Dr Rajiv Desai

Smartphone Overuse

January 2, 2023 by Dr Rajiv Desai

Smartphone Overuse:

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Average person spends 3 to 4 hours on their smartphone each day. 

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Section-1

Prologue:  

If there’s anything that most deserves the claim to be a man’s best friend in the modern age, it has got to be the smartphone. The use of smartphones is now a necessity, not a choice. The technological innovation of smartphones and various software has made our lives more convenient. While the bounties of technological innovation have offered limitless opportunities to make life comfortable, their perils cannot be ignored. Worldwide, there are over 6 billion people that have smartphone data plans and it is projected that this will grow to over 7.5 billion by 2026. According to a recent study, almost half of the American population showed hyper-reliance on smartphones, and more than 90% of young people aged 19–29 reported daily use of smartphones. Smartphone devices have the same capabilities of a fully functioning computer, in the convenient size of a wireless hand-held device. Smartphones have more connectivity possibilities and advances than any other form of screen time electronic devices. For example, individuals can engage in activities such as watching television, gaming, and communications such as texting all on the same device. Capitalising on that convenience, youth reportedly have access to smartphones more so than any other electronic device. A study in the United States showed that only 88% of youth reported having access to a computer, while 95% reported having access to a smartphone. Furthermore, reduced access to a computer was associated with lower household income; whereas smartphone access appeared to be universal among families regardless of gender, race, ethnicity, and socioeconomic background.

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If the first thing you did when you woke up this morning was to check your smartphone, you’re not alone. Nearly 70% of smartphone users begin using their devices within 15 minutes of their alarm going off. Coupled with the fact that the average college student spends around nine hours a day on their phone, the statistics can paint a scary picture. Smartphones have quickly become integrated into every aspect of our lives by connecting us with friends, family, teachers, banks, transportation, food, entertainment, resources and essentially the world. Used wisely and responsibly, smartphones enhance our lives. Thanks to smartphones, we’re more connected than ever. We can share our ideas with people from all over the world. Best of all, with smartphones, we can bring with us endless learning opportunities. On the other hand, in a Southern Chinese city a young man was killed by a truck while crossing a street. Lying in a pool of blood, his smartphone was still playing a video – the last video he watched in his life. A witnesses said “He was focusing on the video without noticing the traffic signal”. Tragedies like this are happening around the world more often than before, thanks to the widespread use, and overuse of smartphones. Smartphone overuse refers to people spending too much time on their smartphones to an extent that it negatively affects their life. Smartphone overuse and smartphone addiction are not synonymous but smartphone overuse may lead to its addiction. Smartphone addiction is regarded as an addictive behavior, with profound implications on mental, physical, and social health and wellbeing. Studies show that excessive smartphone use is linked to procrastination, suicide, spoilt sleep, food and water neglect, headaches, lower productivity, unstable relationships, poor physical health (eye strain, body aches, posture, hand strain), and poor mental health (depression, anxiety, stress). Some of these problems can be both causes and effects of phone addiction (procrastination, anxiety, unstable relationships, etc.). Because of its extensive impact on daily life, some new terms are invented in popular culture to describe this problem, such as phubbing, ringxiety, nomophobia, and smartphone zombie. 

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We have seen the following scenarios probably many times:

• I tell my patient to show me his blood report. He unlocks his smartphone and start searching for blood report. It takes a while as his smartphone has hundreds of files in memory. I tell him hurry up as other patients are waiting outside. After few minutes, he shows blood report on smartphone. I can’t read as text size is very small. I zoom in to enlarge text size to make is readable. Had he brought report on paper, so much time could have been saved without eye strain.
• I took online lectures for students during coronavirus pandemic. All students used smartphone to attend online lecture but I wonder how they read text or understand image on such small screen. Smartphones are okay to listen to lecture but when it comes to viewing text and images, you have to increase text/image size by zooming in and you will find that you can read text/image only in part so you have to keep moving text/image to read the whole content. The text/image need to be moved constantly to gather comprehensive content and comprehensibility is achieved only through piece-meal data gathering. Not only your eyes but even your brain is stressed to assimilate data coming in piece-meal. The smartphones’ small screen size can make it difficult to view and properly display materials and as a result there is a high risk of reducing learning performance due to increased cognitive load. Yet, no student used laptop/PC to attend my online lecture as they are fond of smartphone or cannot afford laptop. A typical student spends around 20% of class time on unrelated digital distractions on smartphone. So, distractions, increased cognitive load and eye strain make smartphone inappropriate device for online learning.   
• Parents have to somehow buy smartphone for their child otherwise their child threatened to commit suicide.
• You see couples or families out to dinner at a restaurant and often none of them are even socialising, they’re just browsing on their screens. What’s the point in even going out? You may as well have stayed home.
• Shoppers and commuters standing in line, travelling in trains & buses, even cyclists and drivers have eyes are on their phones instead of their surroundings.
• Toddlers in strollers are playing with a smartphone — a parent’s or perhaps even their own — instead of observing and learning from the world around them.
• People are walking down the street with eyes on their phones, bumping into others, tripping over or crashing into obstacles.
• Many parents come to doctor seeking help. “Doctor, guide my child who is 14 years old. He is glued to his mobile relentlessly.”

We are spending far too much of our time doing things that don’t really matter to us. The near-universal access to smartphone, starting at ever younger ages, is transforming modern society in ways that can have negative effects on physical and mental health, neurological development and personal relationships, not to mention safety on our roads and sidewalks. We’re wired and tired all the time. Even computers reboot, but we’re not doing it. Don’t get me wrong. I am not against technology. Bill Gates and Steve Jobs admitted to severely limiting their own children’s use of the very same technology that they themselves helped develop. Too much of technology may cause unintended consequences. Moderation in our digital world should be the hallmark of a healthy relationship with technology. Too many of us have become slaves to the devices that were supposed to free us, giving us more time to experience life and the people we love. Instead, we’re constantly bombarded by bells, buzzes and chimes that alert us to messages we feel compelled to view and respond to immediately. Most people now check their smartphones 150 times per day, or every six minutes. And young adults are now sending an average of 110 texts per day. Furthermore, 46 percent of smartphone users now say that their devices are something they couldn’t live without. Majority of students experienced distress when they tried to go without their devices for 24 hours. One in three people admitted they’d rather give up sex than their smartphones. Are we turning into digital robots? Will future generations know how to converse with one another face to face? Will they notice the birds, trees, sunrise and the people with whom they share the planet?

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Screens are stealing time that children and adolescents should be spending on physical activity and sports, reading, or creating and engaging directly with other children, all of which are critical to healthy physical and social development. The only difference between digital addiction and other addictions is that this is a socially condoned behavior. Just walking in a store, coffee shop, airport, one sees a common behavior: people glaring at their smartphones, checking social media, reading articles, and in their own worlds, while gaps of time are allowed to pass. Many of us can also admit that the time spent swiping through cell phone social media and curated articles has increased since the covid pandemic. When you add up these little checks on the phone, you might be startled about how much time you are spending on them.  Add up those 3-5 hours spent on the phone each day and, in one year, you have spent between 46 and 72 days on the phone! If you had that time back, is there something that you would prefer to have done with it?

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According to top addiction experts, “giving your child a smartphone is like giving them a gram of cocaine”. By now, nearly everyone knows we can be addicted to our digital devices. Smartphone services are designed to be as addictive as possible. They’ve been described to be exactly like poker/slot machines. You’re not losing money from using these services so you don’t feel like it’s a problem but we do get micro dopamine hits from likes, notifications and inbox messages. With smartphones growing to be an integral part of life, an overuse of smartphone has become epidemic around the world that nobody is talking about. People say social media is addictive, not the smartphones! Even if this statement is true, these devices enable us to access any website, application or service at the touch of a button from a small device that sits in all of our pockets. We don’t go anywhere without them. Billions of people aren’t face down in their laptops in the streets like they are with smartphones. About 72% of web users are solely using smartphones to surf the net. Smartphone overuse negatively affects people’s life with profound implications on mental, physical, and social health and well-being. It is important to bring the public’s awareness to this growing epidemic and to define smartphone overuse as a public health issue. I have already published introductory article on ‘Smartphone’ on February 9, 2015 on this website but things have changed so much in 8 years that I have to publish article on ‘Smartphone Overuse’.    

  

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Abbreviations and synonyms:

EMF = Electromagnetic field

EMR = Electromagnetic radiation

OR = Odds ratio

RF = Radiofrequency

SNS = Social networking site/service

FOMO = fear of missing out

HEV light = high-energy visible light = blue light

AAP = American Academy of Paediatrics

CYP = children and young people

IGD = internet gaming disorder

SPA = smartphone addiction = SPD = smartphone dependence

IAD = internet addiction disorder

SAS = smartphone addiction scale

PSU = problematic smartphone use

GMV = grey matter volume 

GPA = grade point average

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Terminology:

Some new terms have emerged to describe characteristics of smartphone overuse and addiction. They include: 

-Nomophobia: Nomophobia (short for ‘no mobile phobia’) is a word for the fear of, or anxiety caused by, not having a working mobile phone. It has been considered a symptom or syndrome of problematic digital media use.

-Textaphrenia: Fear of the inability to receive or send text messages.

-Ringxiety: Feeling as though a notification has come through on your phone when it hasn’t.

-Textiety: Feeling anxious because of receiving and responding to text messages immediately.

-Phubbing: When you are bored in face-to-face conversations or don’t want to interact with others, do you slowly start using your phone and divert your attention away from the person? Snubbing another person in favor of your phone is called phubbing (phone + snubbing) and it is a common complaint in relationships. Phubbing your partner is called Pphubbing or Partner phubbing and research acknowledges that it worsens relationship satisfaction and life satisfaction, and could also add to depression. Phubbing could be a form of social exclusion and researchers argue that even watching others phub can induce stress and reduce respect for the phubbers.

-Smombie: This word, which is short for “smartphone zombie,” first appeared in German before it was used in English. It was Germany’s official Youth Word of 2015. A smombie is a person on the street who walks slowly and without attention to their surroundings because they are completely focused on their phone.

-FOMO: This acronym means “fear of missing out.” FOMO is the feeling of apprehension that one is either not in the know or missing out on information, events, experiences, or life decisions that could make one’s life better. Smartphones enable people to remain in contact with their social and professional network continuously. This may result in compulsive checking for status updates and messages, for fear of missing an opportunity.

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Blue light:

Most electromagnetic waves are invisible. But a small band of waves, known as visible light, can be detected by the human eye. Blue light, also known as high-energy visible (HEV) light, is a color in the visible light spectrum that can be seen by human eyes. Visible light waves vary in length from 380 nanometers (violet light) to 700 nanometers (red light). The longer the wave, the less energy it transmits. Blue light has very short, high energy waves. In fact, they’re only slightly longer and less powerful than UV waves, which are too short for people to see with the naked eye. Health experts have warned against the harmful effects of UV rays, which can damage your skin and your eyes. High energy blue light waves are nearly as powerful. Unlike other forms of light, the eyes cannot effectively filter blue light, so more can pass through the eye to the retina.

Blue light, like other colors of visible light, is all around you. The sun emits blue light. So do fluorescent and incandescent light bulbs. Human beings are exposed to more blue light than ever because of the widespread use of devices that rely on light-emitting diode (LED) technology. Computer and laptop screens, flat-screen televisions, smartphones, and tablets all use LED technologies with high amounts of blue light. 

There are some key differences between natural sources of blue light, like daylight, and artificial sources, such as the LEDs used in digital devices. Most of the blue light from the LEDs has wavelengths between 400 and 490 nanometers. Many LED screens peak in the 435-440 nm. Some research shows a link between eye damage and short-wave blue light with wavelengths between 415 and 455 nanometers. Blue light from sun has wavelengths between about 450 and 495 nanometers. 

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Section-2

Introduction to smartphone overuse:

Telephones were initially invented to speak to a person sitting miles away. They were wired, and kept at one place. After a few years mobiles were invented which could be carried easily. With time and the growing requirements of people mobiles underwent a lot of changes and have become smarter. Today mobiles are used not just to get in touch and speak to people but also to send mails, transfer money, online bill payments, make reservations etc. These are merely some of the functions that can be done through mobiles. The invention of internet has made mobiles even smarter and enable them to perform any kind of electronic activities. This is precisely why mobiles are called smart phones today.

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People have had a long-held fascination with technology. This fascination continues unabated into the 21st century as consumers are spending an ever increasing amount of time with technology. First, it was the radio, then the telephone and the TV, followed quickly by the Internet. The current-day fascination with the cell-phone (e.g., smart phones) highlights the latest technology that, for better or worse, appears to be encouraging people to spend relatively more time with technology and less with fellow humans (Griffiths, 2000). Nowhere is this fascination with technology more intense than in young adults – college students in particular (Massimini & Peterson, 2009; Shambare, Rugimbana & Zhowa, 2012).

The word ‘Smartphone’ was introduced years ago, but the meaning has been changed over time.  It began in the past when people only had mobile phones or cellular phones. Smartphones have not only replaced cellphones, but to a certain extent they have also replaced personal computers and a multitude of other devices. Their large screen size and inherent mobility allow for a plethora of functions to be accessed anytime and anywhere. With a smartphone, a person can make calls, send e-mails, watch and share photos and videos, play video games and music, watch TV, keep track of appointments and contacts, surf the Internet, use voice search, check news and weather, use chat applications for voice calls and texting (e.g., WhatsApp) and interact on social networks (e.g., Facebook).  The main factor that distinguishes between a mobile phone and a Smartphone is that “[a] smartphone is a mobile phone that offers more advanced computing ability and connectivity than a contemporary basic ‘feature phone’” (Litchfield, 2010, para. 8). Additionally, the internet also makes the Smartphone even better. Litchfield concludes in his article “Defining the Smartphone” by defining the Smartphone as a device that “runs an open (to new apps) operating system and is permanently connected to the internet” (Litchfield, 2010, para.21). He may be right about this because the Smartphone with accessibility of the internet lets people do many things on this device. 

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Smartphones are becoming indispensable for everyday life and it is estimated that there were 2 billion users across the world in 2012 (Miller, 2012). Almost all adolescents between the ages of 12 and 19 own a smartphone (Ofcom, 2016). Smartphones are typically touch-screen devices with numerous applications (apps). Smartphones offer quick access to the Internet and social media, which facilitates message transmissions or communication. Smartphone technology is an innovative invention in that it combines the functions of conventional phone and computer in a single smaller device. It allows access not only to sophisticated communication networks, but also to a wide range of amusements such as games, multimedia players, photo albums, and electronic books. Smartphones also provide essential tools including Global Positioning System (GPS), camera, recorders, translator, clock, radio, remote control of electrical appliances, torchlight, calculator, e-wallet, and even health trackers. Owing to the convenience and multiple functions of smartphones, users tend to become over-attached and preoccupied with their devices.

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Smartphone use is not universal:

Smartphone use varies throughout the world. From a global perspective, in 2017 there were 5 billion unique mobile subscribers with 57% of connections using a smartphone (GSMA 2018a). For the 5 billion mobile subscribers, the top 3 uses of a cellphone are to make or receive cellular calls, send or receive text messages (SMS), and use messaging apps, while downloading and using apps for purposes other than messaging is ranked number 9 (GSMA 2018b). In 2018, 95% of the US population owned a cellphone, and 77% of the cellphones were smartphones (Pew Research 2018). The percentage of cellphones that are smartphones in the US has remained constant since 2016 (Pew Research 2018).

Worldwide, smartphone use is unevenly distributed across the population. Older people use a smartphone significantly less often than younger people (Berenguer et al. 2017). In the US, about 40% of community dwelling adults age 65 years or older own a smartphone (Anderson and Perrin 2017) with barriers to use including visual and physical impairments (Kuerbis et al. 2017; Bauer et al. 2018a). Additionally, older people often use a smartphone as a standard feature phone, making calls but never downloading apps (Berenguer et al. 2017). People with low income may only have intermittent access to smartphones (Gonzales 2016). Smartphone use by those with serious mental illness is generally lower than for the general population (Klee et al. 2016; Glick et al. 2016; Abu Rahal et al. 2018; Carpenter-Song et al. 2018). Smartphone use is also associated with more education (Pew Research 2018).

Alternatives to smartphones:

Consumers own many technologies in addition to a smartphone. In the US, in 2018, 73% of the population owned a desktop or laptop, and 53% owned a tablet (Pew Research 2018). Most owners of desktops or laptop also own peripheral devices such as printers and scanners. People use smartphones and desktops/laptops for different daily activities, varying by age (Bröhl et al. 2018). Although younger generations use a smartphone most frequently to perform daily activities, all age groups in an international sample preferred to use a desktop PC/laptop for writing emails or letters, and for passing on confidential information (Bröhl et al. 2018). In an international sample of patients with bipolar disorder, 81% looked for information on the Internet, with 89% of these preferring to search from a desktop/laptop (Conell et al. 2016).

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Nowadays, smartphones are ubiquitous. On average, we spend nearly three hours per day on our smartphones (Markowetz, 2015). Unlike other electronic devices, smartphones enable the use of such functions almost anytime and anywhere, with numerous consequences for our daily lives. Smartphones come with benefits, such as constant contact with friends, attractive leisure activities, Internet access to an endless supply of information, and positive consequences for knowledge sharing (Lepp et al., 2013; Omar et al., 2016). Conversely, smartphone use can impair well-being, a trend that has become an issue of great concern to both the public and researchers. For instance, research has shown that smartphone use affects health and well-being, performance, and social interactions. Regarding health-related problems, studies have found that smartphone use is related to higher depression rates and anxiety (Lepp et al., 2014), sleep difficulties (Thomée, 2018), and also musculoskeletal problems in case of smartphone overuse (İNal et al., 2015). Furthermore, a predominance of empirical results indicates a negative association between smartphone use and academic performance (Amez & Baert, 2020), which corresponds with results showing that smartphone overuse is related to lower work productivity and engagement (e.g., Duke & Montag, 2017). Moreover, smartphone use also increases negative affect or stress and reduces the quality of interactions when individuals focus on their own smartphones during social interactions (so-called phubbing; McDaniel & Radesky, 2018; Nuñez et al., 2020).

Even though some of the negative associations between digital technology use and health and well-being are small (Dienlin & Johannes, 2020; Orben & Przybylski, 2019a; Orben & Przybylski, 2019b), smartphone users are concerned about their own smartphone use. For example, research has demonstrated that smartphone users blog about the need to spend time away from their smartphones (Jorge, 2019; Kuntsman & Miyake, 2016), or even search for strategies to better manage their online time, e.g., with the help of applications such as iOS Screen Time, Android Digital Well-Being, Moment, Forest, Quality Time, Detox, Space, or OffTime. Furthermore, groups have organized an annual National (and Global) Day of Unplugging, which have been held for several years now with many followers (National Day of Unplugging, n.d.). Thus, it is not surprising that mass media present unplugging from smartphones as a trendy way to reduce the negative impact from smartphone use on health-related outcomes. Self-help tips are available on many platforms, such as social media, websites, and books with titles such as 24/6: The power of unplugging one day a week (Price, 2018; Shlain, 2019; Syvertsen, 2017). The concerns expressed in these texts reflect general concerns about smartphone use, and advice is given on how to rebalance one’s life by restricting smartphone use (Syvertsen, 2017). In a similar vein, holiday tour operators promote so-called digital detox camps or centers and “mobile free” holidays. All aim to help people escape from everyday digital connectivity. Particularly in Asia such holidays and events are booming (Collier, 2009; Dickinson et al., 2016; Syvertsen, 2017).

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Along with providing the opportunity to access the internet, mobile phones have today become more than just a means of communication among individuals. They have transformed into tools which provide virtual environments and digital identities through which people seek enjoyment, and which also enable users to do shopping and manage their finances. This change has also altered the patterns of mobile phone usage and left this technology subject to potentially problematic usage. Such problematic usage of mobile phones interferes with other activities in daily life, alters interpersonal relations and may even affect people’s health and happiness (Augner & Hacker, 2012; Choliz, 2012; Leung, 2008). Problematic mobile phone usage can be categorized as: dangerous usage (e.g. using a mobile phone while driving), inappropriate usage (e.g. using a phone in cinema or class), and overuse (Walsh, White, & Young, 2007). All three usage types are considered as important indicators that someone is on the path to smartphone addiction (Choliz, 2012). Smartphone addiction causes either directly or indirectly various problems in terms of mental health, campus life and interpersonal relationships (Choi, Lee, & Ha, 2012).

Researchers differentiate between the use of smartphones and their extensive use and, eventually, their addiction. While the first one suggests an adaptation of the device to the social life of a person, the other two reflect behaviors with potential negative effects on the psychosocial adjustment of users. The problematic use does not necessarily imply addictive behavior, although it poses a risk to users (Elhai, Dvorak, Levine, & Hall, 2017; Elhai et al., 2018; Panova & Carbonel, 2018). In fact, although related, these terms present both convergent and divergent points. Although sometimes the problematic use of smartphones can be linked to addiction (craving, for example), there are other types of problematic uses that would not necessarily imply addiction (reckless driving when sending text messages, for example) (Billieux, Maurage, Lopez-Fernandez, Kuss, & Griffiths, 2015; Billieux, Philippot et al., 2015).

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I would delineate smartphone use as follows:

I would use the term problematic smartphone use synonymously with smartphone overuse. You may argue that use of smartphone while driving is not necessarily overuse but tell me who would use smartphone while driving but otherwise normally. People who use smartphone dangerously or inappropriately almost always use smartphone excessively otherwise also. It is their tendency to use phone excessively anywhere results in dangerous or inappropriate use.

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Excessive or problematic smartphone use is twice as prevalent among teenagers as among adults (Park & Park, 2014). Previous studies have reported a prevalence of problematic smartphone use among children and adolescents as high as 10% in countries such as the United Kingdom (Lopez-Fernandez, Honrubia-Serrano, Freixa-Blanxart, & Gibson, 2014), 16.7% in Taiwan (Yen et al., 2009), 16.9% in Switzerland (Haug et al., 2015), 30.9% in Korea (Cha & Seo, 2018), and 31% in India (Nikhita, Jadhav, & Ajinkya, 2015). In a recent study in the United Kingdom, approximately 90% of teenagers between the ages of 16 and 24 years old have a smartphone, and approximately half of them would check their phones within 5 minutes of waking up (Ofcom, 2016). In Korea, 80.4% of elementary school students began to use smartphone at or below 10 years old, and 59.9% of them spent 1 hour or more per day using their smartphone (Lee & Kim, 2018). Girls showed a higher tendency to have difficulties with smartphone use (Choi et al., 2015; Kwon & Paek, 2016; Lee, Kim, & Choi, 2017). Approximately 69% of girls and 63% of boys reported having fears of being separated from or not accessing their smartphones (Louragli, Ahami, Mammad, & Lamrani, 2018). Most of the adolescents spent time on Facebook, followed by WhatsApp, Twitter, Instagram, and other social media platforms (Louragli et al., 2018). Boys used smartphones for entertainment purposes such as games and videos or music whereas girls used more communication applications for texting and chatting (Lee & Kim, 2018).

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Adverse Effects of Smartphone Overuse:

The overuse of smartphone can lead to a series of problems. Studies have shown that, excessive smartphone use is associated with depression and anxiety disorders. In addition to psychological health, it has also been associated with physical health problems. For instance, due to small screen size, touch panel, and handholding, long time using smartphone increases the risk of ocular diseases, dysfunction of fingers, neck pain, and other musculoskeletal problems. Moreover, smartphone overuse also leads to dysfunctions in daily life, as it distracts people, distorts perception of time, and negatively affects productivity and interpersonal relationships. Moreover, smartphone overuse also sucks up time that could have been spent in a more constructive way, and is associated with other lifestyle risk behaviors such as physical inactivity.

Another adverse effect of smartphone overuse is accidents and injuries. Smartphone use leads to slowed reaction time and increased distraction, both of which are associated with accidents. It was reported that about a quarter of motor vehicle accidents were attributable to drivers using cell phones in the United States. In addition, because of reduced situation awareness and distracted attention, pedestrians using smartphones have high risk of traffic accidents and falls. It was estimated that about 2 million pedestrian injuries were related to mobile phone use in the United States in 2010. A self-reported survey in Shanghai showed that more than 80% drivers had ever used mobile phone while driving. 

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Technological addictions and beyond:

The obvious changes in society due to the technological revolution led to large-scale research efforts to describe and also treat the problem of Internet addiction (Young, 1998; see also Camardese, Leone, Walstra, Janiri, & Guglielmo, 2015; Dau, Hoffmann, & Banger, 2015) and its close relative, smartphone addiction (e.g. Choi et al., 2012; Kim, 2013). Although the scientific community has not solved the important question of whether Internet addiction requires its own category in the Diagnostic and Statistical Manual of Mental Disorders (which is—among other reasons—due to strong overlap with tendencies toward ADHD and depression, e.g. Sariyska, Reuter, Lachmann, & Montag, 2015; Yen, Ko, Yen, Wu, & Yang, 2007; Yoo et al., 2004), in the last edition of the DSM, (DSM5), the term Internet Gaming Disorder has been included as an emerging disorder in section III. By the inclusion of this term in this section of DSM-5, a clear call goes out to the scientific community— namely, to investigate this delicate topic. 

