Over the past 10–15 years, research on the growing prevalence of Internet addiction has risen dramatically, spearheaded in the mid-1990s by the work of Dr Kimberly Young . Since that time, problematic Internet use prevalence studies have been conducted around the world and illustrate a growing global public health concern worthy of multi-disciplinary attention.
Durkee and colleagues  deliver a seminal article on the prevalence of maladaptive and pathological Internet use in a large sample of adolescents in 11 European countries. Internet use disorder has been proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 incorporating criteria similar to those found in substance and behavioral addictions, including urges or pre-occupation to engage in Internet use, withdrawal, tolerance, difficulty controlling time spent online, a disregard of harmful consequences, a loss of other interests, using the Internet to escape from problems, deception regarding use and impairment [3, 4]. While the Internet clearly provides adolescents many benefits (e.g. educational access, social networking, a world perspective larger than the classroom), a maladaptive or pathological use of the Internet also seems possible and probable. The fact that maladaptive and pathological Internet use rates were found in 13.5% and 4.4% of students, respectively, raises significant concerns over the potentially deleterious effects of continued use amongst our global youth. Previous research in young adult and adult populations has indicated psychological problems, such as depression and anxiety, and physical problems, such as carpal tunnel syndrome, dry eyes, headaches , altered sleep patterns  and poor academic performance  associated with excessive Internet use. The so-called ‘chicken and the egg’ debate, however, remains as to which condition promotes the other and is a topic in need of study.
Although associated with negative consequences in adult users, we know very little about the short- and long-term effects of Internet addiction on the health and well-being of children and youth . Identifying predictors of maladaptive use in this population is an extremely important first step in targeting contributing factors which may lead to future consequences. Interestingly, Durkee and colleagues found that limited parental involvement in the students' lives was a predictor of pathology—a logical conclusion as low parental involvement (or perceived involvement) by the student has been associated with substance use and other unhealthy behaviors. This finding underscores the need for public health initiatives targeting parental education and community involvement as these have been successful in reducing risky behaviors, such as illicit substance use and teenage sexual activity [9-11].
The article by Durkee et al. prompts us to further explore the factors associated with maladaptive Internet use by examining—longitudinally—harmful outcomes in youth throughout the webbed world. Unfortunately, research exploring potential genetic and environmental predictors of addition development and associated health correlates has been focused largely in substance addiction, absent of other behavioral addiction models . With the majority of the world engaging in Internet use and with the potential for significant negative consequences resulting from maladaptive Internet use, one hopes that the scientific examination of health and educational consequences of repetitive, maladaptive Internet use continues to grow.
The research by Durkee and colleagues is an important step in advancing the global knowledge of Internet use in adolescents, but more work is needed. Preventative health measures for children and adolescents who have no understanding of a world without the Internet should comprise a public health priority worldwide. Currently, educational directives and preventative measures are largely lacking from clinical guidelines  and major public policy initiatives, such as Healthy People 2020  have shown limited interest in behavioral addictions in children and adolescents. Large-scale initiatives such as the Saving and Empowering Young Lives in Europe (SEYLE) project (from which the Durkee and colleagues sample is derived) provide a valuable example of research that strives to identify and call attention to the impact of abnormal Internet use. With increasing numbers of Internet-capable devices and of young people accessing the Internet everyday, mental and public health professionals should be on guard.
Declarations of interest
BO has received a research grant from the Trichotillomania Learning Center and honoraria from Oxford University Press and Current Medicine Group, LLC. JG has received research grants from NIDA, the National Center for Responsible Gaming, Forest, Psyadon, and Transcept Pharmaceuticals, and the University of South Florida. JG receives compensation as the Editor-in-Chief of the Journal of Gambling Studies.