency in internal validity.
Face validity: Experts in psychiatry, community medicine, and the general population rated the questionnaire on a 5-point Likert scale to evaluate its face validity.
Content validity: Inter-rater reliability was assessed using Kappa statistics, with Cohen’s kappa coefficient indicating good agreement between raters.
The questionnaire consisted of two parts: Part 1 focused on the socio-demographic profile and gaming patterns of the participants, while Part 2 included questions related to physical, psychological, and social factors associated with gaming addiction.
To assess the prevalence and degree of gaming addiction among participants, the Gaming Addiction Scale for Adolescents (GASA) developed by Lemmens JS et al., was used (9). The GASA scale measures seven criteria of gaming addiction: salience, tolerance, mood modification, withdrawal, relapse, conflict, and problems, each rated on a 5-point Likert scale, with a cut-off point at the midpoint. Meeting 4 or more criteria indicated addiction according to the polythetic format.
Statistical Analysis
Collected data were entered using Mcrosoft excel and analysed using SPSS version 22.0. Categorical variables were expressed in frequencies and percentages. The significance test for categorical variables was conducted using the Chi-square test, with a p-value <0.05 considered statistically significant. Bivariate logistic regression was performed to obtain unadjusted odds ratios. Variables with a p-value <0.05 were included in the multivariate model to calculate adjusted odds ratios. Additionally, a 95% confidence interval was constructed to assess the estimates.
Among the study participants, approximately 168 (56%) were females and 132 (44%) were males. Out of all participants, 162 (54%) were aged above 14 years, while around 138 (46%) were aged below 14 years. Regarding education, 109 (36.3%) participants were in high school, 103 (34.3%) in middle school, and 88 (29.3%) attended higher secondary school. The majority, 242 (80.7%) belonged to nuclear families, and around 248 (82.7%) resided in owned houses. Out of the 300 study participants, 246 (82%) were found to be playing video games (Table/Fig 1).
The prevalence of video game addiction, noting that 31.7% of the 246 (82.7%) participants who played video games were found to have video game addiction based on the GASA scale is presented in (Table/Fig 2).
The association between video game addiction and the gaming patterns of the participants is illustrated in (Table/Fig 3). Among those with video game addiction, 33.3% played for over four hours daily, showing a statistically significant association (p<0.05) with an odds ratio of 2.5 (95% CI: 1.3-4.6). Additionally, 74.4% of those addicted to video games preferred online gaming, showing a significant association (p<0.05) with an odds ratio of 2.9 (95% CI: 1.6-5.2). Personal Computer (PC) and console gaming were also associated with video game addiction, with odds ratios of 2.57 and 1.833, respectively, showing statistical significance (p<0.05).
Variables showing a statistically significant association with video game addiction in bivariate analysis were further analysed using binary logistic regression to account for confounders. Gaming for more than four hours per day had an adjusted odds ratio of 2.46 (95% CI: 1.2-4.8), and online gaming had an adjusted odds ratio of 2.75 (95% CI: 1.4-5.2), both showing a significant association with video game addiction (p<0.05) (Table/Fig 4).
The association between video game addiction and various physical, psychological, and social health factors are depicted in (Table/Fig 5). Notably, 41% of those with video game addiction experienced eye strain, headache, and neck pain, showing a statistically significant association (p<0.05) with an odds ratio of 2.55 (95% CI: 1.4-4.5). Furthermore, individuals with video game addiction were 2.60 times more likely to verbally abuse others while gaming, 5.74 times more likely to suffer from sleep disturbances, and 4.14 times more likely to have decreased physical activity.
Other variables also showed a statistically significant association (p<0.05) with video game addiction, including anger and irritation when interrupted during gaming, reduced interest in other activities, skipping meals to play games, feeling sad and depressed after losing games continuously, restlessness when unable to play games, and skipping school to play games, with odds ratios of 5.12,4.22, 3.79, 2.65, 6.0, and 7.45, respectively.
Variables with a statistical association with video game addiction were further analysed using regression analysis. Significant variables included verbally abusing others while gaming with an adjusted odds ratio of 4.89 (95% CI: 1.7-18.5), sleep disturbances due to gaming with an adjusted odds ratio of 6.163 (95% CI: 1.19-19.2), anger and irritation when interrupted during gaming with an adjusted odds ratio of 8.09 (95% CI: 1.8-18.5), physical inactivity due to gaming with an adjusted odds ratio of 4.68 (95% CI: 1.4-15.3), and skipping school to play games with an adjusted odds ratio of 3.786 (95% CI: 2.2-16.8) (Table/Fig 6).
The prevalence of video game addiction was found to be 10.6% among school children (10). A study by Goswami V and Singh DR in India reported a similar prevalence rate, with around 24.50% of adolescents being addicted to video games (7). The consistent prevalence rates across these studies indicate a significant proportion of adolescent school children affected by this issue. These rates are notably high, considering the potential consequences of gaming addiction on various aspects of adolescents’ lives, including their physical and mental health, academic performance, and social relationships.
Video games have been around for a long time and have evolved remarkably with technological advancements. Though video game addiction has been included in the latest ICD-11 classification, it is imperative for authors to understand the adverse effects of playing video games across various age groups, with a focus on adolescents. The present study conducted among adolescent school children revealed interesting findings, which are explained in the discussion below, compared with studies done in India and elsewhere.