Although the concept of addiction has multiple definitions, traditionally it has been described as the repeated use of a substance despite the negative consequences suffered by the addicted individual (Alavi et al., 2012). More recently, the notion of addiction has been generalized to include behaviors like gambling, sex, exercise, eating, Internet, and cell-phone use (Griffiths, 1995; Roberts & Pirog, 2012). Any entity that can produce a pleasurable sensation has the potential of becoming addictive (Alavi et al., 2012). Similar to substance addiction, behavioral addiction is best understood as a habitual drive or compulsion to continue to repeat a behavior despite its negative impact on one’s well-being (Roberts & Pirog, 2012). Any oft repeated behavior that triggers “specific reward effects through biochemical processes in the body do have an addictive potential” (Alavi et al., 2012, p. 292). Loss of control over the behavior is an essential element of any addiction. Based on research aimed at better understanding cell-phone addiction, Shambare et al. (2012) concluded that mobile phone use can be “dependency-forming, habitual, and addictive” (p. 577). Importantly, cell-phone addiction does not happen overnight, and, like most forms of behavioral addiction, occurs via a process (Martin et al., 2013). Addiction often begins with seemingly benign behavior (i.e., shopping, Internet and/or cell-phone use, etc.) that, via a variety of psychological, biophysical, and/or environment triggers, “can become harmful and morph into an addiction” (Grover et al., 2011, p. 1). In the case of cell-phones, such an addiction may begin when an initially benign behavior with little or no harmful consequences – such as owning a cell-phone for safety purposes – begins to evoke negative consequences and the user becomes increasingly dependent upon its use. Owning a cell-phone for purposes of safety, for instance, eventually becomes secondary to sending and receiving text messages or visiting online social networking sites; eventually, the cell-phone user may engage in increasingly dangerous behaviors such as texting while driving. Ultimately, the cell-phone user reaches a “tipping point” where he/she can no longer control their cell-phone use or the negative consequences from its over-use. The process of addiction suggests a distinction between liking and wanting. In other words, the cell-phone user goes from liking his/her cell-phone to wanting it. This switch from liking to wanting is referred to by Grover et al. (2011) as the “inflection point.” This tipping point signals a shift from a previously benign everyday behavior that may have been pleasurable with few harmful consequences to an addictive behavior where wanting (physically and/or psychologically) has replaced liking as the motivating factor behind the behavior. The authors argue that the same neural circuitry experienced with substance addiction is activated with this behavioral form of addiction.

Although various aetiological theories could be used to explain which cell-phone activities are most likely to lead to addiction (e.g., Escape Theory), Learning Theory seems particularly appropriate. Learning Theory emphasizes, among other things, the rewards gained from various cell-phone activities (Chakraborty, Basu & Kumar, 2010). When any behavior is closely followed by an effective “rein-forcer” (anything that rewards the behavior it follows), the behavior is more likely to happen again (Roberts, 2011). This is often referred to as the “law of effect”. Based on the principles of operant conditioning, when a cell-phone user experiences feelings of happiness and/or enjoyment from a particular activity (e.g., a funny, six-second Vine video sent by a friend), the person is more likely to engage in that particular activity again (positive reinforcement). The use of a particular cell-phone activity may also operate under the principle of negative reinforcement (reducing or removing an aversive stimulus). Pretending to take a call, send a text, or check one’s phone to avoid an awkward social situation, for instance, is a common negative reinforcing behavior practiced by cell-phone users. Any activity that is rewarded can become addictive (Alavi et al., 2012; Griffiths, 1999, 2000; Grover et al., 2011; Roberts & Pirog, 2012). The rewards encourage higher involvement with and more time spent in the particular behavior (Grover et al., 2011).

The studies on smartphone addiction represent a continuation of the first studies on addiction to the Internet and to mobile phones and share some of their premises (Herrero et al., 2017a; Herrero, Urueña, Torres, & Hidalgo 2019). For example, these studies share the idea that communication technologies can lead to social isolation, which has negative consequences for well-being. They also share the idea that smartphone addiction have the same negative consequences stemming from behavioral addictions (such as gambling, for example), like poor psychological adjustment, problems at work, or an increase in conflicts with family and friends. The study of smartphone addiction has also brought some novelties like its effects on potential increases of security vulnerabilities and potential exposure to future cyber victimizations (for instance, phishing).

It seems possible that those young people who tend to have a smartphone addiction are also likely to have social, domestic and academic problems. In fact, it has been stated that such individuals’ use of smartphones is higher compared to others, and their tendency to use them gradually increases (Kwon et al., 2013). Young people of the most recent generation, also sometimes known as the ‘wired generation’ (Barnes, 2009), continually organize their activities through their smartphones in class or elsewhere, manage their social networks and use smartphones to keep in touch with each other (Jacobsen & Forste, 2011). When it is considered that young people’s tendency to suffer from smartphone addiction is directly proportional to their mobile phone usage (Augner & Hacker, 2012; Martinotti et al., 2011; Walsh et al., 2007), and that mobile phone addiction is the most extreme unhealthy behaviour with regard to mobile phone usage (Hong, Chiu, & Huang, 2012), it can be assumed that inappropriate use of mobile phones in the classroom environment will affect students in a negative way. Furthermore, the opportunity to access the internet everywhere, using various methods, and the increase of eye-catching applications, may cause students to engage in extraneous activities during class, in other words, to practice ‘cyberloafing’ (Kim, Triana, Chung, & Oh, 2015). Cyberloafing might include communicating with friends via social networks, surfing on the internet or shopping online etc., and it affects students negatively (Blanchard & Henle, 2008; Tindell & Bohlander, 2012). While there are studies in which factors affecting cyberloafing behaviours have been studied (Junco, 2012; Tindell & Bohlander, 2012; Yılmaz, Yılmaz, Oztürk,€ Sezer, & Karademir, 2015), there have not yet been any studies examining the relation of cyberloafing to smartphone addiction. In addition, how certain personal traits (e.g. self-regulation, self-efficacy) affect smartphone addiction is not well enough known.

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Gender and smartphone use:

Past research on gender and technology use suggests that differences may well exist in how males and females use their cell-phones (Billieux, van der Linden & Rochat, 2008; Hakoama & Hakoyama, 2011; Haverila, 2011; Junco, Merson & Salter, 2010; Leung, 2008). Based on his study of gender patterns in cell-phone use, Geser (2006) concludes that, “the motivations and goals of cell phone usage mirror rather conventional gender roles” (p. 3). According to Geser (2006), men see a more instrumental use for cellphones whereas women utilize the cell-phone as a social tool. Seen with land-line phones as well, this use pattern among male and female phone users represents one of the most robust research findings to date in terms of understanding how different motives generate unique use patterns across a variety of technologies (e.g., the Internet). Junco et al. (2010) found that female college students sent more texts and talked longer on their cell-phones that their male counterparts.

Females tend to see technologies like cell-phones and Internet as tools of communication – as a means to maintaining and nurturing relationships. Men, on the other hand, tend to see the Internet and related technologies as sources of entertainment (Junco et al., 2010; Junco & Cole-Avent, 2008) and/or as sources of information (Geser, 2006). In a study looking at Facebook addiction, Kuss & Griffiths (2011) conclude that females, unlike their male counterparts, tend to use social networking sites largely to communicate with members of their peer group.

The other relevant and fairly consistent finding regarding gender and cell-phone use is the level of attachment to one’s cell-phone. Several studies have found that females exhibit a higher level of attachment to and dependence on their cell-phones compared with men (Geser 2006; Hakoama & Hakoyama, 2011; Jackson et al., 2008; Jenaro, Flores, Gomez-Vela, Gonzalez-Gil & Caballo, 2007; Leung, 2008; Wei & Lo, 2006). In a large sample (N = 1,415) of young adults, Geser (2006) found that females 20 years or older were nearly three times more likely than males (25% vs. 9 %) to agree with the statement, “I cannot imagine life without the mobile”. Yet, other studies have reported little or no difference in cell-phone dependence across male and female cell-phone users (Bianchi & Phillips, 2005; Junco et al., 2010). 

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Too much smartphone use: 

Consumers love their smartphones. Why shouldn’t they? Over the first decade of their existence, smartphones have become, for many, an indispensable tool for networking and entertainment as well as a primary channel for marketing. However, some are now worried their smartphone habit has veered into overuse, with fears stoked by massive media coverage of smartphone addiction. This notion may be a bit overstated. The addictive potential of a substance (or experience) is partially defined by its effect on dopamine levels. Smartphone use doesn’t come close to raising dopamine levels to the extent of amphetamines or opiates. Nonetheless, many people think there may be a problem. In Deloitte’s most recent Global Mobile Consumer Survey, 45 percent of users believe they check their smart phones too frequently, and a similar percent are actively trying to limit their smartphone use.

When is it too much? 

The level of concern varies. More people are concerned about smartphone use in Argentina, Mexico and Turkey than in Japan, Finland, and Sweden. Similarly, women tend to be more concerned than men, and younger adults (ages 18-24) are more concerned than adults overall. Not everyone, it seems, is worried about their smartphone habits to the same degree.

The concerns may relate to how smartphones are being used. Not all applications are equal. Checking one’s phone while watching TV, commuting on public transit, or shopping is probably not harmful or negative in any way. Though many people admit to looking at their phones 50 times a day, much of that may be as benign as checking tomorrow’s weather forecast.

It’s likely, then, that when people talk about cutting back on their smartphone usage, they’re talking about different sorts of behavior: distracted driving or walking, for instance, can be problematic, while constant focus on smartphones during social situations may be harming relationships. Again, smartphone behavior differs by various factors, but men and younger people tend to use their phones in these circumstances more than women and older adults according to the survey.

Despite many consumers’ stated desire to cut back on distraction by smartphone, Deloitte Global predicts the number of daily glances will continue to rise. Despite concerns, this may not be a bad thing. In 2018, smartphones have become an all-in-one utility. They now act as wristwatches, radios, TVs, computers, cameras, maps, newspapers, magazines, and much more. As they gain functionality, usage will likely also rise.

Rather than trying to help consumers limit their smartphone usage overall, phone manufacturers, software and app developers, and network operators can look to help consumers cut down on usage that may be detrimental, such as distracted driving, sleeping, and walking. Currently, only 4 percent of people trying to cut back on smartphone use are using an app to measure or constrain usage, as per Deloitte’s survey. Most are simply relying on self-control: putting the phone away or turning it off completely.

For many, these techniques seem to be working. According to the Global Mobile Consumer Survey, most consumers around the world think they are succeeding in limiting their smartphone use. What may be changing, in their cases, is a view of what constitutes harmful or negative use.

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In a study of 1,600 managers and professionals, Leslie Perlow, PhD, the Konosuke Matsushita professor of leadership at the Harvard Business School, found that:

• 70% said they check their smartphone within an hour of getting up.
• 56% check their phone within an hour of going to sleep.
• 48% check over the weekend, including on Friday and Saturday nights.
• 51% check continuously during vacation.
• 44% said they would experience “a great deal of anxiety” if they lost their phone and couldn’t replace it for a week.

“The amount of time that people are spending with the new technology, the apparent preoccupation, raises the question ‘why?'” says Peter DeLisi, academic dean of the information technology leadership program at Santa Clara University in California. “When you start seeing that people have to text when they’re driving, even though they clearly know that they’re endangering their lives and the lives of others, we really have to ask what is so compelling about this new medium?”

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Whether smartphones really “hook” users into dependency remains unclear. But “we already know that the Internet and certain forms of computer use are addictive,” says David Greenfield, PhD, a West Hartford, Conn., psychologist and author of Virtual Addiction: Help for Netheads, Cyber Freaks, and Those Who Love Them. “And while we’re not seeing actual smartphone addictions now,” Greenfield says, “the potential is certainly there.” A true addiction entails a growing tolerance to a substance (think drugs or alcohol) so you need more to get “high,” uncomfortable symptoms during withdrawal, and a harmful impact on your life, Greenfield says. Computer technologies can be addictive, he says, because they’re “psychoactive.” That is, they alter mood and often trigger enjoyable feelings. Email, in particular, gives us satisfaction due to what psychologists call “variable ratio reinforcement.” That is, we never know when we’ll get a satisfying email, so we keep checking, over and over again. “It’s like slot machines,” Greenfield says. “We’re seeking that pleasurable hit.”

Smartphones, of course, allow us to seek rewards (including videos, Twitter feeds, and news updates, in addition to email) anytime and anywhere.

Is such behavior unhealthy?

That really depends on whether it’s disrupting your work or family life, Greenfield says. Such a disruption could be small — like ignoring your friend over lunch to post a Facebook status about how much you’re enjoying lunch with your friend. Or it could be big — like tuning out a distressed spouse or colleagues in a meeting to check email, or feeling increasingly stressed by the fact that everyone else seems to be on call 24/7, so we perhaps we should be, too. Other researchers are seeing clear signs of dysfunction, if not an “addiction.”

According to a 2011 study published in the journal Personal and Ubiquitous Computing, people aren’t addicted to smartphones themselves as much as they are addicted to “checking habits” that develop with phone use — including repeatedly (and very quickly) checking for news updates, emails, or social media connections. That study found that certain environmental triggers — like being bored or listening to a lecture — trigger the habits. And while the average user checks their smartphone 35 times a day — for about 30 seconds each time, when the information rewards are greater (e.g., having contact info linked to the contact’s whereabouts), users check even more often.

Besides creating a compulsion, smartphones pose other dangers to our mental life, says Nicholas Carr, author of The Shallows: What the Internet is Doing to Our Brains. “The smartphone, through its small size, ease of use, proliferation of free or cheap apps, and constant connectivity, changes our relationship with computers in a way that goes well beyond what we experienced with laptops,” he says. That’s because people keep their smartphones near them “from the moment they wake up until the moment they go to bed, and throughout that time the devices provide an almost continuous stream of messages and alerts as well as easy access to a myriad of compelling information sources. “By design,” he says, “it’s an environment of almost constant interruptions and distractions. The smartphone, more than any other gadget, steals from us the opportunity to maintain our attention, to engage in contemplation and reflection, or even to be alone with our thoughts.” Carr, who writes extensively in The Shallows about the way that computer technology in general may be diminishing our ability to concentrate and think deeply, does not have a smartphone. “One thing my research made clear is that human beings have a deep, primitive desire to know everything that’s going on around them,” he says.  “That instinct probably helped us survive when we were cavemen and cavewomen. I’m sure one of the main reasons people tend to be so compulsive in their use of smartphones is that they can’t stand the idea that there may be a new bit of information out there that they haven’t seen. I know that I’m not strong enough to resist that temptation, so I’ve decided to shun the device altogether.”

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Causes of Smartphone Overuse:

There are three sub-themes or groups of factors which arguably contribute to the increasing use of the smartphone: namely, personal factors; smartphone factors; and social factors. Availability of extended free time, low self-confidence, and irresponsibility/escaping certain social gatherings/passing the time, are identified as the main personal factors. The availability of competitively priced smartphones and attractive applications of smartphones are also mentioned in relation to increases in the overuse of smartphones. Finally, a range of social factors are linked with the overuse of smartphones including peer pressure, and fear of losing connection. These factors are delineated in a figure below.

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Why are you addicted to your phone:

The smartphone has become a constant companion. We carry it throughout the day and keep it by our bedside at night. We allow ourselves to be interrupted with messages from social media, emails and texts. We answer phone calls at times when it is not socially acceptable, and we put our immediate interactions with friends and family on hold when we hear that ring tone that tells us a message is arrived. Something fundamental in human behavior has changed: our sense of phone etiquette and propriety has caused us to get out of whack in our interactions with one another. So why is it that we allow ourselves to be interrupted? Why do we feel it necessary to answer these calls?

Each year, young adults spend more and more time on their smartphones. In 2018, they averaged 3 hours and 40 minutes engrossed in their devices each day. In 2019 that figure climbed to 4 hours and 30 minutes. Nowadays they have broken five hours. It’s become kind of an appendage to people. The COVID-19 pandemic has only exacerbated the trend. But, its roots trace back to the addictive nature of the devices. Largely by design, the features that make smartphones convenient and fun also let them hijack the brain’s reward and attention systems.

-1. Smartphones offer Variable Rewards:

A study by B.F. Skinner in the 1950s that demonstrated the theory of the variable schedule of rewards. Skinner observed that lab mice responded most voraciously to random rewards. When mice pressed a lever, they sometimes got a small treat, other times a large treat, and other times nothing at all. Unlike other mice that received the same treat every time they pressed the lever, the mice that received variable rewards pressed the lever more often and compulsively.

Similar to how mice behave when expecting to receive treats, we eagerly check our phones at the slightest ring or buzz, because the dopamine trigger in our brains compels us to answer.  The everyday mundane phone messages that we receive frequently throughout the day are akin to the mice’s small treats. The big treats are the messages that give us pleasure — a message from a friend, a phone call from a loved one, or that funny video we must see. It’s the big treat that is addictive to us and, since we don’t know when that big treat is coming, we “press the lever” compulsively and as often as the ringtone calls us. We are compelled to look at the screen and answer, regardless of where we are and who we are with.

-2. Addictive by Design:

Enjoyable activities, from watching Netflix to gambling, switch on the brain’s “reward pathway,” flooding the brain with the feel-good chemical messenger dopamine. Any dopamine-producing activity can lead to “behavioral addiction,” when a person feels compelled to engage in a behavior to the point that it hurts their health, work, or relationships. (The same mechanism drives drug addiction). Smartphone use falls into that category, according to psychiatrist Anna Lembke, Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Texting friends, swiping dating profiles, even checking email, can all be engaging enough that they keep bringing users back for more. “That’s the hallmark of an addictive drug,” Lembke says. “It just intrinsically draws people in.”

Services like Facebook and YouTube leverage our attention and engagement to sell ads or otherwise attract funding. “It’s happening not by accident, but by design,” said Tristan Harris, a former Google design ethicist who co-founded the Center for Humane Technology, during testimony before the Senate Commerce Committee in 2019. “The business model is to keep people engaged.” To attract and hold attention, app engineers employ techniques familiar to anyone who’s set foot in a casino. One strategy is to remove cues that might wake a user from their reverie. Where casinos lack clocks or windows, social feeds lack bottoms. “If I take the bottom out of the glass,” Harris said, “you don’t know when to stop drinking.”

Harris also cites the “pull to refresh” feature, which may or may not reward the user with new email messages or Instagram photos. In pathological gamblers, uncertainty drives bigger dopamine spikes than money. That is, anticipating a reward is more enjoyable than actually receiving the reward. A similar mechanism may be at play when smartphone users refresh an app, betting seconds of their time on the possibility of new content.

Similarities extend even to appearance. Like casinos, home screens are bright and colorful. And red — the most physiologically arousing of the primary colors — abounds, thanks to omnipresent notification badges. A smartphone has the “flashing lights, the colors, the whistles and bells,” Lembke says. “Even when we try to disengage, it’s hard.”

-3. Attention Deficits:

While smartphone use can become problematic, behavioral addiction falls on a spectrum. Like watching TV or even gambling, most people can indulge in moderation without any adverse effects. Still, there are good reasons to disengage. In 2014, neuroscientist Abraham Zangen took advantage of a brief window at the dawn of the smartphone era to compare smartphone-owning college students with students who hadn’t yet adopted the technology. The heaviest users had more trouble focusing than non-users, scoring roughly five to ten percent higher on tests of attention deficit disorder. They also had diminished activity in the right prefrontal cortex, an area of the brain that regulates attention and self-control. Structural changes in this area have been linked with ADHD. “Your attention is being distracted very, very often,” says Zangen, a professor at Ben-Gurion University of the Negev in Israel.

-4. Part of an extended self:

Our sense of self is shaped while we are still in the womb. The development of the self, however, accelerates after birth. A newborn, first and foremost, attaches herself to the primary caregiver and later to things – acquiring what has been called an “extended self.” The leading 20th-century American psychologist William James was among the first to argue for an extended self. In his “Principles of Psychology,” James defined the self as “the sum total of all that a man can call his, not only his body and his psychic powers, but his clothes and his house, his wife and children.” Losing any of this extended self, which could include money or another prized object, as he explained, could lead to a sense of great loss. In early childhood, for example, babies and toddlers cry if they suddenly lose their pacifier or favorite soft toy, objects that become part of their extended selves. Phones play a similar role. It is not uncommon for you to feel a sudden onset of anxiety should you drop phone or unable to find it.  Psychologist Larry Rosen and his colleagues at California State University found that 51 percent of individuals born in the 1980s and 1990s experienced moderate to high levels of anxiety when they were kept from checking in with their devices for more than 15 minutes. Interestingly, the percentage drops slightly – to 42 percent – for those born between 1965 and 1979. This is primarily because they came into being during a time where hand-held technologies were only beginning to make their entry. For this group, phones became part of their extended self only as late teens or as young adults.

-5. Fulfills need to produce and reproduce:

Anthropologist Michael Taussig reminds us that it is in our “second nature to copy, imitate, make models, [and] explore difference” as we try to become a better or different self. Phones help us do that. We take pictures, manipulate images, join discussions, curate a selfie and reach out to others. By texting back and forth, we weave together a conversation. Through searching, we become knowledgeable (even if we lack wisdom). Thus, we join ancestors who painted on cave walls and told stories around fires. It should not come as a surprise then that smartphones use for internet searches is on a rapid rise. We are destined, it seems, to live with our phones in hand.

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Screen time: 

Screen time (ST) refers to time spent engaging with visual screen-based technologies such as televisions, computers/laptops, videogames, smart phones, tablets/iPads, and handheld electronic or gaming devices. Using the Internet, social media, or communicating via text message are all activities which are included in the definition of ST. Solely auditory activities, such as talking on a phone and listening to music, are not included. The concept is under significant research with related concepts in digital media use and mental health. Screen time is correlated with mental and physical harm in child development. The positive or negative health effects of screen time are influenced by levels and content of exposure. To prevent harmful exposure to screen time, some governments have placed regulations on its usage.

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Screen time recommendations by age chart:

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The first electronic screen was the cathode ray tube (CRT), which was invented in 1897 and commercialized in 1922. CRT’s were the most popular choice for display screens until the rise of liquid crystal displays (LCDs) in the early 2000s. Today two most common labels are LCD and LED. What’s the difference between the two? All LED monitors are LCD monitors. But not all LCD monitors are LEDs. Both types of displays use liquid crystals to help create an image. The difference is in the backlights. While a standard LCD monitor uses fluorescent backlights, an LED monitor uses light-emitting diodes for backlights. LED monitors usually have superior picture quality, but they come in varying backlight configurations. And some backlight configurations create better images than others. A liquid crystal is a substance that has properties of both a solid and a liquid. Typically, the molecules in a liquid crystal are bunched up in a very dense and unstructured arrangement. But when the liquid crystal is exposed to electricity, the molecules suddenly expand into a very structured, interconnected shape. Currently there are two main screen types available for your smartphone – Liquid Crystal Display (LCD) and Light Emitting Diode (LED).  Screens are now an essential part of entertainment, advertising, and information technologies.

All forms of screens are frequently used by children and teens. Nationally representative data of children and teens in the United States show that the daily average of screen time increases with age. TV and video games were once largest contributors to children’s screen time, but the past decade has seen a shift towards smart phones and tablets. Specifically, a 2011 nationally representative survey of American parents of children from birth to age 8 suggests that TV accounted for 51% of children’s total daily screen time, while mobile devices only accounted for 4%. However, in 2017, TV dropped down to 42% of children’s total daily screen time, and mobile media devices jumped up to 35%.

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Daily Average of Screen Time of American Children & Teens, By Age (in years)  

Age Group (in years)	Daily Average of Screen Time	Year Data Were Collected
Under 2	42 minutes per week	2017
2-4	2 hours per week	2017
5-8	2 hours per week	2017
8-12	3 hours per week	2019
13-18	8 hours per day	2019

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Limitations on screen time: 

Adults:

There is no consensus on the safe amount of screen time for adults. Ideally, adults should limit their screen time similar to children and only use screens for about two hours a day. However, many adults spend up to 11 hours a day looking at a screen. Adults many times work jobs that require viewing screens which leads to the high screen time usage. Adults obligated to view screens for a means of work may not be able to use screen time less than two hours, but there are other recommendations that help mitigate negative health effects. For example, breaking up continuous blocks of screen time usage by stretching, maintaining good posture, and intermittently focusing on a distant object for 20 seconds. Furthermore, to mitigate the behavioral effects, adults are encouraged not to eat in front of a screen to avoid habit formation and to keep track of their screen use every day. Specialists also recommend that adults analyze their daily screen time usage and replace some of the unnecessary usage with a physical activity or social event.

Children:

In 2019, the World Health Organization came out with guidelines about media use for children under 5:

• Birth to age 1: No sedentary screen time
• Ages 2–4: No more than 60 minutes of sedentary screen time

More extensive guidelines have been put forth by the American Academy of Pediatrics (AAP) in 2016 for children up to age 5, which include screen time, the quality of content used, and how parents are using screens with their children. The screen time limits are as follows:

• Birth up to 18–24 months: No screen time (with the exception of video chatting)
• 18–24 months: Limit screen time as much as possible
• Ages 2–5: Limit screen time to about an hour a day

In addition to these screen time guidelines, the AAP recommends that when screen time does occur, the content should be high-quality, educational, slower-paced, and free of violence. Caregivers should avoid giving apps to children that have highly distracting content. They also recommend that families try to use media with their child so that they can help explain what content is on the screen and how it applies to their own lives. They recommend to turn off devices (including TVs) when the child is not actively using them and to keep bedrooms as screen-free zones. Additionally, they recommend that screens should be put away at least 1 hour before bedtime.

There is no one-size-fits-all approach for how much screen time older kids and adults should get. A general rule of thumb is that screen time shouldn’t interfere with learning, relationships with peers and family, physical activity, sleep, or their mental health. For older kids and adults, it’s hard to put an exact number on how much screen time is too much. However, research shows that there are many ways excessive screen time can damage your physical and mental health.  For children from ages 5 to 18, the AAP came out with recommendations in 2016 that focus less on the amount of screen time and more on how media is being used. They recommend children and teens should keep devices (including TVs) out of the bedroom during bedtime, and screens should be put away at least 1 hour before bedtime. They recommend that caregivers discourage children and teens to use screens during homework for entertainment purposes. Additionally, they recommend that families come up with a “Family Use Plan” that aligns with their family’s needs, values, and goals. This plan should have consistent guidelines and limits for each family member, and families should consider having designated times of the day and areas in the house that are screen-free.

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Early screen viewing is likely to lead to long periods of viewing for the rest of your life. The way you view screens when you are young forms the habits you pick up for ever after it seems. An early taste for entertainment screen media can lead to changes in the brain that stay with you for life. Like other addictions screen time creates significant changes in brain chemistry – most notably, in the release of dopamine. This neurotransmitter – also known as the pleasure chemical – is central to addictions from sugar to cocaine. Dr Peter Whybrow, director of neuroscience at UCLA, calls screens “electronic cocaine” and in China researchers tag them “digital heroin.” Dopamine is produced when we see something that is interesting or new, but it also has a second function. Dopamine is also the neurochemical involved in most addictions – it’s the reward chemical. There are concerns among neuroscientists that this dopamine being produced every single day for many years—through for example playing computer games—may change the reward circuitry in a child’s brain and make them more dependent on screen media. Too much screen time may be displacing face-to-face contact, and that lack of social connection is associated with physiological changes, increased incidence of illness and higher premature mortality.

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Screen Time and Children: 

Children and adolescents spend a lot of time watching screens, including smartphones, tablets, gaming consoles, TVs, and computers. On average, children ages 8-12 in the United States spend 4-6 hours a day watching or using screens, and teens spend up to 9 hours. While screens can entertain, teach, and keep children occupied, too much use may lead to problems.

Here’s how children spend their screen time:

• 73% TV/video viewing
• 16% gaming
• 3% reading
• 1% homework
• 1% video-chatting
• 6% other/unknown

With so much digital media directed toward kids – from streaming videos to games and educational tools – parents rightly worry how much is too much. Experts also now emphasize that how kids use screens is just as important as how much they use them.

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Parents may not always know what their children are viewing, or how much time they are spending with screens. Children may be exposed to:

• Violence and risk-taking behaviors
• Videos of stunts or challenges that may inspire unsafe behavior
• Sexual content
• Negative stereotypes
• Substance use
• Cyberbullies and predators
• Advertising aimed at your child
• Misleading or inaccurate information

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Too much screen time may lead to:

• Sleep problems
• Lower grades in school
• Reading fewer books
• Less time with family and friends
• Not enough outdoor or physical activity
• Weight problems
• Mood problems
• Poor self-image and body image issues
• Fear of missing out
• Less time learning other ways to relax and have fun

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Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews, 2016:

13 reviews were identified (1 high quality, 9 medium and 3 low quality). 6 addressed body composition; 3 diet/energy intake; 7 mental health; 4 cardiovascular risk; 4 for fitness; 3 for sleep; 1 pain; 1 asthma. Authors found moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms; moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life. There was weak evidence for associations of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem, poorer well-being and poorer psychosocial health, metabolic syndrome, poorer cardiorespiratory fitness, poorer cognitive development and lower educational attainments and poor sleep outcomes. There was no or insufficient evidence for an association of screentime with eating disorders or suicidal ideation, individual cardiovascular risk factors, asthma prevalence or pain. Evidence for threshold effects was weak. Authors found weak evidence that small amounts of daily screen use is not harmful and may have some benefits.

Conclusions:

There is evidence that higher levels of screentime is associated with a variety of health harms for children and young people (CYP), with evidence strongest for adiposity, unhealthy diet, depressive symptoms and quality of life. Evidence to guide policy on safe CYP screentime exposure is limited.

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The Positive impact of smartphones: 

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Mobile phones serve plenty of beneficial uses, some of which have the potential to increase an individual’s quality of life. According to Burckhardt and Anderson, quality of life is determined by five dimensions: material and physical well-being, relationships with other people, social, community and civic activities, personal development and fulfilment, and recreation. Based on these dimensions, one can assert that mobile phones promote physical well-being through helping users access help in the case of an emergency, and encourages users to form and maintain relationships with others (e.g., family or partners) via social media networks. Mobile phones can also promote engagement in social, community and civic activities, enabling users to support social causes such as reducing fuel consumption while driving, in addition to promoting personal development and fulfilment through offering users a plethora of information on a variety of topics (via websites, apps). Finally, mobile phones can also help users engage in recreational activities through games and music. While such research highlights the positive contribution made by mobile phones to modern society, problematic or excessive mobile phone use can alternatively contribute to an array of adverse outcomes.

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Smartphone technology a wonderful tool to support various services and the people feel better positioned with it. Smartphones with the availability of social media platforms are key factors for providing services viz: – Better way to communicate with people, Learning, business, and other applications. Gothami & Kumar (2016), says that smartphone have maximum benefits pertinent to education, social life, entertainment etc. John (2013) highlights that smartphones have brought a massive change in the lifestyle of people and they feel comfortable in offering user a vast platform for communication and access to a wide range of applications. People enjoy varied and easier services they provide like: Exposer to learn things, ways to personality development and ideas to succeed in business (Mojaheren, 2017). Tavasalker (2014) highlights that smartphones save time, offers of thousands of Apps, go hands free, e-mails, Free calls, Chat, Wi-fi etc. Felecia (2019) says smartphones provides access to internet, e-mails and social networking cites and also finishes multiple tasks simultaneously. Anderson (2019) reveals that smartphones keep one connected with social networks and enable one to online shopping, latest news updates and sports. While Purewal (2015) is of the opinion that the smartphones have improved life style and made lives of people better by providing multiple features like: – Keeps you safe even if alone, Detect Earthquakes, make doctor mobile, always on the scene, help people to cope with Illnesses and Disabilities etc. Jung (2019) believes that smartphone technology has become very important part of life and people feel incomplete without it. It offers various services like take photos, direction (GPS), track appointments and contacts and also helpful in business purposes. In the light of these studies, it can be concluded that this technology has revolutionized the people’s way of life in all affairs of human development and paved the way for getting multiple features to enjoy individuals’ life.

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Mobile phones have significantly transformed our lives over the past decade and have become indispensable part of our lives. They have not only allowed for people all around the world to connect with ease but have also been adopted for different purposes such as conducting business, entertainment and for providing emergency alerts. Nowadays, we are always mere seconds away from learning about happenings around the world. There is even evidence to suggest that mobile phones have revolutionized the lives of millions of people in poverty by increasing their access to education, weather information (particularly important for farmers and fishermen) and critical knowledge pertaining to business and healthcare from even remotest locations.

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The Negative impact of smartphones:

According to Mount (2012), people use smartphones at least 5 hours a day and also usage of Apps increases significantly and with the result caused degradation in physical social interaction, distraction, addiction, health problems etc. Leonard (2015) has expressed a great concern and says that smartphone use has become a serious addiction phenomenon, it has been found that female college students use phones on an average of ten hours a day. Another survey found that three out of five smart phone users can’t go more than 60 minutes without checking their phones. A new phobia has been developed known as NOMOPHOBIA (fear of being without a phone). Boumosleh & Doris (2017) in their study about Smartphone addiction among the university students found that 35.9 % of students feel tired during daytime and 38.1% have decreased sleep quality as they remain addicted with smartphones till late nights. Similarly, Kendra (2018) expresses that the excessive use of smartphone can exacerbate thumb arthritis by excessive texting on mobile phones.  Reading on smartphones is worse for learning and comprehension (Markley, 2018). According to Kelley (2018), these devices create ADHD –like symptoms in users, thus diminish the happiness between social settings due to the constant flow of information to their phones and also disconnect the relation between parent and children. Butler (2019) has identified the negative aspects of smartphones and says that smartphone owners have produced such sites to enable the users proprietary information or financial data thus causes Security risk. Parasuraman, et.al, (2017), in their research reveals that overuse of smartphone may lead to psychological and physiological complication.

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Along with the numerous benefits, mobile phones also have various limitations.

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Negative impacts of smartphone overuse are as follows:

-1. Distraction:

Sometimes mobile is a disturbing device that creates a distraction between your works. It is seen in students that are easily distracted from their studies because of mobiles, as the device contains applications that attract users to enjoy their software. One such application is the various mobile games that are being played a couple of days make the people addicted and distracted from their goals. Another study, this time from Florida State University, says that smartphones notifications can impair our concentration, even being short in duration they cause enough of a distraction to affect your ability to focus on a given task, decreasing your performance by prompting task-irrelevant thoughts and mind-wandering. This can be very dangerous in some specific situations, like driving, for instance, a simple notification can cause really serious accidents. Simply talking or texting can be distracting and contributes to diminished performance when multitasking. In fact, simply the presence of a cell phone is said to be distracting, especially when in social settings.

-2. Hearing loss:

Simply chatting to someone on the phone won’t damage your hearing, but if you use your smartphone and headphones for listening to music then you might have cause for concern. According to the National Institute on Deafness, around 26 million Americans suffer from noise-induced hearing loss. One source of such noise is from headphones, like the ones that come with your phone. If we listen to music that is too loud, we can damage the tiny hairs in the inner ear, which transmit chemical signals through nerves to the brain.

What level is too loud?

The Dangerous Decibels public health campaign states that repeated exposure to noises above 85 decibels can cause hearing loss – approximately the noise level of heavy traffic. The maximum volume of a smartphone is around 105 decibels – or that of a concert. Listening to music at this volume for more than four minutes would likely result in damage to hearing. Even if you lower it to just 94 decibels, you can cause damage if you listen for over an hour.

-3. Wastage of time:

Although mobiles are helpful in various aspects, it is one of the biggest thing responsible for the wastage of time. Most students and teenagers are affected by it. Students want to play games, watching movies, listening songs, and other kinds of entertainment that waste their precious time. If people are spending a lot of time on their phones, that displaces time for other important activities, like exercise and socialization. It doesn’t leave a lot of free time in your day for physical activity or other things. A recent study from the digital analytic firm Flurry shows that we surprisingly spend on average almost 3-4 hours a day staring at our smart devices, totalizing nearly one day every week!  If you think most of the time you spend on your phone is done doing “productive” activities, the in-depth study by CodeComputerLove will prove otherwise as seen in the figure below.

The act of compulsive checking can be hazardous to our productivity. According to a study by the University of California Irvine, it takes an average of 23 minutes and 15 seconds to get back to the deep focus you had on a task once you have been distracted.  AMA found that even brief mental blocks can cause you to lose as much as 40% of your productive time.

-4. Addiction to mobile phone:

Manifestations of smartphone addiction include: Always keep your phone with you; Constantly checking the phone every few minutes; The phone cannot be turned off during weekends; More interested in texting or seeing posts from online friends than meeting each other in real life; etc. In this mental disorder, people are unable to stop using mobile phones. They even can’t imagine themself without a mobile. Using mobile phones too much makes a person addicted to them.

-5. Computer Vision Syndrome:

Staring at the tiny font in your texts and scrolling through dozens of tweets can lead to eyestrain, blurred vision, dizziness, and dry eyes. And blurred vision plus sore neck muscles can also cause headaches. If you’re experiencing eye discomfort, make your phone’s font size bigger. Phone users should try to hold their phones at least 16 inches away from their faces. Every few minutes look up from your screen at something far away for short breaks, and don’t forget to blink.

-6. Nomophobia:

Short for “no-mobile-phone phobia,” this is exactly what it sounds like: the fear of being without your cell. According to a study of 1,000 people in the U.K., 66% of the population fears losing or being without their phones at any given time. Some of the symptoms of nomophobia include anxiety or negative physical symptoms if you have lost or cannot use your cell phone, obsessively checking to make sure you have your phone with you, and constantly worrying about losing it somewhere. Interestingly, the study found that women suffer from this more than men.

-7. Phantom Pocket Vibration Syndrome:

No, you didn’t just get a text message! A professor at Indiana University found that 89% of the undergraduates in her study experienced phantom vibrations when their phones weren’t actually vibrating. The study also found that students who were dependent on text messages and social media updates were more anxious when their phones weren’t really vibrating.

-8. Cyberbullying:

Cyberbullying means to send, post, or share negative, false, and harmful content about someone else. Research shows that most students and teenagers got cyberbullied. Cyberbullying puts someone’s life in danger.

-9. Security issues:

These are common issues that happen with mobile users. iPhone IOS is little bit secure but in android phones breaching someone’s privacy and data is easier for hackers. Security issues are the dangerous effects of using mobile phones. People faced a lot of problems due to security issues, such as loss of money, image, reputation, and others. Additionally, due to the advanced functionality of mobile phones, an increase in usage may also result in individuals being subjected to security issues such as location tracking, access to personally identifiable information (through software apps), and mobile malware, all of which can increase users risks of falling victim to identity theft or robbery.

-10. Physical health problems: 

Excessive use of mobile phones causes various health problems.

Text Neck:

This clinical condition refers to the onset of cervical spinal degeneration that results from the repeated stress of frequent forward head flexion while we look down at the screens of mobile devices and while we “text” for long periods of time. Text neck syndrome is more common in adolescents, who, for several hours a day and for several days a year, hunch over smartphones and personal computers more frequently than in the past. It is estimated that 75% of the world’s population is hunched over their handheld devices hours daily with their heads flexed forward. The weight of the head on the spine is dramatically increased when it is flexed forward, and the effects and amount of weight are strongly and progressively enhanced by varying the degrees. In fact, a full-grown head weights almost 5 kg in the neutral position. The more the head is flexed, more the forces on the neck surge to more than the double at 15° (roughly 12 kg). In addition, the burden of the weight of the head increases to 18.14 kg at 30° and to 22.23 kg at 45°, reaching a more than fivefold effect at 60°, arriving to a 27.22 kg. Not only the degree of the neck flexion is relevant but also the frequency of head bending induces additive effects on the neck physiology. In fact, the frequent forward flexion can change the cervical spine, curvature, supporting ligaments, tendons, musculature, the bony segments, commonly causing postural change and pain on the neck and associated areas

Text Claw:

A recently coined condition, “text claw” occurs after consistently gripping your smartphone, curling your fingers round into an unnatural position for long periods of time. “Text Claw” is a non-medical term that describes all of the finger cramping and aching muscles that come from constant gaming, scrolling and texting on smartphones, the medical term for it is “cubital tunnel syndrome”. It can also be called “Cell Phone Elbow”, described numbness or tingling in the ring and little fingers that occurs after when the elbow is bent for long periods of time. Bending the elbow for long periods of time like when using a cell phone, sleeping with your elbows bent, or holding your arms bent and by your head can cause cubital tunnel syndrome. This syndrome is caused by pressure or the stretching of the ulnar nerve which runs in a groove on the inner side of the elbow. This causes numbness or a tingling sensation in the ring and little fingers, forearm pain, and weakness in the hands. Keeping the elbow bent for a long time – most often, while holding your phone – can stretch the nerve behind the elbow and put pressure on it.

“Text claw” is also the unofficial term given to a phenomenon caused by repetitive use of the wrist and hand muscles. Overuse of these muscles can lead to pain, weakness, and a loss of range of motion in the wrist and hand. Sometimes this can lead to tendonitis, which causes wrist pain, aching, numbness, and the loss of strength. So text claw can occur without involvement of ulnar nerve.

Strain on your Eyes:   

Direct exposure to blue light – like the one that comes from cellphone screens – can cause damage to the retina of the eye. The American Macular Degeneration Foundation warns that retinal damage of this nature may lead to macular degeneration, which causes the loss of central vision (the ability to see what’s in front of you). In the research however, the blue light was placed directly in front of the eye – which isn’t exactly how cellphones are used. However, long term effects of blue light exposure are not known. Staring at phones for a prolonged amount of time can cause dry eyes and even blurred vision. 

-11. Psychological health effects:

Smartphone overuse causes mental disorders such as depression, anxiety, tension, and others. Overuse or dependence on technology may have adverse psychological effects, including:

Isolation:

Technologies, such as social media, are designed to bring people together, yet they may have the opposite effect in some cases. A 2017study in young adults aged 19–32 years found that people with higher social media use were more than three times as likely to feel socially isolated than those who did not use social media as often.

Depression and anxiety:

According to a review published in 2022, smartphone overuse—which intensified during the pandemic—can worsen the severity of anxiety and lead to psychiatric symptoms, stress, and depression. Another recent study concluded that problematic smartphone use is correlated with suicidal ideation and even suicide attempts. The question always is: chicken or egg? Were they depressed and anxious and, as a result, spending more time with their devices, or is it that spending time online made them depressed and anxious? It’s probably a little bit of both.

-12. Obesity:

One 2021 study found that screen time was associated with binge-eating disorder among 9- and 10-year olds. Teens can binge eat even in the absence of hunger when they’re distracted in front of phones and screens, leading to weight gain. Another 2021 study found that phone use and texting led to higher BMI and weight gain in teens.

-13. Sleeping issues:

Using the mobile phone in an excessive amount badly affects the sleeping routine. Smartphones could cause something akin to a “hangover,” because we can’t detach from them in the time. Workaholics find it especially hard to put down the phone in case they miss a client email. Using technology too close to bedtime may cause issues with sleep. The blue light emitted from a smartphone can trick our bodies out of releasing less melatonin, our natural sleep hormone. That means it could be harder to fall asleep, and when we do it could be less restful sleep. And having notifications, rings, or sounds throughout the night can definitely disturb your sleep.

-14. Children:

Children’s brains are still developing and may be more sensitive to the effects of technology and its overuse than adult brains. A 2018 review of various studies noted the possible adverse effects of children using different technologies. Children who overuse technology may be more likely to experience issues, including:

• low academic performance
• lack of attention
• low creativity
• delays in language development
• delays in social and emotional development
• physical inactivity and obesity
• poor sleep quality
• social issues, such as social incompatibility and anxiety
• aggressive behaviors
• addiction to these technologies
• higher BMI

The research also noted the importance of teaching children to interact with these technologies in healthful ways by monitoring their time using them and providing interesting alternatives. Additionally, a study of teenagers aged 15–16 found that those who had high digital media use had an increased chance of developing symptoms of attention-deficit hyperactivity disorder (ADHD).

-15. Accidents:

People stuck in their mobiles, even walking on roads, or driving a car. Using a mobile phone while driving causes accidents and puts the lives of others at risk. About 61% of active Australian drivers have reported using their mobile phone while driving despite the unlawfulness and dangers surrounding this behavior. Another example is using a mobile phone while crossing the road. Research shows that at least a quarter of pedestrians cross the road while engaged in visual-manual interactions such as texting and browsing on a mobile phone. Given the increasing risks of phone use while walking, some jurisdictions (Honolulu; Mont Clair; Stamford) now prohibit the use of mobile phones while using cross-walks.

-16. Social Effects:

Instead of making us more connected, our smartphones could be making us more isolated. Not only are we more distracted and less ‘present’ in social scenarios thanks to our cellphones, we’re also becoming less connected to our peers on a deeper level. Researchers from the University of Essex found that people who discussed personally meaningful topics when a cellphone was nearby (even if they weren’t being used) reported lower relationship quality and less trust in their partner. They also felt their partner was less empathic to their concerns. Smartphone use is also likely to make us more selfish, and less likely to engage in ‘prosocial’ behavior, says University of Maryland research. Prosocial behavior is defined as an action intended to benefit another person or society as a whole – like volunteering or simply helping out someone in need.

We may not be able to live without our phones but we can take steps now to reduce the negative effects of its overuse. One way is by reducing the time spent on your phone and trying to communicate face-to-face instead of relying on your phone for every small task, so you can focus on what really matters in life.

-17. Death:

Over 55 million people die every year. While most people die of natural causes – illnesses and old age, about five percent of the people on the planet die unnaturally. The two chief contributors to unnatural deaths are road accidents and suicide, and the increasing number of road accidents and suicide cases are now attributed to smartphones and social media use.  According to the World Health Organization, suicide rates among teens aged 15-19 rose by 47% between 2000 and 2017. It is a clear sign that after introducing smartphones and social media, the mental health of people all around the world has deteriorated significantly. While physical and mental health issues, social crime, and suicide among teenagers linked with the excessive use of smartphones are already alarming, this is just the tip of the iceberg when we look into the death caused by the use of smartphones on the road.  Statistics show that 23% of road accidents result from smartphones distracting the driver, which accounts for more than a quarter of a million deaths worldwide.

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Major negative impacts of the overuse of smartphones include academic engagement and performance (low academic performance/not paying attention); physical (experiencing body pain, lack of sleep, and low exercise); mental well-being (stress and anxiety, mood swings and negative emotions); and social (isolation and decreased face-to-face communication) as seen in the figure below:

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Smartphone overuse: A hidden crisis in COVID-19, a 2021 study:  

The COVID-19 has interrupted normal activities and surfaced as the most significant health and economic challenges after the 2nd World War. Most countries have imposed lockdown to break the chain of community transmission of this novel virus, which has changed the way we are used to living in. Stay at home and work from home strategies are recommended worldwide as the most useful to prevent infection at both individual and community levels. This self-isolation has encouraged people to turn to their smartphones to stay connected increasingly.

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Smartphones forge opportunities for individuals to engage more in different online activities such as participating in social network sites, playing video games, surfing the web, and so on. A recent global survey showed that about 70 percent of internet users, especially the young generation worldwide, were using their smartphones or mobile phones more as a direct result of lockdown due to the coronavirus outbreak. Such findings suggest that COVID-19 related lockdown policies might lead to the overuse or excessive usage of smartphones. Now, the question is whether overuse or excessive use of smartphones during the COVID period could develop particular harmful health issues and remain unchanged in the post-lockdown period. Smartphone overuse may lead to physical and psychological health, different musculoskeletal pain such as the neck, lower back, shoulder pain, depression, and anxiety. This may result in the problematic use of smartphone, which can hack the “reward system” of the brain to engage one in activities that s/he was employed during the lockdown period. Thus, there is a high chance that subsequent harms will persist in the form of various mental health disorders, even if the lockdown effect is withdrawn.

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The overusing pattern of smartphone involves a tendency to check notifications all the time. Such behaviour pattern can induce “reassurance seeking” pathway which broadly includes symptoms such as loneliness, low self-esteem, depression, and anxiety. This reassurance-seeking behaviour is explainable with the theoretical model of ‘problematic mobile phone use’ suggested by Bilieux and colleagues. Excessive use of smartphones may also affect sleep patterns by reducing rapid eye movement sleep, slow-wave sleep and consequently causing sleep deficiency. Excessive use of smartphones can potentially lead to gaming disorders and internet use disorders and eventually be considered to cause psychosocial crisis (i.e., sleep deprivation, stress, mood disorder and anxiety), which could be the aftermath of the COVID period.

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School students are also vulnerable, as one study suggested that 61% of parents classified their children as addicted to their smart devices for doing activities. As educational institutions are temporarily closed, and school-children are passing their time at home or pursuing online classes, they can potentially be more exposed to using the internet and smart devices for their entertainment.

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As countries are taking steps to relax lockdown, it is high time to identifying people who might have the problematic use of smartphones or other smart devices. First, we need a screening tool to identify people. Second, we require developing and implementing psychiatric intervention (e.g., establishing peer support). Third, though smartphone overuse currently is not an official diagnosis, the introduction of general health education services is required to reduce smartphone use. Therefore, health communication is required through the mass media to sensitise people about the problematic use of smartphone. For many users, problematic smartphone use might not pose a problem at all. Thus, without proper initiative, problematic smartphone usage can turn into an emerging public health challenge to annihilate lives by perpetuating the socio-psychological problems. It will be a crucial step to monitor smartphone overuse and take necessary action to minimise the problem through protective policies and family support during and after this COVID-19 pandemic.

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Section-2A

Smartphone overuse counterview: 

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The smartphone “overuse” shamers are broken down into three main categories:

-1. Those without smartphones. These are the most understandable, because not everyone can afford smartphones, and it’s definitely annoying to be the only one in a group without one.

-2. Needy narcissistic extroverts who must be the center of attention even when they have no insights to offer. They bore you with insular chatter, and when you reach for your phone in desperation, they tirade you into putting it away, only to continue the same insular ranting that sent you hurrying for your phone in the first place.

-3. Moral crusaders determined to enforce antiquated social etiquette. They especially cling to the arbitrary rule that people who are next to each other need to be talking to each other, simply because of their proximity in space and familiarity with each other. 

The latter group in particular thinks the visual of people standing or sitting next to each other, yet focused on their own phones, is self-evidently tragic and offensive. Using our phones doesn’t mean that we’re bored of each other forever, or that we’ve stopped respecting each other as people.

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Harms of smartphone overuse overblown: 

Behavioral science has spent many years attempting to understand how our interactions with technology might impact on numerous psychological outcomes (Shaw, Ellis, & Ziegler, 2018). This lends itself to a wide variety of research questions from problematic use (e.g., do smartphones cause depression or anxiety?), to the effects of engaging with feedback as part of a behavior change intervention (e.g., does monitoring physical activity improve health?) (Ellis & Piwek, 2018). Approaches within psychology have almost exclusively focused on correlational research that involves asking people to consider their personal experience with a technology rather than measuring their actual behavior (Ellis, Kaye, Wilcockson, & Ryding, 2018a). This reflects a general trend within social psychology as a whole (Baumeister, Vohs, & Funder, 2007; Doliński, 2018), but remains surprising when considered alongside automated systems (e.g., smartphones (Miller, 2012)) that can record human-computer interactions directly (Piwek, Ellis, & Andrews, 2016). For example, behavioral interactions can be measured ‘in situ’ with applications. However, this is not an avenue explored by the majority of psychological research, despite having spent over a decade attempting to define ‘problematic’ or ‘addictive’ smartphone behaviors (Panova & Carbonell, 2018).

Conclusions surrounding use have therefore been largely negative and smartphones have repeatedly been associated with depression (Elhai, Dvorak, Levine, & Hall, 2017), anxiety (Richardson, Hussain, & Griffiths, 2018), disrupted sleep (Rosen, Carrier, Miller, Rokkum, & Ruiz, 2016), cognitive impairment (Clayton, Leshner, & Almond, 2015), and poor academic performance (Lepp, Barkley, & Karpinski, 2015). This repeats a pattern of research priorities, which previously focused on the negative impacts of many other screen-based technologies, systematically moving from television and video games, to the internet and social media (Rosen et al., 2014). 

While some research has reported many beneficial effects of technology use (e.g., Barr, Pennycook, Stolz, & Fugelsang, 2015; Przybylski & Weinstein, 2017; Ward, Dill-Shackleford, & Mazurek, 2018), ominous results have had a far greater impact on public opinion. This has recently led to a UK government enquiry concerning the effects of screen time on health (UK Parliament, 2018). However, regardless of whether research aims to focus on narrow or broad definitions of technology use, our current understanding is based around a set of popular measures that present several methodological shortcomings (Shaw et al., 2018; Ryding & Kaye, 2018). This has become particularly pertinent as methods of investigation have remained static despite exponential changes in the availability and processing power afforded by modern technology (Shaw et al., 2018).  