In the present study, the prevalence of video game addiction among adolescent school children was found to be 31.7%. In a study done by Singh YM et al., the prevalence of gaming addiction was found to be 10.6% among school children (10). Similar results were found in a study done by Goswami V and Singh DR in India, where around 24.50% of adolescents were addicted to video games (7). The consistent prevalence rates of gaming addiction across these studies indicate that a substantial proportion of adolescent school children are affected by this issue. These prevalence rates are notably high, especially when considering the potential consequences of gaming addiction on various aspects of adolescents’ lives, including their physical and mental health, academic performance, and social relationships.
In the present study, video game addiction was associated with gaming for more than 4 hours a day. In a study done by Marmet S et al., among young adults in Switzerland, it was found that binge gaming for five or more consecutive hours was associated with GD (11). Similar findings were observed in a study done by Gorman TE et al., which revealed that excessive video gaming, higher impulsivity scores, and lower social competence scores led to gaming addiction among students (12). Increased gaming time may result in immersion in the game’s virtual environment, leading to decreased interest in performing other activities and mental fatigue.
Increased screentime due to excessive gaming also leads to sleep disturbances and poor sleep quality. In a study done by Zaman M et al., in Pakistan, participants with gaming addiction had significantly lower subjective sleep quality, more sleep disturbances, shorter sleep duration, and more daytime sleepiness than those without gaming addiction (13). Study done by Lam LT among young people revealed that excessive gaming was linked to sleep problems (14). Extended gaming sessions can additionally reduce the amount of available sleep time, leading to disruptions in sleep patterns and insomnia. These findings are in concordance with the present study, in which sleep disturbance was associated with gaming addiction among the study participants. In the long run, these factors may have an impact on an individual’s mental health. Taking regular breaks when playing games may lessen the harmful effects of gaming and make it easier to maintain a healthy lifestyle. Conversely, neglecting these risk factors can negatively affect one’s quality of life and result in impaired functioning.
The present study highlighted that study participants who had video game addiction showed aggressive behaviour when interrupted during gaming sessions and tended to verbally abuse others while gaming. This finding is consistent with research done by Yao M et al., in China, which demonstrated an association between exposure to video games and heightened aggression in individuals (15). Several other studies have also demonstrated that gaming can lead to the development of aggressive behaviour associated with anger and impulsivity (16),(17),(18),(19). In addition, increased levels of pathological gaming, regardless of the content type, predicted an increase in physical aggression in real life among adolescents (20),(21). Aggressive behaviour during gaming not only affects the individual but can also impact those around them, including family members and online gaming peers. Recognising and addressing this behaviour is crucial to prevent potential harm and strained relationships. Verbal abuse, whether directed at other players in online games or individuals in the immediate environment, has serious consequences for both the abuser and the recipient. It can lead to conflicts, social isolation, and exacerbation of mental health issues (22),(23),(24). Effective interventions are needed to address this behaviour and promote healthier interactions.
In the present study, video game addiction was associated with physical inactivity. In a study done by Gülü M et al., it was found that digital game addiction has a positive relationship with physical inactivity and obesity (25). This association shows that individuals excessively engaged in video games might be neglecting physical activities and spending extended periods in sedentary behaviours, both of which are well-established risk factors for obesity. It is essential to motivate adolescents to participate in physical activities as a means to decrease their levels of digital game addiction.
The present study revealed that students skipped school to indulge in gaming, and this behaviour was linked to gaming addiction. A study done by Saunders JB et al., among secondary school students in Hong Kong showed that students with gaming addiction experienced mood disorders, refusal to attend school, and engage in school activities, extreme anger and aggression, and various other health consequences (26). School absenteeism resulting from gaming significantly influences academic performance. Comparable results were identified in research conducted by Brunborg GS et al., and Sun RQ and Ye JH indicating that gaming addiction was linked to decreased academic achievement (27),(28). Adolescence is a crucial phase in a person’s life that shapes their personality. The findings from the study highlight the fact that playing video games can lead to anger issues, sleep disturbances, verbal abuse, school absenteeism, and physical inactivity. All these factors can affect their personal and academic life. These findings will help authors provide behavioural change communication to parents regarding the hazards of video game usage among their children.
Limitation(s)
Since video game addiction is a new phenomenon occurring in the rapidly urbanising world, longitudinal studies are needed to better understand the causal association between video game addiction and the various risk factors. The present study, being cross-sectional in design, has its limitations as only prevalence and associated risk factors could be computed. The incidence of video game addiction could be assessed only by cohort studies. The study was conducted in four private schools; including government schools would have provided a better understanding of video game addiction among children from lower socioeconomic backgrounds.
The findings of the study shed light on the fact that 31.7% of adolescent school children had video game addiction. Independent factors such as gaming for four or more hours per day, online gaming, sleep disturbances, verbal abuse, anger and irritation, and school absenteeism were identified as potential risk factors of video game addiction. In addressing video game addiction among adolescents, a multifaceted approach involving schools, healthcare providers, parents, and policymakers is essential. It requires a collective responsibility to safeguard the well-being of the youth and guide them towards a balanced and healthy lifestyle.
DOI: 10.7860/JCDR/2024/68735.19261
Date of Submission: Nov 23, 2023
Date of Peer Review: Jan 02, 2024
Date of Acceptance: Feb 16, 2024
Date of Publishing: Apr 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 24, 2023
• Manual Googling: Jan 19, 2024
• iThenticate Software: Feb 14, 2024 (12%)
ETYMOLOGY: Author Origin
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