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Are smartphones really that bad? Improving the psychological measurement of technology related behaviors, a 2019 study:

Understanding how people use technology remains important, particularly when measuring the impact this might have on individuals and society. To date, research within psychological science often frames new technology as problematic with overwhelmingly negative consequences. However, this paper argues that the latest generation of psychometric tools, which aim to assess smartphone usage, are unable to capture technology related experiences or behaviors. As a result, many conclusions concerning the psychological impact of technology use remain unsound. Current assessments have also failed to keep pace with new methodological developments and these data-intensive approaches challenge the notion that smartphones and related technologies are inherently problematic. The field should now consider how it might re-position itself conceptually and methodologically given that many ‘addictive’ technologies have long since become intertwined with daily life. 

-1. Capturing smartphone behaviors from self-report:

Historically, time has been the primary focus when attempting to quantify experiences with technology. Respondents are often asked to report their frequency or duration of use, but even simple self-reported estimates concerning mobile phone use (e.g., number of calls made, or text messages sent) have been described as ‘sub-optimal’ when compared to phone operator data (Boase & Ling, 2013). Nevertheless, many studies continue to rely on estimates alone when making links between technology use and other psychological constructs (Butt & Phillips, 2008). When such estimates are scaled to larger samples, these often explain very little of the variance when predicting health or subsequent behavior (Przybylski & Weinstein, 2017; Twenge, Joiner, Rogers, & Martin, 2018).

The use of multiple technologies simultaneously (e.g., a smartphone and a laptop) also make such estimates problematic due the level of cognitive burden required to quantify many different types of automatic behavior (Boase & Ling, 2013; Doughty, Rowland, & Lawson, 2012; Jungselius & Weilenmann, 2018). 

Perhaps in response to this criticism, a growing number of prominent self-report instruments have been developed in an attempt to quantify smartphone related technology experiences (Table 1 below). These scales, built around a conceptualization of problematic use, are often derived from previous measures that were developed to assess a specific type of technology engagement (e.g., social media or video game use). This in itself is problematic as issues associated with smartphone use may be secondary to another behavior (Panova & Carbonell, 2018). For example, while a smartphone can be used to engage with addictive behaviors such as gambling, its use can also support and maintain a healthy lifestyle (Piwek et al., 2016). 

Following traditional methods associated with scale development, factor analyses ensure that tools are reliable, but their validity remains highly questionable (Table 1 below). While measures are framed around ‘smartphone behaviors’, the language used to describe subsequent results becomes misleading. Paper titles including the words ‘smartphone use’ are inaccurate when this has simply not been measured, causing confusion for casual readers, policy makers, and even those who work within the field (Ellis et al., 2018a). There is also little evidence to support the existence of the constructs under investigation (e.g., technology ‘addiction’), yet many papers and scales continue to use language associated with a specific diagnosis (see Panova & Carbonell, 2018 for a recent review). 

These measures generally assess a respondent’s attitudes and feelings towards their smartphone or technology usage. While no less important, the constructs under investigation may be fundamentally different to the very behavior they seek to explain. To date, current self- report measures do not align well with or predict simple objectively measured smartphone behaviors (Table 2 below). It would appear that objectively measured time spent on a device may correlate with some self- report scales or duration estimates, but this relationship appears patchy. Current scales have therefore yet to demonstrate an ability to predict comparatively simple behaviors that appear to be stable within participants (Ellis et al., 2018a; Wilcockson, Ellis, & Shaw, 2018). 

Even if current measures do correlate with behavior, there is still reason to question the extent to which they measure constructs as expected. First, given the range of activities that can be performed on a smartphone, scores will have little bearing on a person’s overall experience with that technology. One may speculate that active versus passive use will be an important mitigating factor when quantifying outcomes. For example, engaging in positive conversation online can bring many health benefits, with passive consumption likely to be less valuable (Day, Ong, & Perry, 2018). Second, scales present leading questions that focus on worries surrounding a participant’s relationship with their smartphone, which may be more representative of general traits. For example, measures used to assess problematic smartphone use are also likely to detect core elements of impulsivity, anxiety, or extraversion. Items that ask participants about levels of impatience associated with reduced use may instead reveal a general impulsivity that is not smartphone specific and could apply to any other personal product used on a regular basis (Belk, 2013). Indeed, how unique these results are to a specific technology and not a globalized behavior that filters into other daily activities (e.g., exercise, coffee consumption) remains unknown.  

Our current understanding is therefore based around a set of measures, which will struggle to capture and understand the subsequent impact of technology. However, this has not prevented the development of theoretical models that are based entirely around data generated from these psychometric tools (Billieux, Maurage, LopezFernandez, Kuss, & Griffiths, 2015). Of course, and as with any psychological phenomenon, several of these scales and the constructs they aim to measure are likely to go beyond behavior. However, the scales are routinely used without this broad conceptualization in mind and are framed as an assessment of usage alone. In recent years, these problems have become magnified further as theoretical and methodological advances have allowed for dynamic and fluid approaches to data collection. These can provide greater specificity and flexibility when exploring our relationship with technology (Jankowska, Schipperijn, & Kerr, 2015). 

-2. Objective measures of smartphone usage:

If technology use cannot be controlled experimentally, then exposure to general (e.g., hours of smartphone use) or specific use (e.g., hours of Facebook use on a device) provides an alternative source of objective data (Scharkow, 2016). This removes issues concerning social desirability and cognitive burden. However, while those in computer science have been measuring such interactions with smartphone technology since around 2010, these developments have had very little impact on how psychology attempts to quantify, explain, and under- stand technology use more generally (Oliver, 2010). For example, only a handful of papers have attempted to validate existing scales against behavior, with mixed results (Table 2 above). 

These objective-based studies confirm that people use devices like smartphones and associated applications frequently and habitually (Andrews, Ellis, Shaw, & Piwek, 2015). However, this alone does not equate to any form of problematic usage. It may seem reasonable to assume that those who spend a long time in front of a screen have problematic use, however, heavy users are not necessarily the same as problematic users (Andrews et al., 2015; Oulasvirta, Rattenbury, Ma, & Raita, 2012). This research also challenges the notion that mobile technology use is becoming more prevalent. For example, the quantity of short checking behaviors observed in research conducted in 2018 for example (Ellis, Davidson, Shaw, & Geyer, 2018b) are remarkably consistent with those recorded in 2015 and 2009 (Andrews et al., 2015; Oulasvirta et al., 2012). In addition, while at a population level it would appear that smartphone use is high, within-participant patterns are consistent and establishing a true absolute baseline of typical usage for an individual appears possible (Fullwood, Quinn, Kaye, & Redding, 2017; Wilcockson et al., 2018). 

In recent years, objective studies have also started to focus on the potential negative impacts of smartphones on mood however, their conclusions are dramatically different from previous findings, which rely on self-report alone. For example, Rozgonjuk, Levine, Hall, and Elhai (2018) observed that depression and anxiety severity were not associated with total smartphone usage. In addition, higher depression scores correlated with less phone checking over a week, suggesting that periods of low-mood may lead to less engagement with technologies that primarily enable social interaction. This supports the notion that a sudden lack of smartphone use may be an early warning sign of social withdrawal (Mou, 2016). Machine learning approaches have also demonstrated that smartphone use alone does not predict negative well- being. Katevas, Arapakis, and Pielot (2018) combined an experience sampling methodology with 23 objective measures of behavior including phone unlocks, calls received, and battery drain. In one of the largest studies of its kind, participants who reported lower levels of well-being tended to use their smartphones more at night. However, this relationship was unidirectional as late-night smartphone usage was independent of low mood, which was assessed throughout the day over several weeks. 

-3. Conceptual and methodological challenges:

Research that attempts to develop methods, which can quantify smartphone and related technology use often aligns with a conceptual framework that problematizes usage without considering how typical these behaviors are in the general population. Conceptually, the field appears to have taken this approach with video games, the internet, and social media, however, smartphones may finally be the point where psychologists consider going beyond these clinical definitions (Ellis et al., 2018a). Similarly, while psychology now has access to new technologies that would improve current practices, a number of methodological challenges also remain if new data collection methods and analytical routines are to prosper. 

Conclusion:

Results concerning the negative impact of smartphones on psychological well-being may surprise rather than worry many psychologists. Smartphones are primarily used to facilitate social interactions and psychology has spent many years convincingly arguing that social support and integration has many positive health benefits (Day et al., 2018; Haslam et al., 2018; Jao, Loken, MacAndrew, Van Haitsma, & Kolanowski, 2018; Pachucki, Ozer, Barrat, & Cattuto, 2015). Even priming topics associated with smartphones appears to make relationship concepts become more accessible (Kardos, Unoka, Pléh, & Soltész, 2018). New technology also offers a host of new possibilities to improve physical and mental health (Ellis & Piwek, 2018). Conclusions from psychological science are therefore completely at odds with what might be expected in the general population and a new wave of research is starting to challenge previous findings (e.g., Elhai et al., 2018). Given our current understanding, one might argue that the biggest threat facing those who engage regularly with a smartphone is that these interactions take up time, which might have been traditionally spent elsewhere. For example, a lack of physical activity is of a far greater demonstrable risk to young people with previous research highlighting clear links between media exposure and childhood obesity (Chekroud et al., 2018; Lee et al., 2012; Vioque, Torres, & Quiles, 2000). 

When it comes to understanding the impact of technology more generally, there is an intrinsic lack of high-quality evidence (Ellis et al., 2018a). Revised psychometric tests may hold some value in the future, provided they are grounded in relevant theory and validated accordingly. However, psychological science should be in a position to go beyond these, particularly as social psychology appears to be acknowledging the limitations associated with a lack of behavioral measurement and validation of self-report measures across the field (Doliński, 2018). Moving forward, researchers may also wish to consider how behavioral data could be collected from other digital devices that can capture real-world behavior. Perhaps more importantly, a frank an open debate is required regarding how psychologists might conceptualize, measure, and understand general technology usage, which has long since become a core component of daily life (Shaw et al., 2018).  

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The Hazards and Harms of Screen Time have been Overblown: 

Self-reported screen time guesstimates skew “digital media use” research data.

Warnings about the dangers of so-called “problematic” digital media use or internet addiction may be ill-informed due to flawed research data, according to a recently published systematic review and meta-analysis of 47 studies by an international team. This paper (Parry et al., 2021) was published in the peer-reviewed journal Nature Human Behaviour. Parry et al.’s objective was to investigate how closely subjective self-reported estimates of screen time usage matched non-self-reported logs that objectively tracked someone’s actual digital media usage. After identifying and extracting 106 comparisons based on samples from 52,007 individuals, the researchers identified significant discrepancies between the exact amount of time people logged on various digital devices compared to their self-reported estimates.

-1. Self-Reported Measures of Screen Time are often Unreliable Guesstimates:

Less than 10% of self-reported data evaluated for this systematic review and meta-analysis was within 5% of the actual time spent using digital media. Taken together, the findings suggest that 95% of screen time studies inaccurately estimate usage. “Self-reports of behavior are an index of what respondents believe that they do—their perceptions of their own behavior—and not necessarily what they actually do,” Parry et al. explain. “The purpose of this meta-analysis, therefore, is to develop a deeper understanding of the convergent validity of self-report measures for digital media use.” Previous research into the reliability of self-reported data (Schwarz & Oyserman, 2001) suggests that the cognitive limitations of autobiographical memory make it very difficult for respondents to accurately self-report frequent and habitual daily behaviors that are repeated countless times throughout the day. “The screen time discrepancies highlight that we simply do not know enough yet about the actual effects (both positive and negative) of our media use,” first author Doug Parry of Stellenbosch University said. “Researchers, journalists, members of the public, and crucially policymakers need to question the quality of evidence when they consider research on media uses and effects. We can no longer simply take claims of harmful effects at face value.” “For decades, researchers have relied on estimates of how we use various technologies to study how people use digital media and the potential outcomes this behavior can lead to. Our findings suggest that much of this work may be on unstable footing,” he added.

Other researchers involved in this systematic review and meta-analysis included Brit Davidson of the University of Bath School of Management, Craig Sewall from the University of Pittsburgh, Jacob Fisher at the University of Illinois Urbana-Champaign, Stanford University’s Hannah Mieczkowski, and the University of Oslo’s Daniel Quintana.

“These highly flawed studies are over-inflating the relationships between digital media use and typically negative outcomes, such as mental health symptoms and cognitive impairments, which of course explains the pervading view that smartphones, among other technologies, are bad for us,” Davidson said. “Media and technology use takes the blame for everything from increases in teenage depression and suicide to a higher incidence of Attention Deficit Hyperactivity Disorder (ADHD) and violence,” she added. “If we want to investigate harms properly, we must first tackle assumptions about screen time and disentangle how people are actually using their phones or other technologies of interest.”

-2. Inaccurate Self-Reported Data may have Over-Inflated Smartphone Risks:

Some scholars have speculated that the invention and widespread use of 21st-century smartphones—which Apple Inc. first sold on June 29, 2007—may have “destroyed a generation.” On the flip side, others (Orben, 2020) question the validity of these overblown concerns and postulate that parents throughout modern history have feared the consequences of new inventions on their children as part of “the Sisyphean cycle of technology panics.”

In her recent (2020) paper, Amy Orben of Emmanual College at the University of Cambridge highlights “how the Sisyphean cycle of technology panics stymies psychology’s positive role in steering technological change and the pervasive need for improved research and policy approaches to new technologies.” She also states, “To ensure that psychology does not become an accomplice to a never-ending Sisyphean cycle of technology panics, the research area has to acknowledge the need for radical change.” Relying less on self-reported data to measure digital media use could be one such radical change.

In terms of breaking the Sisyphean cycle of technology panics, another new study (Vuorre, Orben, & Przybylski, 2021) of 430,000 teenagers in the US and UK found that current digital technology engagement is no more harmful to the mental health of today’s adolescents than watching TV was for young people during the 1990s. A team of researchers from Oxford University published these findings in the peer-reviewed journal Clinical Psychological Science.

“If we want to understand the relationship between tech and well-being today, we need first to go back and look at historical data—as far back as when parents were concerned too much TV would give their kids square eyes—to bring the contemporary concerns we have about newer technologies into focus,” first author Matti Vuorre, a postdoctoral researcher at the Oxford Internet Institute, said.

“As more data accumulates on adolescents’ use of emerging technologies, our knowledge of them and their effects on mental health will become more precise,” co-author Andy Przybylski added. “We need more transparent and credible collaborations between scientists and technology companies to unlock the answers. The data exists within the tech industry; scientists just need to be able to access it for a neutral and independent investigation.”

“Although we found little evidence suggesting that technology is becoming more harmful over time, we note that data accrued by internet-based and social-media platforms are needed to examine these possibilities,” Vuorre et al. conclude more rigorously. “It is our hope that transparent and robust science would emerge in collaboration with industry stakeholders to elucidate better the changing roles of technology in young people’s lives.”

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Section-3

Prevalence of smartphone use and overuse: 

If there’s anything that most deserves the claim to be a man’s best friend in the modern age, it has got to be the smartphone. Mobile devices have penetrated every type of human activity. Nearly everyone uses one at home, school, work, and during times of leisure. So much so that not having access to a mobile phone paved the way for an actual phobia, nomophobia. As such, understanding the current smartphone overuse statistics is important to get a grasp of how serious it really is.

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International estimates of the prevalence of forms of technology overuse have varied considerably, with marked variations by nation and increases over time. Prevalence of mobile phone overuse depends largely on definition and thus the scales used to quantify a subject’s behaviors. Two main scales are in use, the 20-item self-reported Problematic Use of Mobile Phones (PUMP) scale, and the Mobile Phone Problem Use Scale (MPPUS), which have been used both with adult and adolescent populations. There are variations in the age, gender, and percentage of the population affected problematically according to the scales and definitions used. The prevalence among British adolescents aged 11–14 was 10%. In India, addiction is stated at 39-44% for this age group. Under different diagnostic criteria, the estimated prevalence ranges from 0 to 38%, with self-attribution of mobile phone addiction exceeding the prevalence estimated in the studies themselves. The prevalence of the related problem of Internet addiction was 4.9-10.7% in Korea, and is now regarded as a serious public health issue. A questionnaire survey in Korea also found that these teenagers are twice as likely to admit that they are “mobile phone addicted” as adults. For most teenagers, smartphone communication is what they think is an important way to maintain social relationships and has become an important part of their lives. Additional scales used to measure smartphone addictions are the Korean Scale for Internet Addiction for adolescents (K-scale), the Smartphone Addiction Scale (SAS), and the Smartphone Addiction Proneness Scale (SAPS). These implicit tests were validated as means of measuring smartphone and internet addiction in children and adolescents in a study conducted by Daeyoung Roh, Soo-Young Bhang, Jung-Seok Choi, Yong Sil Kweon, Sang-Kyu Lee and Marc N. Potenza.

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Behaviors associated with mobile-phone addiction differ between genders. Older people are less likely to develop addictive mobile phone behavior because of different social usage, stress, and greater self-regulation. At the same time, the study by media regulator Ofcom has shown that 50% of 10-year-olds in the UK owned a smartphone in 2019. These children who grow with gadgets in their hands are more prone to mobile phone addiction, since their online and offline worlds merge into a single whole.

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Three smartphone stat you cannot ignore:

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General Smartphone Statistics:

Smartphones have become part of everyone’s daily routines. In fact, the number of smartphone and mobile phone users globally has surpassed half of the world’s population. Meanwhile, phones have long overtaken desktops as the most preferred medium for browsing the web. This signals the ubiquity of smartphones in people’s lives. And anything that commands this much attention can easily spiral to overuse and addiction. This is perhaps, in part, due to the fact that phones have become a foremost source of news, entertainment, and the latest updates from friends and followers.

• There are 5.22 billion smartphone users in the world. This accounts for 66.6% of the global population (DataReportal, 2021).
• By 2025, 72% of web users will solely be using smartphones to surf the net (CNBC, 2019).
• A web user, on average, spends 3 hours and 39 minutes browsing the internet on mobile (DataReportal, 2021).
• 96% of Americans own a mobile device (Pew Research Center, 2019).
• 81% of Americans own a smartphone (Pew Research Center, 2019).
• The country that spends the most time on the internet via mobile daily is the Philippines with an average of 5 hours and 54 minutes (DataReportal, 2021).
• Comscore’s 2019 Global state of mobile report says 70% of all digital media engagement in the US happens from a smartphone. So TV, games, laptops, gaming consoles, theatres, etc. are all squeezed into the tiny remainder of 30%.
• The 2019 report also says that 70% of all phone use lasts lesser than 2 minutes and 50% of all phone pickups occur within 3 minutes of the previous pickup.

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Smartphone Usage Statistics:

Given that smartphones are mini-computers, they can take on a wide variety of functions. This grants users a lot of dimensions to use the device.

• Americans open their phones 160 times a day, or once in 9 minutes (TechRepublic, 2020).
• On average, a person spends 4 hours and 10 minutes on mobile devices daily (DataReportal, 2021).
• Delving deeper, a user clicks, taps, and swipes their phone 2,617 times daily (BankMyCell, 2021).
• 43.5% of users unlock their phones between 51 and 100 times daily (Android Authority, 2020).
• 87% of users check their smartphone within 1 hour before going to sleep and after waking up (BankMyCell, 2021).
• 73.4% of users fiddle with their phones while on the toilet (TechRepublic, 2020).
• 66% of users sleep with their smartphones (TechRepublic, 2020).
• 45% of users would rather not have sex for a year than give up their phones (Reviews.org, 2020).
• 32.7% of users spend more time with their phones than their lovers (Reviews.org, 2020).
• 86% of users check their phones even if they are talking to friends and family (BankMyCell, 2021).
• 87.8% of users feel anxious when they leave their phones at home (Reviews.org, 2020).

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Smartphone Usage in School:

• 49% of students are distracted by phones and other gadgets in class (Inside Higher Ed, 2019).
• Smartphone usage statistics show that students spend about 20% of their time in class texting and checking social media (Oxford Learning, 2019).
• 80% of schools have a policy that restricts the use of mobile phones in class (EdWeek, 2019).
• Students who didn’t use smartphones wrote 62% more information in their notes (CNBC, 2019).
• 76.19% of teachers believe smartphones are distracting students in class (SlickText, 2019).

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Smartphone Usage at Work:

• 62% of employees believe that the use of mobile devices helped them become more productive (TRUCE Software, 2021).
• 56% of workers also believe that it’s their right to use their personal smartphones at work (TRUCE Software, 2021).
• 36% of workers rely on their mobile phones to get work done (TRUCE Software, 2021).
• Workers waste 56 minutes per day using their phones in non-work activities. This means, every week, almost five productive hours are lost to smartphones (Business News Daily, 2020).
• 55% of employees admit that they are often distracted by their smartphones (Business News Daily, 2020).
• 80% of employees receive automatic notifications on their phones. These can distract them at work (TRUCE Software, 2020).
• 25% of workers have illicitly used their phones during meetings (TRUCE Software, 2020).
• 51% of the workforce have answered work-related calls while driving (TRUCE Software, 2020).

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Cell Phone Usage Statistics by Age:

Millennials lead the pack in terms of smartphone usage and ownership, and for good reason. Many of the people in this generation are in the working realm, thus they have a variety of uses for smartphones. Besides using phones for leisure, cell phone usage statistics by age also show that they leverage the device at work.

• The 18 to 29 age bracket has the largest share of smartphone owners at 96%. This is followed by the 30 to 49 age bracket (92%), 50 to 64 age bracket (79%), and the 65 and older age bracket (53%) (Pew Research Center, 2019).
• In terms of generation, millennials have the highest smartphone user base at 94%. They are followed by Gen X (88.8%), Gen Z (72.8%), and Baby Boomers (68.1%) (eMarketer, 2020).
• On average, Gen Zers receive their first mobile phone when they are 10.3 years old (MarketingWeek, 2019).
• 53% of children in the US have a smartphone by the age of 11 (Common Sense Media, 2019).
• Meanwhile, 84% of US teens own smartphones (Common Sense Media, 2019).
• About one in five children has a smartphone by the age of 8 (NPR, 2019).
• College graduates have the largest share of smartphone owners at 91%. They are followed by those who received some college education (85%), high school graduates (72%), and those who didn’t finish high school (66%) (Pew Research Center, 2019).
• Children in the UK spend 3 hours and 20 minutes daily on their phones (The Guardian, 2020). On the other hand, 74% of parents have their smartphones within reach as they sleep. 12% even stated that they had their phones in bed (EdSource, 2019).
• 55 per cent of urban Indian parents have revealed that their children between 9 and 13 years old have access to smartphones throughout the day. As many as 71 per cent parents admitted that their children between 13 and 17 years have access to smartphones for all or most of the day (LocalCircles 2022).

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Teenage Smartphone overuse:

Socialization is essential for teens to forge friendships and develop deeper relationships. As such, smartphones keep them connected with friends even if they’re in separate classrooms. Time spent on mobile devices affects their studies, sleep, emotions, and mental states. Clearly, a cutback on smartphone usage is necessary for many teens.

• 95% of US teens have access to a smartphone and 45% are almost always online (Pew Research Center, 2019).
• 57% of teens often use smartphones to pass time while 37% often use them to connect with other people. Meanwhile, 30% tinker with their phones to pick up new information (Pew Research Center, 2019).
• 29% of teens keep their mobile devices in bed while they sleep (EdSource, 2019).
• 72% of teens check phone messages and notifications the moment they wake up (Pew Research Center, 2019).
• 54% of teens admit to spending too much time on their smartphones (Pew Research Center, 2019).
• 56% of teens feel lonely, anxious, or upset when they don’t have their phones with them (Pew Research Center, 2019).
• 53% have tried cutting back on the time spent on their phones (Pew Research Center, 2019).

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The Dangers of Heavy Smartphone Use:

• 17.3% of parents admit that they spend more time on their phones than with their children (Reviews.org, 2020).
• 55.4% of users use or look at their smartphones while driving (Reviews.org, 2020).
• 21% of teen drivers that figured in an accident were distracted by their smartphones (Carsurance, 2021).
• Teens who spend 5 hours daily on their mobile devices are 71% more likely to develop risk factors for suicide compared to those who only use their devices for an hour (BankMyCell, 2020).
• In 2019, distracted driving claimed the lives of 3,142 people in the US. Smartphones are among the leading causes of distracted driving (NHTSA, 2021).
• 36.5% of students have been cyberbullied (Cyberbullying Research Center, 2019).
• Hidden apps used by hackers accounted for almost 50% of all malicious mobile activities online (McAfee, 2019).
• Smartphones are 7 times dirtier than the toilet (MedicalXpress, 2020).

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Time Spent Using Smartphones by Region in 2022:

Here’s the full breakdown of each nation’s daily smartphone use in hours and minutes:

Rank	Country	Continent	Time Spent on Smartphone per Day
1	Philippines	Asia	5 hours 47 mins
2	Thailand	Asia	5 hours 28 mins
3	Brazil	South America	5 hours 25 mins
4	Colombia	South America	5 hours 9 mins
4	South Africa	Africa	5 hours 9 mins
6	Argentina	South America	5 hours 4 mins
6	Nigeria	Africa	5 hours 4 mins
8	Indonesia	Asia	4 hours 56 mins
9	Malaysia	Asia	4 hours 49 mins
10	Mexico	North America	4 hours 37 mins
11	Saudi Arabia	Asia	4 hours 35 mins
11	UAE	Asia	4 hours 35 mins
13	Ghana	Africa	4 hours 34 mins
14	Egypt	Africa	4 hours 25 mins
15	Turkey	Europe/Asia	4 hours 16 mins
16	Taiwan	Asia	4 hours 12 mins
17	India	Asia	4 hours 5 mins
18	Kenya	Africa	3 hours 51 mins
–	Global Average	–	3 hours 43 mins
19	Romania	Europe	3 hours 41 mins
20	Russia	Europe/Asia	3 hours 39 mins
21	Singapore	Asia	3 hours 38 mins
22	Morocco	Africa	3 hours 35 mins
23	Portugal	Europe	3 hours 34 mins
25	Vietnam	Asia	3 hours 32 mins
25	Hong Kong	Asia	3 hours 32 mins
26	Israel	Asia	3 hours 31 mins
27	US	North America	3 hours 30 mins
28	China	Asia	3 hours 6 mins
29	Ireland	Europe	3 hours 5 mins
30	New Zealand	Oceania	2 hours 59 mins
31	Poland	Europe	2 hours 58 mins
32	Sweden	Europe	2 hours 55 mins
33	Canada	North America	2 hours 51 mins
34	Australia	Oceania	2 hours 49 mins
35	Spain	Europe	2 hours 48 mins
36	South Korea	Asia	2 hours 46 mins
37	Italy	Europe	2 hours 45 mins
38	UK	Europe	2 hours 41 mins
39	Greece	Europe	2 hours 37 mins
40	Austria	Europe	2 hours 29 mins
40	Switzerland	Europe	2 hours 29 mins
42	Netherlands	Europe	2 hours 22 mins
43	Belgium	Europe	2 hours 19 mins
43	France	Europe	2 hours 19 mins
45	Germany	Europe	2 hours 14 mins
46	Denmark	Europe	2 hours 13 mins
47	Japan	Asia	1 hour 39 mins

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The average iPhone user spends a full work week on their phone, 2021 report:

A new study published by gaming company SolitaireD states that, on average, most iPhone users spend 39 hours and 54 minutes on their phones every week, roughly the equivalent of a workweek (spread over seven days). This comes from analytics taken from 667 iPhone users between August 13 through August 18, 2021. Perhaps more surprisingly, the study revealed that 78% of respondents underestimated how much time they actually spent on their phones. The average estimate of phone use was 3 hours 42 minutes, but the average actual daily usage time is 5 hours 42 minutes. Most of that time was spent on social media, with an average of 1 hour 23 minutes, along with content consumption (e.g., YouTube or TikTok), web browsing, and online shopping. Participants also underestimated how often they picked up their phones every day (40 times versus an actual average of 99 times). The study claims that about 20% of smartphone users (roughly one in five) use their phones eight hours a day or more.

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Screen time survey reveals consumers spend 50 days a year on smartphones, 2019 report:

According to the findings of a survey by Code Computerlove, the average screen time in the UK is 3 hours and 23 minutes per day – a whopping 50 days every year. This rises significantly in the 16-24 age group, who spend four hours a day on their mobiles (60 days a year). There were significant differences in the findings between age groups. On average 16- to 25-year-olds spend an hour longer every day on their mobiles compared to the 45 and older age group (average 3 hours). Despite its ‘mobile’ element, most people use their smartphones while watching TV (64% use their mobiles in front of the telly). This was followed closely by people using their devices in bed (55%), on the bus or train (34%) and at work (33%).

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Smartphone overuse is someone else’s problem, a study finds in 2016:

San Franciscans love their smartphones. But don’t tell them that — most are in denial about how dependent they are on their devices, a new survey found. Fewer than 1 in 4 city residents surveyed in Bank of America’s annual Trends in Consumer Mobility Report believe they are guilty of being on their phones too much. More than half, however, were willing to point the finger toward others: 52 percent said the people around them were guilty of overuse. The study surveyed more than 1,000 adults across Bank of America’s major markets including San Francisco. The margin of error for the national data was plus or minus three percentage points with a 95 percent confidence level. 

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Smartphone addiction is increasing across the world: A meta-analysis of 24 countries in 2022:

Smartphone ownership and screen time are increasing across the world, but there have been few attempts to quantify smartphone addiction on a global scale. Authors conducted a meta-analysis of studies published between 2014 and 2020 that used the Smartphone Addiction Scale, the most common measure of problematic smartphone use. Authors focused on adolescents and young adults (aged 15 to 35) since they tend to have the highest screen time and smartphone ownership rates. Across 24 countries, 83 samples, and 33,831 participants, authors demonstrate that problematic smartphone use is increasing across the world. China, Saudi Arabia, and Malaysia had the highest scores while Germany and France had the lowest. Authors suggest that the clinical interpretation of these scores should be updated given current global trends.

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People’s views: Pew research center study of 2019:

Across the 11 countries surveyed, people’s attitudes toward mobile phones tend to be largely positive. In most of the countries, a large majority say mobile phones have been good for them personally, and many also say mobile phones positively impact education and the economy. Mobile phone users also overwhelmingly agree that their phones help them to stay in touch with faraway friends and family and keep them informed of the latest news and information. Majorities say mobile phones are good for society, even amid concerns about their impact on children.

Overwhelming majorities say mobile phones have been more positive than negative for them personally as seen in the figure below:

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Mobile phone users have mixed views about upsides and downsides of their phones, are especially divided over whether they ‘couldn’t live without’ phones.

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In every country surveyed, mobile phone users are more likely to say their phone is something that frees them rather than something that ties them down. Across the 11 countries surveyed, mobile phone users are somewhat more divided when it comes to whether their phone helps save them time or makes them waste time. Mobile phone users are even more divided when assessing their reliance or lack thereof on their mobile device. In six countries – Mexico, Colombia, India, the Philippines, Venezuela and Vietnam – around half or more see their phone as something they don’t always need. But in five others – Jordan, Lebanon, South Africa, Tunisia and Kenya – users are more inclined to say they couldn’t live without it. When asked about a variety of ways in which mobile phones might affect their day-to-day lives, users across the surveyed countries generally agree that mobile phones have mostly helped them keep in touch with people who live far away and obtain information about important issues. But there is less consensus when it comes to mobile phones’ impact on people’s ability to earn a living, concentrate and get things done, or communicate face-to-face. Across the 11 countries surveyed, there is less agreement about whether mobile phones have helped people earn a living. Majorities of users in nine countries say their phone has had a positive impact on their livelihood – ranging from 55% in Tunisia to 81% in Kenya – while Jordanians and Lebanese most commonly say that mobile phones have not had much impact either way on their ability to make a living. Across all dimensions measured in the survey, publics in the 11 countries are most negative about the impact of mobile phones on children. Nowhere does a majority feel that mobile phones have had a good influence on children. And in eight countries, majorities of the population say that mobile phones have had a bad influence on children today. Concern is widespread about the risk that mobile phones might expose children to immoral or harmful content.  In addition to the impact of mobile phones on children, health and morality stand out as particular areas of concern. A median of 40% – and clear majorities in Lebanon (71%), Jordan (69%) and Tunisia (63%) – say the increasing use of mobile phones has had a bad influence on people’s physical health. Meanwhile, a median of 34% say mobile phones have had a positive impact on morality, similar to the share who say the impact has been negative. In all 11 countries surveyed, smartphone users are more likely than non-smartphone users to say they try to limit the time they spend on their mobile phone. People’s efforts to limit screen time also extend to children. Among parents whose child has access to a mobile phone, about half or more in seven of these countries say they ever set limits on how much time their child can spend on their phone.

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Section-4

Nomophobia:

The popularity of smartphones is ascribable to the affordances they provide. Smartphones make it possible to perform a variety of daily tasks in one device, including, but not limited to, calling and texting people, checking and sending email messages, scheduling appointments, surfing the Internet, shopping, social networking, searching for information on the Internet, gaming, entertainment, etc. (Park, Kim, Shon, & Shim, 2013). Because smartphones are ubiquitous and provide numerous capabilities, Kang and Jung (2014) propose that smartphones go beyond serving communication, information and entertainment purposes. They state that smartphones enable people to “fulfill needs such as learning, individual capability, safety, and human relationships” (Kang & Jung, 2014, p. 377), which is attributed to the mobility of smartphones.

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While the mobility of smartphones provides apparent benefits and enable individuals to satisfy their basic needs (Kang & Jung, 2014), it may also induce some problems associated with smartphone use. Previous studies have shown that smartphones may cause compulsive checking habits (Oulasvirta et al., 2012), that smartphones may lead to compulsive usage and increased distress (Lee, 2014, Matusik and Mickel, 2011), and that smartphones can be addictive (Chiu, 2014, Lee, 2014, Salehan and Negahban, 2013).

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Another problem exacerbated by smartphones is nomophobia. Nomophobia, or no mobile phone phobia, is “the fear of being out of mobile phone contact” (SecurEnvoy, 2012, para. 1). The term, nomophobia, is an abbreviation for no-mobile-phone phobia, and it was first coined during a study conducted in 2008 by the UK Post Office to investigate anxieties mobile phone users suffer (SecurEnvoy, 2012). The 2008 study in the UK, conducted with over 2100 people, demonstrated that some 53% of mobile phone users suffered from nomophobia (Mail Online, 2008). The study also revealed that men were more prone to nomophobia than were women, with 58% of male participants and 48% of female participants indicating feelings of anxiety when unable to use their phone.

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Another study conducted in the UK (SecurEnvoy, 2012) surveyed 1000 employees and showed that the number of people suffering from nomophobia increased from 53% to 66%. Unlike the 2008 study, the 2012 study found out that women were more susceptible to nomophobia, with 70% of the women compared to 61% of the men expressing feelings of anxiety about losing their phone or not being able to use their phone (SecurEnvoy, 2012). In terms of the relationship between age and nomophobia, the study found that young adults, aged 18–24 were most prone to nomophobia with 77% of them identified as nomophobic, followed by users aged 25–34 at 68%. Moreover, mobile phone users in the 55 and over group were found to be the third most nomophobic users.

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In one of the very first research studies into nomophobia (King, Valença, & Nardi, 2010), nomophobia is considered a 21st century disorder resulting from new technologies. In this definition, nomophobia “denotes discomfort or anxiety when out of mobile phone (MP) or computer contact. It is the fear of becoming technologically incommunicable, distant from the MP or not connected to the Web” (King et al., 2010, p. 52). Thus, this definition seems to encompass not only mobile phones but computers, as well. In another study (King et al., 2013), nomophobia is defined as “a disorder of the modern world [that] has only recently been used to describe the discomfort or anxiety caused by the non-availability of an MP, PC or any other virtual communication device in individuals who use them habitually” (p. 141). Although their definition includes the unavailability of computers, they argue that computers are replaced by mobile phones, which presumably have smartphone capabilities, and tablets. Therefore, they state that their research focus is less on computers and more on virtual communication environments, including mobile phones (King et al., 2013, p. 142). Their definition implies a dependency on virtual environments for communication. In a recent study (King et al., 2014), nomophobia is defined as follows:

Nomophobia is the modern fear of being unable to communicate through a mobile phone (MP) or the Internet. … Nomophobia is a term that refers to a collection of behaviors or symptoms related to MP use. Nomophobia is a situational phobia related to agoraphobia and includes the fear of becoming ill and not receiving immediate assistance (p. 28).

In this definition, King et al. (2014) seems to emphasize the inability to communicate through a mobile phone. Another point that is worth mentioning is the description of nomophobia as a situational phobia related to agoraphobia. While the previous definitions appear to embrace the feelings of anxiety resulting from the unavailability of such devices as computers or virtual communication devices, this recent definition is more related to mobile phones and denotes nomophobia as a situational phobia.

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Nomophobia versus smartphone addiction:

Nomophobia and smartphone addiction differ mainly in the way a smartphone user behaves with their smartphones. A smartphone user experiences nomophobia when fear or anxiety over not using a smartphone (Bian & Leung, 2015; Emanuel et al., 2015; SecurEnvoy, 2012; Yildirim, 2014) occurs. On the other hand, a smartphone user suffers from smartphone addiction when he or she excessively uses a smartphone regardless of harmful consequences (Bian & Leung, 2015).

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Symptoms and signs of nomophobia:

Basically, human beings are social creatures. Previously our social bonding was quite strong. We used to do a lot of face to face social interaction. Due to rapid urbanization, migration and increasing numbers of nuclear families, disintegration of social fabric has taken place in our society leading to a vacuum kind of situation. Mobile phones have effectively filled this vacuum, e.g., with the help of social media through which we are connected with others, nearly all the time. Now we have thousands of social media friends (virtual friends), while in reality, may be with very few we really interact. The continuous pressure of remaining on social media, we tend to use our mobile phones continuously and that is creating problem for us, viz., nomophobia.

Nomophobia occurs in situations when an individual experiences anxiety due to the fear of not having access to a mobile phone. The “over-connection syndrome” occurs when mobile phone use reduces the amount of face-to-face interactions thereby interfering significantly with an individual’s social and family interactions. The term “techno-stress” is another way to describe an individual who avoids face-to-face interactions by engaging in isolation including psychological mood disorders such as depression.

Anxiety is provoked by several factors, such as the loss of a mobile phone, loss of signals, and a dead mobile phone battery. Some clinical characteristics of nomophobia include using the device impulsively, as a protection from social communication, or as a transitional object. Observed behaviors include having one or more devices with access to internet, always carrying a charger, and experiencing feelings of anxiety when thinking about losing the mobile. People usually reduce sleep when they overuse their mobile phones. Lack of sleep can lead to depression and lack of care, which makes people willing to indulge in mobile phones. Research shows that the dependence on mobile phones is due to adverse mental health. Compared to other people, their sleep time will be shorter, the longer they use the phone, the more severe their depression. The increase in mobile phone usage is related to the decline in self-esteem and coping ability.

Other clinical characteristics of nomophobia are a considerably decreased number of face-to-face interactions with humans, replaced by a growing preference for communication through technological interfaces, keeping the device in reach when sleeping and never turned off, and looking at the phone screen frequently to avoid missing any message, phone call, or notification (also called ringxiety). Nomophobia can also lead to an increase of debt due to the excessive use of data and the different devices the person can have. Nomophobia may also lead to physical issues such as sore elbows, hands, and necks due to repetitive use.

Irrational reactions and extreme reactions due to anxiety and stress may be experienced by the individual in public settings where mobile phone use is restricted, such as in airports, academic institutions, hospitals and work. Overusing a mobile phone for day-to-day activities such as purchasing items can cause the individual financial problems. Signs of distress and depression occur when the individual does not receive any contact through a mobile phone. Attachment signs of a mobile phone also include the urge to sleep with a mobile phone. The ability to communicate through a mobile phone gives the individual peace of mind and security.

Nomophobia may act as a proxy to other disorders. Those with an underlying social disorder are likely to experience nervousness, anxiety, anguish, perspiration, and trembling when separated or unable to use their digital devices due to low battery, out of service area, no connection, etc. Such people will often insist on keeping their devices on hand at all times, typically returning to their homes to retrieve forgotten cell phones.

Nomophobic behavior may reinforce social anxiety tendencies and dependency on using virtual and digital communications as a method of reducing stress generated by social anxiety and social phobia. Those with panic disorders may also show nomophobic behavior, however, they will probably report feelings of rejection, loneliness, insecurity, and low self-esteem in regard to their cell phones, especially when times with little to no contact (few incoming calls and messages). Those with panic disorder will probably feel significantly more anxious and depressed with their cellphone use. Despite this, those with panic disorder were significantly less likely to place voice calls.

Nomophobia has also been shown to increase the likelihood of problematic mobile phone use such as dependent use (i.e. never turning the device off), prohibited use (i.e. use in any environment where it is forbidden to do so), and dangerous use (i.e. use while driving or crossing a road). Nomophobics fear of not being able to access information—has the greatest impact on the likelihood of engaging in illegal use while driving.

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General symptoms:

• anxiety
• respiratory alterations
• trembling
• perspiration
• agitation
• disorientation
• tachycardia

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Emotional symptoms:

• depression
• panic
• fear
• dependence
• rejection
• low self-esteem
• loneliness

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Comorbidity:

Like other psychiatric diseases, an important issue of nomophobia is comorbidity: some scholars talk about a double diagnosis, since often pathologies tend to cluster together, like anxiety and panic disorder, other forms of phobia (and in particular social phobia or social phobia disorder), obsessive-compulsive disorder, eating disorders, depression and dysthymia, alcohol and drug addiction, as well as other behavioral addiction disorders (including mobile and/or Internet dependence, gambling, online gaming, compulsive shopping, and sexual behaviors) and personality disorders (borderline, antisocial, and avoiding). All these pathologies should also be considered in the differential diagnosis, together with atypical depression and psychosis. In these cases, nomophobia may act as a proxy for a more serious psychiatric disorder.

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Treatments:

Currently, scholarly accepted and empirically proven treatments are very limited due to its relatively new concept. However, promising treatments include cognitive-behavioral psychotherapy, EMDR (Eye Movement Desensitization and Reprocessing), and combined with pharmacological interventions. Treatments using tranylcypromine and clonazepam were successful in reducing the effects of nomophobia.

Cognitive behavioral therapy seems to be effective by reinforcing autonomous behavior independent from technological influences, however, this form of treatment lacks randomized trials. Another possible treatment is “Reality Approach,” or Reality therapy asking patient to focus behaviors away from cell phones. In extreme or severe cases, neuropsychopharmacology may be advantageous, ranging from benzodiazepines to antidepressants in usual doses. Patients were also successfully treated using tranylcypromine combined with clonazepam. However, it is important to note that these medications were designed to treat social anxiety disorder and not nomophobia directly. It may be rather difficult to treat nomophobia directly, but more plausible to investigate, identify, and treat any underlying mental disorders if any exist.

Even though nomophobia is a fairly new concept, there are validated psychometric scales available to help in the diagnostic, an example of one of these scales is the “Questionnaire of Dependence of Mobile Phone/Test of Mobile Phone Dependence (QDMP/TMPD)”.

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The role of nomophobia and smartphone addiction in the lifestyle profiles of junior and senior high school students in the Philippines, a 2020 study:

Nowadays, adolescents spend a lot of their time on smartphones. They find it difficult to go about their daily lives without using their smartphones. Losing a mobile phone or Wi-Fi connection can be distressing to anyone. This study examined the prevalence of nomophobia and smartphone addiction among Filipino adolescents and their association with adolescent lifestyle profiles (ALPs). Furthermore, gender and grade (i.e., junior vs. senior high school students) differences in nomophobia, smartphone addiction, and ALPs as well as their differences in four nomophobia groups and among participants with and without smartphone addiction are determined.

Highlights:

• Nomophobia and smartphone addiction rates were 95.5% and 62.6% respectively.
• There was a strong positive association between nomophobia and smartphone addiction.
• Nomophobia and smartphone addiction predicted adolescent lifestyle profiles.
• Females have higher tendency of nomophobia than males.

Conclusions:

An ALP is a summary of the health-promoting lifestyle behaviors and choices of an adolescent (e.g., health responsibility, physical activity, nutrition, positive life perspective, interpersonal relationship, stress management, and spiritual health) (Hendricks, Murdaugh, & Pender, 2006).  Past studies on nomophobia and smartphone addiction have primarily focused on smartphone usage patterns and mental well-being (Bian & Leung, 2015; Gezgin, 2017; Gezgin et al., 2018b, Gezgin et al., 2018a; Gezgin & Çakir, 2016; Samaha & Hawi, 2016; Yildiz Durak, 2019). However, few studies have examined the relationship that nomophobia and smartphone addiction share with the lifestyle behaviors of adolescents. Thus, this is the first study to have examined nomophobia and smartphone addiction in relation to ALPs among Filipino adolescents.

The role of nomophobia and smartphone addiction in adolescent lifestyle profiles (ALPs) were evident within the following subdomains: positive life perspective, health responsibility, physical activity, interpersonal relationship, nutrition, stress management, and spiritual health. A moderate level of nomophobia seems to have a beneficial impact on positive life perspectives, interpersonal relationships, stress management, and spiritual health and a negative effect on health responsibility, and physical activity. In contrast, smartphone addiction had a significant impact on positive life perspective and interpersonal relationship but not on health responsibility, physical activity, nutrition, stress management, and spiritual health in this study.

Implications of the study findings:

In this study, a high percentage of the participants had nomophobia and smartphone addiction. Further, they shared a strong, significant, and positive correlational and predictive relationship with ALPs. These findings suggest that both nomophobia and smartphone addiction adversely affect the health-promoting lifestyle behaviors of adolescents. Therefore, rules governing smartphone use should be enforced at home and in schools. Further, preventive measures should be developed and implemented to avoid the exacerbation of nomophobia and smartphone addiction and promote a healthy lifestyle among adolescents. Furthermore, most of the participants in this study had only moderate levels of nomophobia. Therefore, parents and teachers should undertake active surveillance of their smartphone use to avoid the exacerbation of their nomophobia and smartphone addiction.

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Section-5

Smartphone addiction:

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With the rapid development of electronics and information technology, worldwide smartphone mobile subscriptions surpassed 6.5 billion in 2022 and are expected to reach 7.7 billion in 2027. The multiple features of smartphones, such as communications, multimedia, photography, navigation, and internet access, have made our social, cultural, and economic relations much more efficient. However, with the dramatic increase in smartphone users, problems related to smartphone use are also becoming more and more serious. Long duration of and frequent daily smartphone use has led to unprecedented rates of smartphone addiction, which has been characterized by previous studies as the overuse of smartphones that is interfering with the user’s daily life. In fact, prevalence of smartphone addiction has been reported in several countries of which one Saudi study reported a proportion reaching up to 66.4% in Arab medical students. When smartphone use becomes an addiction that interferes with daily life and with professional activities, a multitude of consequences may occur. Studies have found relationships between smartphone addiction and physical problems, mental disorders, as well as social maladjustment. Furthermore, smartphone addiction was found to be associated with poor academic performance among university students.  

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Smartphone addiction in children and adolescents has a negative effect, as excessive use of smartphones can cause physical symptoms, such as fatigue, indigestion, and sleep problems, as well as psychopathological problems, such as depression, anxiety, and impulsiveness. In addition, Gönener et al. stated that each use of a smartphone could cause physiological changes, such as headache, dizziness, tinnitus, and an increase in body temperature. Smartphone addiction can also be a problem socially, as it has a negative effect on social development, and it has the potential to negatively affect school life and academic achievement. In addition, excessive smartphone use may cause unexpected and possibly exorbitant phone charges, which may cause economic problems for some families and conflicts with parents accordingly. Furthermore, children and adolescents who are addicted to smartphones are not only unable to concentrate on their studies, but they also often show problems in forming friendships due to deviant behavior. Moreover, as children spend more time immersed in relationships in the virtual world, they may experience difficulties forming and maintaining interpersonal relationships in the real world.

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Adolescent smartphone addiction has been found to be different according to gender and age. In Finland, female adolescents used mobile phones more than male students, and in South Korea, female adolescents were more vulnerable to the risk of overdependence than male adolescents. Additionally, female youths were at greater risk of smartphone overdependence than male youths in all age groups, excluding infants and children by gender. In terms of age, it was also found that middle school students were the most vulnerable to the risk of overdependence of all school levels. Furthermore, middle school students were higher in both high-risk and potential-risk groups than elementary and high school students.

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Nowadays, addiction not only refers to drug or substance abuse, but it also refers to gambling, internet, games, or even smartphones. These also fall under the category of behavioral addiction. The conventional diagnostic system strictly regards only symptoms caused by repetitive and excessive substance use as addiction. However, not only average people but even clinicians use the term ‘addiction’ when a person is obsessed with a certain activity that results in disturbance of his/her daily activities and shows a pattern similar to substance dependence. The classic example of this activity is gambling. In the conventional diagnostic system, gambling is classified as an impulse control disorder; but after continuous studies on its similarity with substance addiction, it was considered addiction in the DSM-5 based on the results of studies on its neurobiological and psychopathological evidence. Recently, it has been reported that internet based activities such as gaming, chatting and pornography have been showing similar levels of addiction as those of drug and substance abuse. Moreover, as the internet become more accessible through smartphone, the addiction pattern associated with smartphone has been shown more routinely and the concerns relating the phenomenon have increased.

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Studies found that longer use was significantly associated with smartphone addiction as increased exposure is linked with increased dependency. Furthermore, later time of use was also significantly associated with smartphone addiction, with use after 1 a.m. conferring a 3-fold increased risk. This association may be indicative of impaired control and use despite harm, which are a characteristic of a behavioral addiction. For an addiction to be present, subjective distress and functional impairment must also be present – in the case of smartphone addiction, neglect of other meaningful activities, pre-occupation with the phone, distress when access to the phone is not possible, and continued use despite evidence of harm. On the other hand, measuring duration of use is an inexact proxy for addiction, as some people may experience the features of addiction with lower duration of use while others may use their phone in an adaptive way for long periods of time (for example, answering work emails during a long commute) but be able to put the phone down without distress and attend to appropriate activities such as communicating with family members, or going to bed on time.

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Addiction has been defined by the American Society of Addiction Medicine (2011) as a “chronic disease of brain reward, motivation, memory and related circuitry” (p.1), which is characterized by a person’s inability to abstain from use, impairment in behavioral control, lack of recognition of problems with behaviors and interpersonal relationships, and emotional response dysfunction. Addiction typically is discussed as it relates to drug use, but the language of addiction can also pertain to a variety of stimuli, including cellphone use.  The concept of addiction in relation to cellphone and smartphone use is not a new phenomenon, with several researchers who have explored this phenomenon (e.g., Carbonell et al., 2018; De-Sola  Gutiérrez et al., 2016; Jenaro et al., 2007; Kwon et al., 2013; Lopez-Fernandez et al., 2017; Roberts et al.,  2014; Smetanuik, 2014; Tossell et al., 2015). Within the literature, “cellphone” and “smartphone” has been used interchangeably, but specifically, smartphones are simply cellphones that have advanced capabilities such as the ability to download and use apps and access to the internet (Smith, 2011). In the past, cellphone addiction has been categorized as problematic cellphone or smartphone use (Carbonell et al., 2018; Jenero et al., 2007; Lopez-Fernandez et al., 2017; Smetanuik, 2014). The addictive nature of cellphones is characterized along the lines of a behavioral addiction, a disorder with symptoms behaviorally expressed, and associated with a pleasurable and irresistible quality (Black, 2013). 

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Prior to the arrival of the cell phone, abundant research had been conducted on behavioral addictions to videogames, exercise, online sex, food, shopping, work, and the Internet. Indeed, for several authors, a large number of behaviors are potentially addictive if there is a concurrence of negative consequences and physical and psychological reinforcements in a specific context. In general, Brown and Griffiths note that an addiction entails abuse without control, alterations in mood, tolerance, abstinence, and personal harm or conflicts in the environment, as well as a tendency to relapse. Sussman and Sussman profile addiction, in its broadest sense, as the capacity to get “hooked” on reinforcing behaviors, excessive worry about consumption or behaviors with high positive reinforcement, tolerance, loss of control, and difficulty in avoiding said behavior, despite its negative consequences. Specifically, Echeburua et al. noted as defining elements of behavioral addictions, the loss of control, the establishment of a dependent relationship, tolerance, the need for progressively more time and dedication, and severe interference with daily life. Cía highlights the automatism by which these behaviors lead to uncontrollable use, in addition to feelings of intense desire or irresistible need, loss of control, inattention to usual activities, the focalization of interests on the behavior or activity of interest, the persistence of the behavior despite its negative effects, and the irritability and malaise associated with abstinence. Shambare et al. consider cell-phone addiction to be one of the greatest addictions of the current century. They highlight six types of behavior, habitual (habits performed with little mental awareness), mandatory (officially required or parentally mandated), voluntary (reasoned and conducted for specific motivations), dependent (motivated by the attached importance of social norms), compulsive (strong urge to continuously perform the behavior), and addictive, or behavior defined by the user’s progressive exclusion of other activities, causing physical, mental, and social harm, while attempting to control the user’s dysphoric feelings. Therefore, excessive attention and uncontrolled dedication to one’s cell phone is an addiction.

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According to Griffiths (1996), a behavior must fulfill six criteria in order to be considered an addiction: salience, mood modification, tolerance, withdrawal, conflict, and relapse. Many researchers see these as the core components of behavioral addiction (De-Sola Gutiérrez et al., 2016; Jenaro et al., 2007; Roberts et al., 2014; Smetaniuk, 2014). However, behavioral addictions have not been universally accepted within some reputable sources, including the Diagnostic and Statistical Manual of Mental Disorders, Version 5 (DSM-5). With the exception of gambling addiction, the DSM-5 fails to elaborate on behavioral addictions due to the lack of sufficient peer-reviewed evidence to establish diagnostic criteria (American Psychiatric Association, 2013).  This lack of inclusion of behavioral addictions has led to much criticism as well as a call for more research into and treatment of behavioral addictions (Hajela & Love, 2017).

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Understanding Smartphone Addiction from a Biopsychosocial Perspective:

Figure below depicts Biopsychosocial perspective of smartphone addiction:

The biopsychosocial model of addiction posits that biological/genetic, psychological, and sociocultural factors contribute to substance use and all must be taken into consideration in prevention and treatment efforts. As explained in figure above, smartphone addiction is a complex and heterogeneous problem, and there is a need to understand it from a biopsychosocial perspective. Griffith has proposed the components model of addiction, which proposes that all addictions comprise a set of criteria that rewards physiological and psychosocial behaviors. He proposed six core components for understanding the biopsychosocial process of smartphone addiction. These are salience, mood modification, tolerance, withdrawal, conflict, and relapse.

-1. Salience:

Predominant smartphone usage over other activities of life influences feelings (craving), cognitive distortions, and deterioration of social behavior. A study on university students has shown high cognitive absorption levels among the smartphone-addicted group. Cognitive absorption is characterized by temporal dissociation, focused immersion, heightened enjoyment, control, and curiosity. Further, functional magnetic resonance imaging (fMRI) study reported that smartphone addiction inhibits cognitive control during emotional processing and influences social interaction. Similarly, a neuroimaging study on adolescents with mobile phone addiction correlates higher impulsive scores with altered gray matter volume and white matter integrity. Similarly, subjects with gaming addiction have shown enhanced craving and brain activity in the lateral and prefrontal cortex for gaming stimuli.

-2. Mood modification:

The subjective experiences reported using smartphones as a coping strategy to avoid loneliness and dysphoric mood. A study observed that students utilizing their mobile phones as a coping mechanism might get trivial appeasement for loneliness, boredom, and anxiety-induced situations. However, long-term utilization might negatively influence mental health.  A study reported that dysfunctional cognitive and emotional processes mediate anxiety, depression, and problematic smartphone usage. In a recent study with Indian university students, 43% agreed the mobile phone provides an escape from problems, and 70% agreed that the mobile phone helped them overcome bad moods such as feelings of inferiority, helplessness, guilt, anxiety, and depression.

-3. Tolerance:

The prolonged time spent or frequent checking on smartphones to achieve the former mood modifying effects. Earlier studies claim that the frequent checking of smartphones is because of instant access to rewards. Further, social media has reportedly become the source of perceived social support. Currently, people ascribe perceived social support by likes and shares on social networking sites (e.g., Facebook, Instagram, and Twitter) and communicating through icons. A study has shown that Facebook connectedness is related to greater life satisfaction, lower anxiety, and depression levels, and enhanced social capital. In contrast, extroverts and neurotics with a high Facebook usage negatively influence life satisfaction and social relationships.

-4. Withdrawal:

Recent studies coined a new word Nomophobia (No mobile phone phobia), and FOMO, “fearing of being without a mobile phone,” which is the condition of feeling anxiety when missing their smartphones. This condition is widely visible in youngsters with low self-esteem, anxiety, impulsiveness, and high extroversion/introversion levels. Another study reported interpersonal sensitivity, obsession-compulsion, and strong predictors for nomophobia.

-5. Conflict:

Spending prolonged time on smartphones leads to intrapersonal and interpersonal conflicts, influencing their social relations with family and friends. In addition, texting is a potential distractor among school and college students impacting classroom performance. A study reported that the average time for distraction in class is less than 6 minutes. Furthermore, there has been a decline in face-to-face interactions among teens and making them less talkative to adults.

-6. Relapse:

There is not sufficient literature to support the relapse condition in smartphone addiction. This condition tends to check the smartphone to recur the previous hedonic experience after a long period of abstinence. Checking smartphones after waking up and before sleeping to get updated is associated with low self-control.

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Addiction to cellphones, and addiction to smartphones in particular, has gained research interest for number of reasons. First, due to the steady increase in smartphone users within the past decade, there are now approximately 257.3 million smartphone users in the United States as of 2018 (Holst, 2018). Second, some researchers have proposed new pathologies such as nomophobia (no mobile phone phobia), textaphrenia (people thinking they hear a text or feel a vibration indicating a message coming in when there is not one), texiety (an anxious feeling of not sending/receiving texts), post-traumatic text disorder (mental and physical injuries due to texting), and binge texting (Nehra et al., 2012; Taneja, 2014; Verma et al., 2014). Third, smartphones are of scientific interest due to the risks associated with using them; for example, using them while driving (e.g., Bradish et al., 2019; Nikerson et al., 2008). 

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It should come as no surprise that cellphones are a vital part of everyday life for most college students, functioning as a tool for such goals as social interaction, information retrieval, and entertainment. According to the findings from the Pew Research Center (2019), among young adults ages 18-29, 99% own a cellphone, with 96% owning a smartphone. Although smartphone availability allows instant gratification, it comes at a price. College students spend an excessive amount of time on their cellphones, with one study indicating that college students spend nearly 9 hours on the phone daily (Roberts et al., 2014). In fact, higher phone use has been associated with lower grades, perhaps in part because college students use their phones while in class (Bjornsen & Archer, 2015; Jacobsen & Forste, 2011; Lepp et al., 2014; Lepp et al., 2015; Li et al., 2015). Cellphone use also affects the mental and physical health of college students. Although not defined by the researchers, excessive cellphone use leads to poorer sleep quality (Fossum et al., 2014; Li at al., 2015), increased levels of anxiety, lower life satisfaction, (Lepp at el., 2014), headaches, irritability, and lack of concentration (Acharya et al., 2013), just to name a few. 

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Many researchers have postulated why college students are showing signs of smartphone addiction. One prominent idea is that students are showing these symptoms due to the fear of missing out (FOMO). FOMO moderately relates with smartphone use frequency (r = .42, p < .001) and significantly relates to problematic cellphone use (r = .51, p < .001), such as dependence or withdrawal when not using a smartphone (Elhai et al., 2018; Wolniewicz et al., 2018). The abundance of information students might be missing expanded exponentially with advanced capabilities of smartphones, such as internet connectivity and access to social networking sites (Kwon et al., 2013). In fact, diverse usage may lead to more specific addictions, such as social networking site addiction (Liu & Ma, 2018) or internet addiction (Chak & Leung, 2004).  It is highly likely that expanded uses of smartphones contribute to the potential for addictive behaviors.

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According to the American Psychiatric Association (APA), addiction is “A complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences.”  Regardless of whether addiction is substance or behavior related, there are five elements of addiction. The first element is feeling different; it includes the feeling of uncomfortability, loneliness, restlessness, or incompleteness. The second element of addiction is a preoccupation with behavior; excessive thoughts about and desire to perform a behavior; excessive time spent planning and engaging in the behavior, including recovering from its effects; and less time spent on other activities, despite potentially diminishing appetitive effects. Temporary satiation is the third element of addiction; after acute engagement in addictive behavior, some period of time may occur in which urges are not operative, the addiction craving is “shut down,” but soon returns. The fourth element is loss of control, wherein many people who claim to be struggling with addiction experience feeling obliged to exhibit addiction, which is associated with an experience of loss of control and, in some cases, neglect of essential self-care, which suggests a loss of will. The final element is negative consequences, which involve ongoing engagement in addictive behavior despite suffering from numerous negative consequences. This last component of addiction has often been used as a criterion for identifying dependence on the addictive behavior. “Smartphone addiction” is a form of technological addiction. Generally, it is similar to internet addiction. Smartphone addiction consists of four main components: compulsive behaviors, tolerance, withdrawal, and functional impairment.

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Excessive smartphone use as a behavioral addiction:

Although excessive use of smartphones is not currently recognized as a formal clinical disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or International Classification of Diseases (ICD-10), many aspects of the behavior appear to share similarities with other recognized behavioral addictions. To date, the DSM-5 has recognized gambling disorder as the only behavioral addiction, while other addictive behaviors such as “Internet gaming,” “sex addiction,” “exercise addiction,” or “shopping addiction” are classified as impulse disorders (American Psychiatric Association (APA), 2013, p. 481).

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Table below displays the suggested symptomatology of smartphone addiction, based on DSM-5 criteria for gambling disorder and substance abuse (APA, 2013). Thus, smartphone addiction is defined as a form of behavior characterized by the compulsive use of the device that results in various forms of physical, psychological, or social harm.

Characteristic	Gambling disorder	Substance abuse	Smartphone addiction
Tolerance/increased in frequency, duration, and quality in order to attain the same level of satisfaction	Gambling with increased amount of money to attain same level of excitement	Need high dose of substance or longer period to attain the same level of satisfaction	Need longer duration and frequency to achieve satisfaction or counteract associated negative emotions
Preoccupied/obsessive thoughts	Often preoccupied with gambling (e.g., reliving past experience and planning future gambling)	Spent a great deal of time to obtain, use, or recover from the use of substance	Feel strong need to check frequently
Dangerous use/continue behavior despite the negative impact	Continue gambling despite having financial problems resulting from gambling; rely on others for financial support	Continue using the substance despite it negatively affecting their physical or psychological well-being, even once it is acknowledged that their physical or psychological problem could have been caused or worsened by the substance	Insomnia or sleep disturbance related to frequent checking
	Lie to conceal money spent on gambling	Continue using the substance even when it causes harmful effects	Continue use in prohibited contexts or potentially dangerous situations (e.g., driving, walking, risky live-streaming)
	Chasing the loss with bigger amount money	Cravings and urges to use the substance	High amounts of money spent*
Difficulty in controlling	Repeated unsuccessful attempts to control, reduce, or stop gambling	Repeated unsuccessful attempts to control, reduce, or stop substance use	Repeated unsuccessful attempts to control, reduce, or stop the compulsive use of smartphone
Impact negatively on functioning in occupational, social, and daily life	Lost a significant relationship, job, or educational or career opportunity because of gambling	Important social, occupational, or recreational activities are given up or reduced because of substance use.	Withdrawing from family or shared events because of smartphone use
		Fail to fulfill major role obligations at work, school, or home	Negative effects on school, family, social, or emotional functioning
Withdrawal	Feel restless or irritable when attempting to cut down or stop gambling	Withdrawal symptoms	Feelings of unease, craving, abstinence, dependence, irritability when unable to use the phone
	Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed)	Craving, or a strong desire or urge to use the stimulant	Increased anxiety and/or irritability if phone is not accessible
Not better explained by other disorder	Not better explained by other disorder	Not better explained by other disorder	Not better explained by other disorder

*In addition to the above-proposed criteria, the cost of purchasing phone accessories or applications (apps) has been suggested to be included as one of the criteria as well (Anuj, Rajasekar, & Krishnagopal, 2013; James & Drenn, 2005). Approximately 70% of the youth changed their smartphones in less than 3 years, and 25% of them changed within a year. The average bill of $140 monthly may lead to financial difficulties or smartphone debt (Anuj et al., 2013; James & Drenn, 2005). Adolescents frequently change smartphone to improve their status among peers, which may boost their self-esteem and the feeling of acceptance (Ehrenberg, Juckes, White, & Walsh, 2008; Walsh, White, Cox, & Young, 2011).

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Diagnostic Criteria for Smartphone Addiction:

In the past years, negative physical and psychosocial effects associated with excessive smartphone use have been emphasized by a growing number of studies (Demirci et al., 2015; Duke & Montag, 2017; Grant et al., 2019). Recent research highlighted behavioral similarities between excessive smartphone use and other addictive disorders, such as failure to resist use, withdrawal, continuation of use despite being aware of negative consequences, or deception of others regarding the amount of time spent on use (Lin et al., 2016). Moreover, excessive smartphone use has been repeatedly linked to impulsiveness and depression (Demirci et al., 2015; Grant et al., 2019). These behaviors also show close similarity to the criteria for internet gaming disorder (IGD) in the DSM-5 (Petry et al., 2015). Consequently, criteria for “smartphone addiction” (SPA) were introduced (Lin et al., 2014) to define a condition characterized by excessive smartphone use and its problematic consequences for work-related achievements and interpersonal relationships, as well as for physical and mental health (Demirci et al., 2015; Duke & Montag, 2017; Grant et al., 2019).

Recent work by Lin, et al identified 6 behavioral criteria that had the highest diagnostic accuracy for the diagnosis of smartphone addiction:

-1. Continued inability to resist the impulse to use the smartphone

-2. Symptoms of dysphoria, anxiety, or irritability after a period of withdrawal from use

-3. Using the smartphone for a period longer than intended

-4. Persistent desire and/or unsuccessful attempts to quit or reduce smartphone use

-5. Heightened attention to using or quitting smartphone use

-6. Persistent smartphone use despite recurrent physical or psychological consequences

In addition, they identified 4 functional criteria:

-1. Excessive use resulting in persistent or recurrent physical or psychological problems

-2. Use in a physically hazardous situations (such as while driving or crossing the street) or situations that have other negative impacts on daily life

-3. Use that impairs social relationships or performance at school or work

-4. Use that is very time-consuming or causes significant distress

Diagnosis rests upon the presence of 3 or more main criteria plus 2 or more functional criteria, and in which addictive behavior is not associated with obsessive-compulsive disorder or bipolar disorder.

An alternative or adjunctive tool, the Mobile Phone Addiction Craving Scale (MPACS) was developed by De Sola, et al in 2017 consisting of 8 Likert-style questions and designed to help a smartphone user self-evaluate the degree of anxiety or restlessness felt by the lack of availability of their smartphone.

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Prevalence of smartphone addiction:

• 33% of teens and 50% of parents occasionally or very often try to reduce the amount of time they spend on their mobile devices, but most fail to change. Lake Research Partners, Device Addiction Survey (2017)
• Young adults (age 15–24) check their smartphones an average of 150 times per day (or every six minutes), and send an average of 110 texts per day — New York Times report, 2017
• 50% of surveyed teens admitted that they felt addicted to their mobile devices. — Lake Research Partners, Device Addiction Survey (2017)
• 60% of U.S. college students consider themselves to have a cell phone addiction — Roberts, J., Yaya, L., & Manolis, C. (2014) The invisible addiction
• 54% of young adults are checking their devices constantly (multiple times per hour) — Bank of America Trends in Consumer Mobility Report (2015)
• 77% of surveyed parents feel that their teens get distracted by devices and don’t pay attention when they are together. — Lake Research Partners, Device Addiction Survey 2017

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Mobile Phone Addiction as an Emerging Behavioral Form of Addiction Among Adolescents in India, a 2022 study found prevalence of mobile phone addiction to be 33% among adolescents. Similar studies conducted in India earlier had reported prevalence of MPD as 31.3% by Nikhita et al. in Navi Mumbai and 30.3% in Haryana by Jamir et al. A slightly higher prevalence of addiction-like behavior was proposed by Basu et al. (40%) in Delhi but this difference could be because of the different study populations (medical students) in which the study had been conducted. Medical students may be at higher levels of stress and burnout which could render them at risk for developing addictions more than the general population.

When compared with other Global studies the prevalence of mobile phone addiction has ranged from 2.4% to 60.3%. Studies done in South Korea by Cha et al. and in China by Chen et al. had shown prevalence to be 30.9% and 29.8% though they used scales different from this study. Whereas some studies like Shi et al., in 2021, in China (41.2%) had reported a higher prevalence which could be because of heterogeneous scale (MPAI), and the study focussed on college students. Similarly, Alsalameh et al. in Saudi Arabia who enrolled an older population (19-32 years) also had reported a higher prevalence. The differences in prevalence estimated in other studies done in the United Kingdom (10%), Spain (14.8%), Italy (6.3%), and Iran (17.7%) could be because of different scales used for estimation of mobile phone addiction and different study population (mainly school going students who have limited access to mobile phone during school time). 

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Sizeable prevalence data (see Table below) have been generated in response to specific addiction criteria, dependence, problematic use, excessive use, and risky behavior. Within each criterion, broad percentage ranges are supported by various methodologies, instruments, and samples, making comparisons difficult.

	Scale	Sample/area	Age/population	Prevalence (%)	Criterion
Beranuy Fargues et al.	CERM	430 + 209/Barcelona	13–18	5.35	Addiction
			19–25	5.26
Toda et al.	MPDQ	271/Japan	19–23	18.8	Dependence
				17.5
Jenaro et al.	COS	337/Salamanca	18–32	10.4	Addiction
Perry and Lee	Ad Hoc	214/Mauricio	19–25	6–11	Addiction
Leung	MPAI	624/Amsterdam	14–28	28.7	Addiction
Addiction Institute [Instituto De Adicciones]	Ad Hoc	556/Spain	12–25	8.5	Problematic use
				0.4
Leung	MPAI	402/Hong Kong	14–20	27.4	Addiction
Ha et al.	ECPUS	595/Korea	15.9 mean	33	Excessive use
Koo	CPAS	577/Korea	Adolescents	2.9	Addiction
				8.2	Problematic use
Sanchez Martinez and Otero	Ad Hoc	1328/Madrid	13–20	20	Dependence
Beranuy Fargues et al.	CERM	1.879/Barcelona	15–25	5.57	Abuse
					Addiction
Koo	CPAS	469/Korea	High school students	4.1	Addiction
				7.5	Abuse
Halayem et al.	STDS	120/Tunisia	13–20	33	Addiction
					Dependence
Ruiz-Olivares et al.	Ad Hoc	1011/Córdoba	18–29	32.6	Problematic use
Lu et al.	STDS	146/Japan	22–59	3.1	Addiction
				5.4	Dependence
Martinotti et al.	MAT	279/Italy	13–20	6.3	Problematic use
					Addiction
Lopez-Fernandez et al.	MPPUS	1.132/Spain	12–18	14.8	Problematic use
				5.4	At risk
Lopez-Fernandez et al.	MPPUS	1.026/England	11–18	10	Problematic use
				10.5	At risk
Mazaheri and Najarkolaei	MPAI	1180/Iran	18–39	64.5	Addiction
				56.2
Tavakolizadeh et al.	MPAI	700/Iran	University students	36.7	Addiction
Shin	MIUI	597/Korea and USA	University students	8.88	Dependence
Kalhori et al.	MPPUS	600/Tehran	20–30	23.4	Problematic use
					Dependence
Tosell et al.	Longitudinal online registry	34/USA	University students	62	Addiction
	SAMI/CPAS

It is known that self-reported questionnaires differ in self-implication and sincerity depending on whether they are administered in person or by correspondence. In fact, certain behaviors tend to be minimized in self-reports. Taking into account that several studies on cell-phone addiction have used the self-attribution or self-perception of the interviewee, Beranuy Fargues et al. observed that in this sense, 22.1% of adolescents and 27.9% of young people were considered to be cell-phone addicts, although only 5.35% and 5.26% of them exhibited dangerous or harmful behaviors. Billieux et al. also found that certain dimensions of impulsivity, such as impatience, low perseverance, and length of cell-phone possession, were predictors of greater self-attribution of addiction. Therefore, self-attribution results in high prevalence data and leads to a greater subjective sensation of addiction, which is decreased when using objective or validated criteria beyond subjective self-perception. 

The prevalence samples are generally based on young students and adolescents, which means that prevalence essentially refers to this population without the consistent availability of exact ages. Although we know that cell-phone abuse can be truly problematic in young students and adolescents, we lack a broader understanding of the problem with respect to the general population. It is important to evaluate the differences between the adolescent and adult populations and observe the effects of cell-phone use on each of them. In addition, relevant inter-geographical and intercultural differences have not been sufficiently studied to date, although some studies have noted a greater prevalence in Middle East (Iran) and East Asian populations, specifically in Korea where university students showed a greater level of dependence (11.15%) than the Americans (6.36%).

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Sociodemographic Differences of smartphone addiction:

-1. Differences by Age:

The youngest group, particularly adolescents, is the most highly affected by and at risk for both substance and behavioral addiction, which has led the majority of studies to address these age groups.

In general, the data show that the total time spent on cell phones decreases with age, with the highest times reported for people less than 20 years old, principally adolescents, approximately 14 years old. This fact is related to the decreased self-control found in this age group. Specifically, the most frequent use of their time is spent on text messaging, with other forms of contact increasing over time.

Cell-phone use in adolescents is so important that some adolescents never turn off their cell phones at night, fostering vigilance behavior that makes rest difficult. Specifically, 27% of young people between 11 and 14 years of age admit that they never turn off their cell phones, a behavior that increases with age such that between 13–14 years old, one out of every three young people never turns off his/her device.

The age of possession of one’s first cell phone is also relevant: the younger age at which this occurs, the greater the probability of problematic use in the future. In particular, Sahin et al.  found that the greatest indices of problematic use or addiction are found when one’s first phone is obtained at an age younger than 13 years.

-2. Differences by Gender:

Virtually all the studies indicate that females have higher levels of dependence and problematic use than males. Female cell-phone use is typically related to sociability, interpersonal relationships and the creation, and maintenance of contacts and indirect communication, and texting and instant messaging are their most frequently used applications. In addition, a cell phone can be used to avoid unpleasant moods, which leads to impatient and uneasy behavior associated with conscious self-control and spending difficulties.

For males, cell-phone use is simultaneously based on text messages, voice conversations, and gaming applications, and they show a higher tendency than females to use their cell phone in risky situations. A study carried out by Roberts et al. found that the most problematic applications are voice calls, text messages, and social networks. The differences between males and females are based on usage time rather than utilization. Females spend more time than males on each of these applications, which leads to behavior oriented toward intense and close social relationships, whereas males use their time in a more practical and instrumental way.

For females, therefore, the cell phone is a means of social contact, in which messaging and social networks play a relevant role, while for males, a more diversified type of usage is observed. This differs from Internet use, which shows the inverse profile: problematic behavior is observed more frequently in males. Cell-phone abuse thus responds to a pattern of greater lack of impulse control; similarly, being female could be a protective factor for problematic Internet use.

-3. Education and Economic Status Differences:

Despite the lack of evidence of educational and economic level differences in usage, Mazaheri and Najarkolaei found that students from families with higher cultural and economic levels have higher levels of dependence, a fact they relate to the isolation and loneliness felt when studying far from home; here, the cell phone is a tool for contact. In the same sense, Tavakolizadeh et al.  confirmed a direct relationship between education level and problematic use, which they attributed to the time spent away from home and the isolation caused by extended periods of study. Sanchez Martinez and Otero confirmed a relationship between students and problematic cell-phone use, negative family relationships, and parents with a high level of education without economic difficulties. They explain that this relationship is due to the need to maintain compensatory social relationships.

Sahin et al., on the contrary, found that the level of cell-phone addiction is greater in students from families with lower versus higher incomes. Lopez-Fernandez et al. also observed a significant relationship between student cell-phone use and their parents’ level of education. The higher the level of education of the father or mother was, the less problematic the cell-phone use; if the parents had university degrees, the exclusive technological entertainment of their children decreased. In the same direction, Leung found a relationship between low socioeconomic and educational levels and problematic cell-phone use.

In terms of family education, Zhou et al. also observed a significant relationship between parents’ abuse of and dependence on cell phones and children’s addiction to the Internet and other technologies, which they interpreted as the result of affective abandonment.

-4. Geographical and Cultural Differences:

It is logical to assume that geographical and cultural differences exist regarding problematic cell-phone use; however, scarce conclusive geographical data are available on the topic. It appears that greater cell-phone dependence exists in East Asian countries, such as Korea, which can be explained by their sizeable cell-phone offerings and high technological penetration among the youngest strata. Shin carried out a comparative study evaluating the degree of mobile Internet dependence of university students in the United States and Korea. Their data confirmed that the Koreans showed a greater level of dependence (11.15%) than the Americans (6.36%).

-5. Personality and Psychological Variables:

Essentially, problematic cell-phone studies aim to detect the variables or personality traits that coexist with problematic or addictive behavior. In this sense, one can also talk about vulnerability, insofar as some of these traits can be precursors to or predictors of addiction to either drugs or certain behaviors. Specifically, they have focused on the five-factor model (FFM) of personality as well as on self-esteem, self-concept, self-identity, and impulsivity. The “Big Five Personality Traits,” also known as the FFM, has been used in research on both cell phone and substance addiction. The FFM establishes five dimensions of personality (extraversion, openness to experience or change, conscientiousness, agreeableness, and neuroticism or emotional instability). Takao, using the NEO five-factor inventory, observed that being female, extrovert, neurotic, and low opened to experience predict 13.5% of cases of problematic cell-phone use.

-6. Psychological Problems and Psychiatric Comorbidities:

With respect to the psychological problems derived from cell-phone abuse, the research focuses on sleep interference and its coexistence with using substances such as alcohol and tobacco and with symptomatology and psychiatric comorbidities, particularly anxiety, stress, and depression.

-7. Substance Use:

Substance use in relation to cell phones is often encapsulated within broader research that considers the user’s inability to maintain healthy lifestyle habits, together with symptomatology and psychiatric comorbidities. In effect, personality problems and psychiatric symptoms coexist with substance and behavioral abuse. If we include the psychological and neurobiological bases of addictions, be they related to substances or behaviors, it is natural to observe the coexistence of both, as found in research on the Internet. In particular, Lee et al. demonstrated the existence of a neurobiological pattern of common EEG registers for Internet use and depression.

In a study with students, Sanchez Martinez and Otero found a significant relationship between cell-phone abuse, school failure, depressive symptomatology, smoking and consuming cannabis, and other drugs. Similarly, Toda et al. also observed a relationship between cell-phone use and smoking, solely in males, without alcohol consumption, likely due to its lower penetration in their Japanese sample. Social networks have also been shown to coexist with substance use. Therefore, there is a coexistence relationship between substance use and behavioral addiction. In fact, neuroticism predicts the consumption of tobacco, cocaine, and heroin and openness to experience predicts the consumption of marijuana; all of these impulsive behaviors attempt to control internal dysphoric states, a context very similar to cell-phone abuse. However, these types of studies tend to be found within broader research, and there have been few studies specifically focused on the coexistence of problematic cell-phone use and substance use.

-8. Associated Personality and Psychiatric Problems:

Research into psychiatric problems and symptoms is more abundant for the Internet than for cell phones. In the latter, anxiety, depression, and stress are observed, as well as problems with sleep and loneliness. The vast majority of studies have been carried out using students and with diagnostic evaluations that are not always supported by validated or regulated diagnostic instruments.

Augner and Hacker discovered significant relationships between cell-phone abuse, chronic stress, emotional stability, and depression in young women. Tavakolizadeh et al. also observed a coexistence relationship between one’s mental health state – the tendency toward somatization, anxiety, and depression – and excessive cell-phone use.

There are differences between the psychopathological manifestations of problematic cell phone and Internet use, with Internet use demonstrating a majority profile of introversion and loneliness. Depression appears to be more consubstantial with Internet use, while anxiety seems to be more consubstantial with problematic cell-phone use, specifically via text messaging. This indicates that the Internet responds to different psychological behavioral patterns than cell phones.

Social network psychopathological variables tend to be similarly related to the context of the Internet, where problematic use is related to depression and neuroticism, particularly in females. The potential differential profile of comorbidities associated with problematic cell-phone use related to applications, such as social networks and instant messaging, needs a thorough revision.

An inverse relationship is apparent between mental health and problematic cell-phone use. In particular, students with lower levels of mental health and psychological stability are more susceptible to developing addictive tendencies to cell phones. These students search for a reduction of tension and dysphoria through social contact, although the existence of manifestations of addiction among healthy students is not excluded with regard to specific or contextual needs. Hooper and Zhou indicate, on the contrary, that stress in students with addiction could be the result of problems derived from problematic cell-phone use. Chen also observed a relationship between depression and cell-phone addiction, a coexistence that Young and Rodgers had previously demonstrated, nevertheless indicating that depressive symptoms are associated with many manifestations of alcohol and drug addiction. Therefore, it is unsurprising to find this relationship with respect to the Internet, although it is unknown whether depression points to a vulnerability or consequence.

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Internet and smartphone addiction:

Addiction refers to “loss of control” and “despite adverse consequences”. Substance-free addiction (or behavioral addiction) covers pathological gambling, food addiction, internet addiction, and mobile phone addiction. Nowadays, much has been said about new Medias and technologies addiction that connect us and make us lonely at the same time, consequently, leads to adverse mental health disadvantageous. Smartphones are increased rapidly as an indispensable member of our everyday life for most people, especially students all over the world. Smartphones provide users with internet-based communication, business trading, education, entertainment media, and even clinical applications; thus, smartphone use must share many functional or psychological properties with internet use. Mobile technology addiction is driven by the human urge to connect with people, and the related necessity to be seen, heard, thought about, guided, and monitored by others, that reaches deep in our social brains and far in our evolutionary past. Internet-based technologies addiction can eventually lead to individual social and psychological damage, accompanied by somatic symptoms.

Smartphones involves an extensive range of mobile applications for information, communication skills such as message, e-mail, education, and amusement purposes. Smartphones are becoming progressively essential in individuals and societies’ lives. Smartphones have facilities such as touch screens, mobile Internet access via Wi-Fi or social networks, ability for installation of smartphone applications, and involving media players, digital cameras, and GPS-based navigation make it popular. Smartphone addiction has many aspects that are similar to those of internet addiction and as such the internet addiction criteria must be considered when developing smartphone addiction criteria. Internet addiction and smartphone addiction differ in terms of addiction-risk factors. Dr. Ivan Goldberg first described the term internet addiction disorder (IAD) for pathological, obsessive internet use. Internet addiction is an overarching term characterizing five problematic Internet-related issues: cyber sexual addiction, cyber relationship addiction, net obligations, information overload, and addiction to interactive computer games. Symptoms of internet addiction include social isolation, family conflict, divorce, academic failure, job loss and debt. Internet addiction is described as the inability to control one’s internet use and is a condition that results in the serious impairment of various life functions. The psychological consequences involve the following: obsession for the internet or internet gaming; imbalance of real-life relationships, sleep, work, and education; increased aggression, hostility, and stress; problems with verbal memory and attention; maladaptive coping strategies; and low well-being and high loneliness.

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There have been several reviews in recent years that have discussed the issue whether excessive smartphone use is considered a behavioral addiction. In addition, studies have examined whether there are differences between excessive smartphone use and Internet addiction disorder (IAD). Montag et al. have argued that excessive smartphone use is a form of Internet Addiction Disorder. In this sense, IAD should be divided into two types of use: a mobile use and a non-mobile use. They have suggested that there is a specific use of IAD of a particular content and a generalized IAD where several channels are overused. The rationale for this division is that motivation, cognitive and affective factors predispose individuals to prefer a specific application and type of device. However, there is little empirical evidence in support of these assumptions. Although there may be small differences between some mechanisms and risk factors underlying online behavioral addictions, such as pornography use, gaming disorder and social network use, the resemblance between them is very strong. In addition, there are few studies that have examined whether specific cognitive and motivational mechanisms could lead to a preference of a specific type of device. Nevertheless, recent studies show that excessive use of the screens including, computer screens and smartphones is associated with serious mental problems and cognitive impairments. Therefore, research should focus on the negative consequences of excessive smartphone use rather than on whether it should be considered as a behavioral addiction.

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Social Networking Sites (SNSs) and smartphone addiction:

The research so far suggests SNSs have become a way of being, with millions of people around the world regularly accessing SNSs using a variety of devices, including technologies on the go (i.e., tablets, smartphones), which appear to be particularly popular for using SNSs. The activity of social networking itself appears to be specifically eclectic and constantly changing, ranging from using traditional sites such as Facebook to more socially-based online gaming platforms and dating platforms, all allowing users to connect based on shared interests. Research has shown that there is a fine line between frequent non-problematic habitual use and problematic and possibly addictive use of SNSs, suggesting that users who experience symptoms and consequences traditionally associated with substance-related addictions (i.e., salience, mood modification, tolerance, withdrawal, relapse, and conflict) may be addicted to using SNSs. Research has also indicated that a fear of missing out (FOMO) may contribute to SNS addiction, because individuals who worry about being unable to connect to their networks may develop impulsive checking habits that over time may develop into an addiction. The same thing appears to hold true for mobile phone use and a fear of being without one’s mobile phone (i.e., nomophobia), which may be viewed as a medium that enables the engagement in SNSs (rather than being addictive per se). Given that engaging in social networking is a key activity engaged in using mobile technologies, FOMO, nomophobia, and mobile phone addiction appear to be associated with SNS addiction, with possible implications for assessment and future research.

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Addictive Apps on smartphone:

Current research on smartphone addiction has mainly focused on addiction at the device level. However, research on device overuse still leaves much unexplained. For example, people who were classified as non-problematic using existing assessment tools were also concerned about smartphone overuse during certain daily activities. Therefore, understanding the smartphone overuse problem by focusing more specifically on mobile apps is necessary to obtain deeper insights of the problematic smartphone use. This motivated researchers to explore more specifically on app addiction. They investigated smartphone usage for college students using surveys, logged data, and interviews. The analysis of data shows that social and communication apps are the top 2 most addictive categories among participants. Female and male participants show no significant difference in terms of smartphone addiction. However, female participants tend to report that they are addicted to more apps. The psychological factors associated with app addiction are different between app categories. For example, compared to communication apps, participants report that it is easier to withdraw from social apps, but more difficult to control time spent on them. Millions of different apps are available on Androids and iPhones, and they’re all competing for your attention. After all, the more time users spend on an app, the more money companies will pay to advertise on it. “The people designing these apps are very sophisticated,” says Adam Alter, a psychology professor at New York University. “They’re doing everything they can to keep us engaged.”

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Smartphone addiction can encompass a variety of impulse-control problems, including:

• Virtual relationships. Addiction to social networking, dating apps, texting, and messaging can extend to the point where virtual, online friends become more important than real-life relationships. We’ve all seen the couples sitting together in a coffee shop or restaurant ignoring each other and engaging with their smartphones instead. While the Internet can be a great place to meet new people, reconnect with old friends, or even start romantic relationships, online relationships are not a healthy substitute for real life interactions. Online friends tend to exist in a bubble, not subject to the same demands or stresses as messy real-world relationships. Since few real-life relationships can compete with these neat, virtual relationships, you may find yourself spending more and more time with online friends, retreating from your real world family and friends. Compulsive use of dating apps can change your focus to short-term hookups instead of developing long-term relationships.
• Online compulsions, such as gaming, gambling, stock trading, online shopping, or bidding on auction sites like eBay can often lead to financial and job-related problems. While gambling addiction has been a well-documented problem for years, the availability of Internet gambling has made gambling far more accessible. Compulsive stock trading or online shopping can be just as financially and socially damaging. People with high levels of smartphone addiction are more prone to compulsive shopping online mediated by smartphone-induced flow experiences and mood regulation activities using smartphones. eBay addicts may wake up at strange hours in order to be online for the last remaining minutes of an auction. You may purchase things you don’t need and can’t afford just to experience the excitement of placing the winning bid.
• Information overload. Compulsive web surfing, watching videos, playing games, searching Google, or checking news feeds can lead to lower productivity at work or school and isolate you for hours at a time. All this compulsive use of the Internet and smartphone apps can cause you to neglect other aspects of your life, from real-world relationships to hobbies and social pursuits.

While you can experience these impulse-control problems with a laptop or even desktop computer, the size and convenience of smartphones means that we can take them just about anywhere and gratify our compulsions. In fact, studies suggest that most of us are rarely ever more than five feet from our smartphones. Many people admit to regularly using them in theaters, while driving, during religious services, business meetings, kids’ school performances, in the shower, and even during sex. So what causes our obsession with these always-connected devices? Smartphones and the Internet can be addictive because their use, just like the use of drugs and alcohol, can trigger the release of the brain chemical dopamine and alter mood. And just like using drugs and alcohol, you can rapidly build up tolerance so that it takes more and more time in front of these screens to derive the same pleasurable reward.

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General warning signs of smartphone addiction:

• Problematic and conscious use in dangerous situations or prohibited contexts with social and familial conflicts and confrontations, as well as loss of interest in other activities. A continuation of the behavior is observed despite the negative effects or the personal malaise caused.
• Harm, repeated physical, mental, social, work, or familial interruptions, preferring the cell phone to personal contact; frequent and constant consultations in brief periods with insomnia and sleep disturbances.
• Excessive use, urgency, abstinence, tolerance, dependence, difficulty controlling, craving, increasing use to achieve satisfaction or relaxation or to counteract a dysphoric mood, the need to be connected, feelings of irritability or of being lost if separated from the phone or of sending and viewing messages with feelings of unease when unable to use it.
• Anxiety and loneliness when unable to send a message or receive an immediate response; stress and changes in mood due to the need to respond immediately to messages.
• Trouble completing tasks at work or home. Do you find laundry piling up and little food in the house for dinner because you’ve been busy chatting online, texting, or playing video games? Perhaps you find yourself working late more often because you can’t complete your work on time.
• Isolation from family and friends. Is your social life suffering because of all the time you spend on your phone or other device? If you’re in a meeting or chatting with friends, do you lose track of what’s being said because you’re checking messages or updates on your phone? Have friends and family expressed concern about the amount of time you spend on your phone? Do you feel like no one in your “real” life—even your spouse—understands you like your online friends?
• Concealing your smartphone use. Do you sneak off to a quiet place to use your smartphone? Do you hide your smartphone use or lie to your boss and family about the amount of time you spend online? Do you get irritated or cranky if your online time is interrupted?
• Have a fear of missing out (FOMO). Do you hate to feel out of the loop or think you’re missing out on important news or information if you don’t check you phone regularly? Do you need to compulsively check social media because you’re anxious that others are having a better time, making more money, or leading a more exciting life than you? Do you get up at night to check your phone?
• Feeling of dread, anxiety or panic if you leave your smartphone at home, the battery runs down or the operating system crashes. Or you feel a phantom vibration—you feel your phone vibrating but when you check, there are no new messages or updates.
• Physical signs that you are spending too much time on your phone include eye strain, wrist pain and numbness, headaches, back pain, changes in weight, and insomnia.

Excessive cell phone use exhibits all the hallmarks of an addiction. But does experiencing one or more of these symptoms mean that you are truly addicted? David Greenfield, PhD, is one of the world’s leading authorities on issues of technology dependency and addiction. He is the author of the groundbreaking book Virtual Addiction: Help for Netheads, Cyber Freaks and Those Who Love Them and founder of the Center for Internet and Technology Addiction. He believes that 90% of cell phone owners overuse their phones, but that only 10-12% are truly addicted. It is Greenfield’s opinion that, to be classified as an addict, you need to experience “some deleterious impact on a major life sphere, whether it’s an impact on your work, your academic performance, your home life, primary relationship, parenting, legal status.”

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Causes Smartphone Addiction:

We live in a tech savvy world where a year old gets introduced to a smartphone and the parents proudly present it to the world that how the 1-year-old child can easily access the phone. Similarly, the school going children were relied on phones for their online classes during the lockdown, and since then their dependence on the smartphones has also increased. The college going students, or even adults for that matter, get reward like feelings after posting on social media and getting numerous likes and comments. The working class need their phone because our entire world has been put into our smartphones. Need to get somewhere? Switch on the GPS. Want to plan a party? Open ‘keep’ to note down points. Want to remind yourself to attend a meeting? Put it on as a reminder. Why just this, but our mornings also start by switching off the alarms on our beloved smartphones. The retired class find their solace in the smartphone to stay connected with their friends or their children. So, you see, one way or another, we are all highly dependent on our phones. But sometimes, this behaviour of constantly being on or checking the phone increases to the limit where staying without our phone seems like a task.

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The dopamine connection:

Dopamine is often referred to as the ‘feel good chemical’ that released by our brain to make us feel good, happy, and a surge of ‘high’. Your brain contains several pathways that transmit a feel-good chemical dopamine when you’re in rewarding situations. When you exercise, when you accomplished your work, you will feel good, satisfied and fulfilled. This is the phenomenon where dopamine is at work. Dopamine plays a critical role in both our mental and physical functions in forming our reward seeking behavior. Dopamine is there to drive and motivate you to take action and to seek pleasure such as food, sex, alcohol and some cases, the internet. Whenever you first experience something new, you will anticipate the rise of dopamine level inside your brain. Just like whenever you think about going to travel to a country that you have never been before, you will instantly feel the excitement and joy. Actually, dopamine is good because it gives us the drive to accomplish and to take action on what we desire. Without dopamine, perhaps, you will just feel lazy and lie on your sofa and do nothing.

So, what does this has to do with cell phone addiction? Everything.

According to Nir & Far, smartphones able to give us three types of rewards that will increase our dopamine level.

-1. The first type of reward is called reward of the hunt.

This is where we are expecting new experiences and information whenever we check our phones. Ever wonder why people are so addicted to their phone? This is simply because they are expecting to see something new through their phones. Status updates from their friends, new Apps, fresh messages, and everything that is fresh can spark our dopamine level.

-2. The second type of reward is known as the reward of self.

This is where people are looking to get validation and agreement from other people. We have to admit it, humans are creatures where we are always seeking approval and validation. We want others to agree with us and like. Thus, whenever you posted a photo to your social media account, you will want to check it constantly to see if people comment or like your photo. Every time someone likes your photo or whatever you share in the social media, it makes you feel good, hence, the increase of dopamine level. Eventually, your brain will accept the act of consistently checking your phone and it becomes habitual. Just like if you are a blogger and you posted an article on your blog. People praise your work and it gets a lot of shares and likes. This will make you feel pleasurable and wanted to write more. You have to understand that a phone is not addictive by itself without the presence of internet, social media, games, etc. Your phone only becomes addictive when these other functions are available at your fingertips.

-3. The third type of reward is the reward of the tribe.

As human beings, we resist being alone and we wanted to be part of a bigger family. Guess what, social media and our phone give us this connection with other people that we crave. We wanted to feel like we belong to a larger group and always being accepted. This is why social media has skyrocketed and used by millions.

Whenever you are accepted into a group, you feel excited for what’s coming. Whenever other people like your status, comment and agree with what you have to say in social media, you feel great and want more.

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There are several reasons leading to smartphone addiction among children and adolescents. It is generally accepted that the causes of smartphone addiction are a complex interplay between various factors as described below:

-1. The duration of smartphone usage:

Many smartphone users see their smartphone not only as a means of making phone calls, but also as a games console, a handheld computer, and even as a friend with whom they have a personal relationship (Kwon et al., 2013). The daily duration of calling and the number of messages sent are related to problematic phone usage (Augner & Hacker, 2012). In other words, excessive usage of smartphones causes addiction (Augner & Hacker, 2012; Kwon et al., 2013; Lin et al., 2015). According to the ‘optimal follow theory’, the frequent and repeated use of mobile phones may lead to addiction. Smartphone applications lead people to check their phones more frequently (Salehan & Negahban, 2013; van Deursen, Bolle, Hegner, &Kommers (2015). This habit of checking in turn causes people to use their phones much more (Oulasvirta, Rattenbury, Ma, & Raita, 2012). According to van Deursen et al. (2015), this process of checking is repeated since new messages, notifications and news feeds function as ‘rewards’ and, as a consequence, addiction may develop and control of behaviour be lost. According to the results of the study, habitual use of smartphones is included among the significant variables contributing to the smartphone addiction (van Deursen et al., 2015). It has been stated in all these studies that the duration of smartphone usage is a significant variable in terms of addiction. So, the duration of smartphone usage has a positive effect on smartphone addiction.

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-2. Cyberloafing:

Having developed a topology of concepts regarding personal Internet usage and studied the relations among these concepts, Lim, Loo, and Teo (2001) defined cyberloafing as ‘any voluntary act of employees using their companies’ Internet access during office hours to surf nonwork-related web sites for non-work purposes, and access (including receiving and sending) non-work-related email’. As personal technological devices such as smartphone and tablet PCs have become popular, the structure of internet access and usage has also changed and the potential for individuals to engage in cyberloafing behaviours has increased (Kim et al., 2015). When classroom environments are considered, it can be seen that students have now started to use their smartphones in multiple different ways, although there are differences between cyberloafing at work and cyberloafing in school (Baturay & Toker, 2015). Cyberloafing at school has been defined as the tendency for students to use the internet during course hours for activities not relevant to their schoolwork (Kalaycı, 2010). There are a number of studies in the literature relating to cyberloafing for specific student groups (Akbulut, Dursun, Donmez,€ & S¸ ahin, 2016; Yılmaz et al., 2015; Baturay & Toker, 2015). Research has also stated that cyberloafing behaviours cause various negative effects for students and the learning environment in general. There is no study in the body of literature which studies cyberloafing and smartphone addiction together. On the other hand, students’ potential for cyberloafing behaviours has increased as a result of the growing use of smartphones (Kim et al., 2015). To illustrate, some researchers have postulated that young people generally use their smartphones to connect to social networking sites (SNSs), which can be seen as among behaviours leading to cyberloafing, to shape and construct their social circle (Andreassen, Torsheim, & Pallesen, 2014; Jacobsen & Forste, 2011). The four behaviors involved in cyberloafing are described as Development, Recovery, Deviant and Addiction Behaviors. “Cyberloafing is a habit and could result in problematic behaviour”. Excessive cyber idleness behaviour is also related with addiction behaviour (Doorn, 2011). It can be asserted that smartphone applications which trigger cyberloafing behaviours are connected to an addiction to smartphones. So Cyberloafing has a positive effect on smartphone addiction.

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-3. Environmental factors:

Innovative technology has enabled the multifaceted features of a smartphone. Owing to its ubiquitous nature, one can browse web services and search for information at any time and in any place. Salehan and Negahban (2013) argue that the rapid growth of social networking service (SNS) and mobile phone applications has promoted the extensive use of smartphones. Higher frequency of Internet-based use of smartphone applications, for example social and game apps, is a strong predictive factor of smartphone overuse. Ben-Yehuda, Greenberg, and Weinstein (2016) also demonstrated in their study the close relationship between Internet addiction and smartphone use. Smartphone use also generally involves Internet access, so the causes of both activities are very likely related. Furthermore, easier accessibility to smartphones allows Internet users to fulfill their desire to use them more excessively as compared to using computers.

Family environmental factors, particularly parenting styles also relates to problematic smartphone use. A failure to develop a positive parent-child relationship, family function, and effective family communication potentially increases the likelihood for problematic smartphone use among adolescents (Gladkaya, Gundlach, Bergert, & Baumann, 2018; Spear, 2000; Zhu, Xie, Chen, & Zhang, 2019). Adolescents have a high tendency to engage in risk-taking, high exploration, seeking novelty and sensation, social interaction, and play behaviors that enable them to acquire certain skills for maturation and independence (Spear, 2000), especially in response to life stresses or changes in brain structures (Crews, He, & Hodge, 2007). This need for change, diversity, and intensity of stimulation can easily be fulfilled with smartphone use and this may make them more susceptible to problematic smartphone use. Furthermore, this may also reflect the increasing sterile, overly regulated, and limited public play spaces for young people.

Permissive parents adopt a do-not-control and nondemanding style of parenting. They are usually not well organized and provide less training and guidance to their children regarding becoming an independent adult. As a result, their children and adolescents tend to be poor in controlling impulse or self-regulation and hence vulnerable to problematic smartphone use (Bae, 2015). It was also reported that less authoritative parents who provide less effective supervisory and rational attachment predispose adolescents to problematic smartphone use (Bae, 2015; Lian, You, Huang, & Yang, 2016). Apart from that, excessive smartphone use might also serve as a coping mechanism to relieve stress or to reduce emotional tension when an individual experiences family dysfunction, domestic violence, or parental addiction (Chiu, 2014; Kim, Min, Min, Lee, & Yoo, 2018). Adolescents may seek pleasure and temporary distraction or even escape from their problems by absorbing themselves with their smartphones, but this is unlikely to be an effective long-term solution to address their problems because avoidance behavior does not build resilience (Alhassan et al., 2018). The behavior will increase the likelihood of developing dependence on smartphones as a way to deal with psychological problems, such as depression, aggression, and loneliness (Alhassan et al., 2018).

Domestic violence and abuse can predispose children to negative psychological consequences such as antisocial behaviors, posttraumatic stress disorder, anxiety disorder, and substance use disorder (Cao, Li, Zhao, Zhang, & Guo, 2016; Steinberg, 2000). Adolescents tend to maintain emotional closeness with others in online virtual environment to compensate the lack of interpersonal relationship in reality (Bae, 2015). The availability of the entertainment functions of a smartphone can also distract young people from existing family problems (Chiu, 2014; Kim et al., 2018).

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-4. Psychological factors:

There have been studies that have explored the possible psychological factors that contribute to excessive smartphone use. A study found that compulsive smartphone use behavior often evolved from habitual use and it was concluded that “checking behavior” comprises a major component of smartphone use (Oulasvirta, Rattenbury, Ma, & Raita, 2011). Smartphone users had the tendency to repeatedly check on the home screen, text messages, and emails despite no notifications. This unnecessary checking habit can serve as a gateway to explore all other apps, which may subsequently contribute to problematic smartphone use (Oulasvirta et al., 2011). Repeatedly phone checking may reinforced by the pleasure experienced from the contents of the apps and then realizing the content into daily life practice that serve as a reward, thus facilitating the losing of behavioral (Song, Larose, Eastin, & Lin, 2004).

Premorbid conditions in social communication such as social anxiety disorder, loneliness, or other psychosocial issues can make an individual susceptible to excessive use of technological devices (Darcin, Kose, Noyan, Nurmedov, & Dilbaz, 2016). Bian and Leung (2014) also pointed out that loneliness and shyness predispose individuals to develop a dependence on smartphones. Such young people are more likely to engage in various activities available on a smartphone, for example, playing online games, reading e-books and news, taking photos or recording videos, and so on. They are also more comfortable using their smartphone for social communication as it involves social cues filtering especially facial expression and gestures, thereby reducing self-disclosure and being interpreted in this virtual environment. In addition, they are also able to take time to structure the messages by texting, while gaining better control of the communication (Joinson, 2004). In addition, people with low self-esteem and high anxiety (Bianchi & Phillips, 2005; Hong et al., 2012) are more prone to develop mobile phone addiction to cope with negative emotions (Toda et al., 2008). Bianchi and Phillips have found that psychological predictors of problematic mobile use may be: younger age, self-negative views, low esteem and self-efficacy, a dysregulated arousal (such as in high extroversion or in introversion). Impulsivity, a sense of urgency, and sensation seeking could be also related to mobile phone overuse.

Personality also plays a role in problematic smartphone use. Based on the “Big Five” personality scale, which includes neuroticism, extraversion, openness to experience, conscientiousness, and agreeableness, Cho, Kim, and Park (2017) demonstrated that neuroticism and extraversion can have significant mediating effects on problematic smartphone use. This finding was in line with several previous studies (Bianchi & Phillips, 2005; Herrero, Urueña, Torres, & Hidalgo, 2017). These researchers contend that high neuroticism is associated with greater passively and less emotional stability (Hwang & Jeong, 2015) and this increases the likelihood of using smartphones excessively as a coping strategy. On the other hand, individuals with high extraversion are found to deal with stress more actively, and are therefore less vulnerable to stress. However, social extraversion was also noted to be positively correlated with mobile phone addiction (Bianchi & Phillips, 2005; Hong et al., 2012). Such people typically like to socialize and share with their peers to gain pleasure and gratification and thus increase the use of smartphones. Interestingly, Pearson and Hussain (2016) linked narcissism with problematic smartphone use. A narcissistic person always shows a grandiose sense of self-importance and self- promotion. A study using the narcissistic personality inventory (NPI) found a positive association between the person’s level of narcissism and their dependence on smartphones. For such individuals, smartphones provide a vehicle to help them promote themselves on social media.

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-5. Social factors:

In contrast to the findings obtained in relation to Internet addiction, girls have been found to be more likely to use smartphones excessively (Choi et al., 2015; Kwon & Paek, 2016; Lee et al., 2017). Although it is unclear about the difference between the addictions, it was suggested that girls have a narrower range of uses for the phone, such as chatting, blogging, updating personal homepages, and searching for information, but are more highly dependent on their smartphone (Heo, Oh, Subramanian, Kim, & Kawachi, 2014).

School is another essential determinant of the development of behavioral addiction (Roeser, Eccles, & Sameroff, 2000). Young people have the tendency to connect to each other and organize activities through smartphones in the classroom or other places. Furthermore, with the readily accessible Internet, students can easily engage in “cyberloafing” activities in their classrooms (Gokcearslan, Mumcu, Haslaman, & Cevik, 2016).

A lack of peer support and need for belonging can also contribute to increased smartphone usage (Ihm, 2018; Wang et al., 2017). Choi et al. (2015) found that smartphone use can facilitate interpersonal relationships by connecting different people to one another. People with low satisfaction with their offline interpersonal relationships are more likely to spend more time on their smartphones as an alternative way to maintain social contacts (Bae, 2015; Zhu et al., 2019). Similarly, Herrero et al. (2017) found that a lower level of social support may precipitate greater social isolation and sense of loneliness, which then contributes to excessive smartphone use. More alarmingly, they showed that risky behavior that compromised cybersecurity and personal safety became more likely and this made these individuals more vulnerable to cyber-attack and cyber-victimization (Herrero et al., 2017).

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-6. Protective factors:

Self-regulation or self-control is an essential determinant in problematic smartphone use among adolescents (Gokcearslan et al., 2016; Van Deursen, Bolle, Hegner, & Kommers, 2015). Self‐control refers to the ability to regulate personal desires or actions and to adapt to the environment in a way that enhances the attainment of personal goals (Hong et al., 2012). People may be less likely to develop problematic smartphone use (Cho et al., 2017) if they are more capable in regulating their thoughts, emotions, and impulses (De Ridder, Lensvelt-Mulders, Finkenauer, & Stok, 2012). In other words, they have the willpower to resist the temporary satisfaction that arises from compulsive smartphone use.

Several studies also looked into the importance of parenting style as a factor that might influence excessive smartphone use. A more positive parenting style was described to predict higher self-regulation (Bae, 2015; Kwan & Leung, 2017; Lian et al., 2016). For example, young people who have experienced more authoritative styles of parenting generally have more secure attachments and develop greater trust and more of a sense of control in their relationships with others. This style of parenting can also contribute to better self-regulation, which can reduce impulsivity and more effective coping strategies to deal with problems (Lam, Peng, Mai, & Jin, 2009). Hwang, Choi, Yun, and Jeong (2017) also pointed out that parental mediation, which refers to the strategies adopted to ameliorate the negative effects of media use among children, has positive effects on problematic behavior including problematic smartphone use. It involves restriction by setting rules on the amount of time and types of allowed content as well as actively explaining and discussing the use of smartphones. In their study, authoritative parents tended to be more confident about providing parental mediation because they believed it would be effective in protecting their children from smartphone addiction.

Good peer relationship and social support are also essential protective factors in preventing problematic smartphone use (Kim et al., 2018). Positive interaction among peers could help buffer psychosocial problems such as anxiety and depression, as well as lead to higher self-esteem, which promotes healthy identity development (Bae, 2015; Zhu et al., 2019). Adolescents with better engagement with friends and in school are more likely to receive less discrimination and greater acceptance, which promotes positive thoughts and emotions. This helps with more stable social relationship and better emotion regulation, thereby decreasing the risk for problematic smartphone use.

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Harms of smartphone addiction:

All the negative impacts of smartphone overuse discussed in section 2 earlier are applicable as harms of smartphone addiction. Additionally, smartphone addiction can also negatively impact your life by:

• Increasing loneliness and depression. While it may seem that losing yourself online will temporarily make feelings such as loneliness, depression, and boredom evaporate into thin air, it can actually make you feel even worse. A 2014 study found a correlation between high social media usage and depression and anxiety. Users, especially teens, tend to compare themselves unfavorably with their peers on social media, promoting feelings of loneliness and depression.
• Fueling anxiety. One researcher found that the mere presence of a phone in a work place tends to make people more anxious and perform poorly on given tasks. The heavier the phone user, the greater the anxiety experienced.
• Increasing stress. Using a smartphone for work often means work bleeds into your home and personal life. You feel the pressure to always be on, never out of touch from work. This need to continually check and respond to email can contribute to higher stress levels and even burnout.
• Exacerbating attention deficit disorders. The constant stream of messages and information from a smartphone can overwhelm the brain and make it impossible to focus attention on any one thing for more than a few minutes without feeling compelled to move on to something else.
• Diminishing your ability to concentrate and think deeply or creatively. The persistent buzz, ping or beep of your smartphone can distract you from important tasks, slow your work, and interrupt those quiet moments that are so crucial to creativity and problem solving. Instead of ever being alone with our thoughts, we’re now always online and connected.
• Disturbing your sleep. Excessive smartphone use can disrupt your sleep, which can have a serious impact on your overall mental health. It can impact your memory, affect your ability to think clearly, and reduce your cognitive and learning skills.
• Encouraging self-absorption. A UK study found that people who spend a lot of time on social media are more likely to display negative personality traits such as narcissism. Snapping endless selfies, posting all your thoughts or details about your life can create an unhealthy self-centeredness, distancing you from real-life relationships and making it harder to cope with stress.

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Measurement of smartphone addiction:

Scales and Questionnaires:

The need to study potentially negative impacts of mobile phone misuse has required the development of a number of tools to identify maladaptive mobile phone use. Specifically, a range of psychometrically sound scales/questionnaires has been developed to measure problematic mobile phone use. The Problematic Mobile Phone Use Questionnaire [PMPUQ] was developed to measure problematic phone use based on four factors: prohibited use, dangerous use, dependence symptoms, and financial problems associated with its use. Additionally, the Problematic Cellular Phone Use Questionnaire [PCPU-Q] is another scale that has been developed to measure problematic cell phone use based on the taxonomies of substances use dependence (e.g., symptoms, functional impairment). However, one of the pioneering tools used in this area of research, the Mobile Phone Problem Use Scale [MPPUS], has ubiquitously been used in the literature for many years. Problem mobile phone use in the MPPUS is measured based on potential predictors of behavioral and technological addiction. The MPPUS considers issues involving tolerance, withdrawal, craving, negative life consequences (e.g., social, financial), and escaping from other problems. This scale has demonstrated high levels of validity and reliability, and has been used in several studies across different countries, and is considered to be a highly useful tool in measuring a universal score of problematic mobile phone use.

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The allure of discovering what constitutes cellphone addiction has been widespread. Currently over 18 scales have been created to identify the possible psychological variables that may underlie addiction to cellphones. Given the expanded functions of smartphones over cellphones and the likelihood that smartphones exacerbate symptoms of addiction, we begin by making a distinction between the two types of phones. Here we focus on scales designed to assess smartphone addiction specifically. 

Commonly used questionnaires for smartphone addiction screening as of 2016 are depicted in table below:

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Existing assessments of smartphone addiction include four scales (De-Sola Gutierrez et al., 2016): the Smartphone Addiction Inventory (SPAI; Lin et al., 2014), Smartphone Addiction Questionnaire (SPAQ; Al-Barashdi et al., 2014), Smartphone Addiction Measurement Instrument (SAMI; Tossell et al., 2015), and the Smartphone Addiction Scale (SAS; Kwon et al., 2013). The SAS has been the most influential of the four key smartphone addiction instruments.  

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SAS:

Smartphone addiction scale (SAS) is a scale for smartphone addiction and it is a 33-item self-report measure of behaviors associated with problematic smartphone use. The 33 items are arranged into six subscales: Daily-Life Disturbance, Positive Anticipation, Withdrawal, Cyberspace-Oriented Relationship, Overuse, and Tolerance.  The measure utilizes a six-point Likert scale response format ranging from “1” (strongly disagree) to “6” (strongly agree), with a maximum total score of 198. During its development stages, the internal-consistency test result (Cronbach’s alpha) was 0.967.

The Smartphone Addiction Scale (SAS) takes a smartphone’s characteristics into consideration. And contains six subscales of problematic smartphone usage (daily-life-disturbance can be defined as having a hard time concentrating in class or while working, pain on the wrists or at the back of the neck, and sleeping disturbance; positive-anticipation is described as feeling excited about smartphone use, even feeling empty without a phone; withdrawal is represented as being impatient and intolerable without a smartphone, and becoming irritated when bothered while using a mobile phone; overuse refers to the uncontrollable use of a smartphone; tolerance is represented as always trying to control one’s phone use but usually failing to do so; and cyberspace-oriented relationship mainly involves questions about one’s relationships obtained via phone technology). This scale was proven to be relatively reliable and valid, and it has been extensively applied to different kinds of modified versions around the world. The SAS also yields a total score that is reveals the severity of smartphone addiction; higher scores indicate more severe addictions.

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English Version of SAS

English Version of SAS
Items		Strongly disagree	Disagree	Weakly disagree	Weakly agree	Agree	Strongly agree
1	Missing planned work due to smartphone use	1	2	3	4	5	6
2	Having a hard time concentrating in class, while doing assignments, or while working due to smartphone use	1	2	3	4	5	6
3	Experiencing lightheadedness or blurred vision due to excessive smartphone use	1	2	3	4	5	6
4	Feeling pain in the wrists or at the back of the neck while using a smartphone	1	2	3	4	5	6
5	Feeling tired and lacking adequate sleep due to excessive smartphone use	1	2	3	4	5	6
6	Feeling calm or cozy while using a smartphone	1	2	3	4	5	6
7	Feeling pleasant or excited while using a smartphone	1	2	3	4	5	6
8	Feeling confident while using a smartphone	1	2	3	4	5	6
9	Being able to get rid of stress with a smartphone	1	2	3	4	5	6
10	There is nothing more fun to do than using my smartphone.	1	2	3	4	5	6
11	My life would be empty without my smartphone.	1	2	3	4	5	6
12	Feeling most liberal while using a smartphone	1	2	3	4	5	6
13	Using a smartphone is the most fun thing to do.	1	2	3	4	5	6
14	Won’t be able to stand not having a smartphone	1	2	3	4	5	6
15	Feeling impatient and fretful when I am not holding my smartphone	1	2	3	4	5	6
16	Having my smartphone in my mind even when I am not using it	1	2	3	4	5	6
17	I will never give up using my smartphone even when my daily life is already greatly affected by it.	1	2	3	4	5	6
18	Getting irritated when bothered while using my smartphone	1	2	3	4	5	6
19	Bringing my smartphone to the toilet even when I am in a hurry to get there	1	2	3	4	5	6
20	Feeling great meeting more people via smartphone use	1	2	3	4	5	6
21	Feeling that my relationships with my smartphone buddies are more intimate than my relationships with my real-life friends	1	2	3	4	5	6
22	Not being able to use my smartphone would be as painful as losing a friend.	1	2	3	4	5	6
23	Feeling that my smartphone buddies understand me better than my real-life friends	1	2	3	4	5	6
24	Constantly checking my smartphone so as not to miss conversations between other people on Twitter or Facebook	1	2	3	4	5	6
25	Checking SNS (Social Networking Service) sites like Twitter or Facebook right after waking up	1	2	3	4	5	6
26	Preferring talking with my smartphone buddies to hanging out with my real-life friends or with the other members of my family	1	2	3	4	5	6
27	Preferring searching from my smartphone to asking other people	1	2	3	4	5	6
28	My fully charged battery does not last for one whole day.	1	2	3	4	5	6
29	Using my smartphone longer than I had intended	1	2	3	4	5	6
30	Feeling the urge to use my smartphone again right after I stopped using it	1	2	3	4	5	6
31	Having tried time and again to shorten my smartphone use time, but failing all the time	1	2	3	4	5	6
32	Always thinking that I should shorten my smartphone use time	1	2	3	4	5	6
33	The people around me tell me that I use my smartphone too much.	1	2	3	4	5	6

Smartphone Addiction Scale–short version (SAS-SV):

Ten items were selected for inclusion on the SAS-SV as per expert panel review of the 33 SAS items. Initial validation analyses of the SAS-SV were conducted in a South Korean adolescent sample. The SAS-SV was found to correlate strongly with the SAS (’ r ¼ 0.96) and demonstrated high internal consistency (Cronbach s alpha ¼ .91) in its initial validation study.

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Caveat:

Understanding how people use technology remains important, particularly when measuring the impact this might have on individuals and society. However, despite a growing body of resources that can quantify smartphone use, research within psychology and social science overwhelmingly relies on self-reported assessments. These have yet to convincingly demonstrate an ability to predict objective behavior. The existing self-report instruments are unlikely to be sensitive enough to accurately predict basic technology use related behaviors. As a result, conclusions regarding the psychological impact of technology are unreliable when relying solely on these measures to quantify typical usage.  

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Cell-Phone Addiction: A Review of 2016:

There is a consensus about the existence of cell-phone addiction, but the delimitation and criteria used by various researchers vary. Cell-phone addiction shows a distinct user profile that differentiates it from Internet addiction. Without evidence pointing to the influence of cultural level and socioeconomic status, the pattern of abuse is greatest among young people, primarily females. Intercultural and geographical differences have not been sufficiently studied. The problematic use of cell phones has been associated with personality variables, such as extraversion, neuroticism, self-esteem, impulsivity, self-identity, and self-image. Similarly, sleep disturbance, anxiety, stress, and, to a lesser extent, depression, which are also associated with Internet abuse, have been associated with problematic cell-phone use. In addition, the present review reveals the coexistence relationship between problematic cell-phone use and substance use such as tobacco and alcohol. The majority of the studies have focused on the adolescent and student populations, a period of life where impulsivity and sensation seeking play an important role. Thus, the concept of cell-phone addiction cannot be extended to the population as a whole until additional data and studies on the adult population are available.

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The Association Between Smartphone Addiction and Sleep: A UK Cross-Sectional Study of Young Adults of 2021:

Using a validated instrument, 39% young adults reported smartphone addiction. Smartphone addiction was associated with poor sleep, independent of duration of usage, indicating that length of time should not be used as a proxy for harmful usage. This study found that proxy measures of screen time were not synonymous with addiction; a validated addiction instrument should be used to capture this phenomenon.

Remember, prolonged screen time is not synonymous with addiction.   

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Counterview:  

While substance use has been linked to changes in brain structure, which in turn has been linked to reported problems in life (e.g. Leshner, 1997), this is likely due to the direct physiological impact of substances on the brain. Some authors – including journalists from mass media and the popular science press – occasionally claim that harmful structural brain changes can occur also from using digital technology. Media reports sometimes claim that internet use and new technology can ‘re-wire’ children’s brains and make them addicted (e.g. Ferranti, 2016). However, while some behaviours may certainly change brain structure and its function, this cannot, in itself, be taken as evidence for the development of addiction, nor can it even be considered a harmful outcome per se. Brain changes are part of a normal development process, in particular during adolescence (Blakemore and Mills, 2014). Changes in brain structure, as measured by magnetic resonance imaging (MRI) studies, seem to be subject to strong genetic control between late childhood and adolescence and are thus unlikely to be affected in any major way by subtle environmental influences such as technology (Mills, 2014). As Mills (2014) concludes in a recent review of the neuroscience literature on the effects of internet use on the adolescent brain, “Major brain changes, akin to what is suggested by the phrase ‘rewiring the brain’ are unlikely” (p. 385).

Another popular claim sometimes found in media reports (e.g. Ferranti, 2016; Kardaras, 2016), which draw on neuroscience literature though do not necessarily reflect the body of evidence accurately, is that internet can ‘hijack the brain’ by interfering with its reward system to the point where a behaviour becomes encoded as habit. This idea draws on the dopamine theory of addiction, which reached some prominence in neuroscience as an explanation of why addiction occurs. Dopamine is a neurotransmitter which has been shown to play a major role in reward and learning (Di Chiara and Imperato, 1988). The dopamine theory of addiction suggests in simple terms that drugs cause a dopamine release stronger than that of natural rewards, making drug intake more motivationally important than other activities in life, in the end resulting in uncontrollable drug use and addiction. The idea when applied to digital technology is that as a pleasurable activity, digital technology will stimulate the release of dopamine in the brain and produce feelings of reward similar to a drug. It has been suggested that the individual will find the feelings of reward produced by digital technology so desirable that they are unable to control or stop the behaviour, thus leading to addiction.

A review by Nutt et al., (2015), accounting for evidence from 40 years of research on the dopamine theory of addiction, concludes that dopamine release is not responsible for the euphoric effect of all abused substances (p. 307) and that the relationship between dopamine and addiction is likely to be more complex than the dopamine theory of addiction suggests. This effectively debunks the claim that dopamine release and feelings of reward resulting from use of digital technology alone could cause addiction. The same review states that dopamine might even have a role in resilience against becoming dependent on some substances, turning the dopamine theory of addiction on its head (p. 308). The dopamine theory of addiction has been further challenged for either excluding relevant studies that do not support the link between reward and addiction or for relying too much on evidence from animal models that do not necessarily generalize to humans (Nutt et al., 2015). Release of dopamine is not problematic in itself, but a natural function that serves many important roles in normal brain functioning, such as influencing attention, working memory, motivational salience and fluent motor function. From a logical standpoint, if using digital technology could hijack the brain (or the dopamine system) and cause addiction, simply by being pleasurable, it stands to reason that most people would be addicted to it. This is clearly not the case, suggesting that dopamine release and feelings of reward alone do not cause addiction. This is supported by recent thinking in the neuroscience literature on substance addiction, as only a minority of drug users develop addiction (Nutt et al., 2015).

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Section-6

Smartphone, children and parents: 

The evolution of media from traditional to newer forms of digital media in the past decade has resulted in changes in the patterns of media use. For example, in 1970, children began to regularly watch TV at 4 years of age, whereas today, children begin interacting with digital media at 4 months of age. Exactly what young children are doing on mobile technology has not been studied in great detail, because mobile device usage is relatively recent and methodologically difficult to assess. By parent report, most children in the Kabali et al study watched YouTube or Netflix primarily, and smaller proportions watched educational programs and played early-learning apps (eg, alphabet and counting apps). A large minority also played games or watched cartoons. Common Sense Media’s Zero to Eight survey has found disparities in the use of educational media on mobile devices, with 54% of children from higher-income families often or sometimes using educational content on mobile devices but only 28% of children from lower-income families doing so. Thus, younger children and those from lower-income families are more likely to use mobile devices for entertainment purposes.

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Children’s use of digital technology has increased rapidly over the past decade, raising important questions around how time spent on digitally-mediated activities may affect children in positive or negative ways (Putnam, 2000; Turkle, 2011; Bell, Bishop and Przybylski, 2015; George and Odgers, 2015). The question is no longer if children are using digital technology, but how, why, and with what effects (2015). Clearly, digital technology offers many potential benefits to children, allowing them to connect with peers or access educational resources or entertainment (Livingstone and Bober, 2006; Valkenburg and Peter, 2009; boyd, 2014). At the same time, there are legitimate concerns around who children interact with online (Pew Research Center, 2012), if they experience cyber-bullying or access age appropriate content (boyd and Hargittai, 2013), or whether screen-based communication may jeopardize their social development or well-being (George and Odgers, 2015).

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Even though adults also use digital technology to a great extent, concerns tend to centre on children’s use because of the many social, biological, cognitive, and psychological changes that characterize this life period. Children go through critical developmental stages, such as identity formation and building positive friendships while immersed in the digital age (George and Odgers, 2015). Turkle (2011) has argued that children today are interacting more with their phone than with each other, which may cause them to miss out on important social experiences. Others say that children still interact with one another as much as before and that the interactions are of similar quality; it is the venues for social interaction that have changed, becoming digital (e.g. boyd, 2014). Because friendships and communication with peers are important for the development of life-long social skills, there are concerns that children’s social skills might somehow be altered or negatively affected when digitally mediated (George and Odgers, 2015). This extends to a broader societal concern that children may lose out in important areas of life because they spend so much of their time in front of screens. In this respect, the digital age has introduced new challenges for parents who face the difficult task of striking a balance between allowing independent exploration, and providing appropriate limitations and oversight (Pew Research Center, 2016).

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Responding to some of these concerns, researchers have explored how the time children spend using digital technology impacts their lives across various domains. Over the course of the past two decades, individual research studies have indicated that increased use of digital technology might have some negative impacts on children’s well-being, ranging from mental health issues such as depression (Kim et al., 2010) or addiction (Young, 1996), to public health issues like obesity (Sisson et al., 2010). At the same time, most of these claims have been disputed by other scholars and many studies show how digital technology brings great benefits to children (e.g. Livingstone et al., 2011; Byrne et al., 2016; Baranowski et al., 2008; Granic, Lobel and Engels, 2014), highlighting its social and interactive features (e.g. boyd, 2014; Cole and Griffiths, 2007; Hussain and Griffiths, 2009; Valkenburg and Peter, 2007), how it opens up new opportunities for performance, creativity and expression (Lowood, 2007) and features as an everyday practice in the home for purposes of social interaction and relaxation with the family (Enevold, 2012). Recent research suggests that video gaming positively influences cognitive, motivational, emotional and social development (Granic et al., 2014), while other research suggests that video gaming might disrupt children’s sleep patterns (Dworak et al., 2007). So there are seemingly contradictory body of evidence.

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Impact of time spent using digital technology on children’s mental well-being:

Various studies show that the time spent on digital technology can have both positive and negative effects on child well-being, depending on the activity and how much time is spent. No use and high use tends to be associated with negative effects, while moderate use seems to have positive effects. However, these effects – whether positive or negative – are typically weak and only contribute a small part to explaining overall child mental well-being. As some studies have concluded, if the goal is to improve the mental well-being of children it seems more important to ensure a healthy life style for children in general rather than reducing screen time. As Przybylski (2014), Parkes and colleagues (2013) and Ferguson (2017) suggest in their respective studies, factors shown to have robust and enduring effects on child wellbeing such as family functioning, social dynamics at school and socioeconomic conditions, are more important than the direct influence of time spent using digital technology. While gender differences were found in relation to how children use digital technology, few significant gender differences in terms of the impact on mental well-being, were found in these studies. As Przybylski (2014) suggests, even if no direct negative effects result from heavy technology use, it may crowd out other activities that could benefit the child. Longitudinal data and cohort studies are needed to understand the cumulative effects of spending a lot of time on digital technology from a young age.

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Impact of time spent using digital technology on children’s social relationships:

Various studies support the statement that the internet (or digital technology) by itself is not a main effect cause of anything (McKenna and Bargh, 2000; Peter et al., 2005), but that it is the contextual and individual factors that determine impacts on social interaction and relationships. Valkenburg and Peter (2009) conclude in their review of a decade on research on the social consequences of the internet for adolescents that there has been a clear shift in research findings in this area. While early research from the 1990s tended to report that internet use was detrimental to social interaction and relationships, recent studies tend to report mostly positive impacts, a conclusion also reached in a review by George and Odgers (2015). Valkenburg and Peter (2009) speculate that this is connected with changes in how adolescents used the internet in the 1990s compared to today. In the past, it was difficult to use the internet to maintain existing friendships since the majority of an individual’s social network was not yet online, this is not the case today, when most young people have access. This makes it more likely that digital technology will have positive impacts on friendships and social networks because a large amount of time spent online is spent on strengthening existing bonds of friendship, and not on isolating people in a lonely online space. Today’s internet users are far from lonely, which seems to explain the positive impacts of time spent using digital technology on children’s social relationships (Valkenburg and Peter, 2009).

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Impact of time spent using digital technology on children’s physical activity: 

Various studies show that the evidence on the impact of time spent using digital technology on physical activity is mixed and inconclusive. While a number of longitudinal and cross-sectional studies have found a link between time spent using digital technology and reduced physical activity, other studies report no such associations. Explanations for reduced physical activity seem to depend on multiple factors beyond the time spent on digital technology, some of which have yet to be examined. Researchers do seem to broadly agree that the link between screen time and physical activity is unlikely to be direct. For example, Tolbert Kimbro and colleagues (2011) suggest that perceptions of neighbourhood safety and the residential environment (e.g. access to parks or playgrounds) might influence the time spent both on digital technology and physical activity. It has been suggested that indoor play offers a compelling alternative to outdoor play in less affluent neighbourhoods and in families where parents have less time available to supervise their children (Tandon et al., 2012). This claim is supported by studies showing that individuals who live in more disadvantaged neighbourhoods tend to have less access to portable play equipment and report lower levels of physical activity and higher rates of obesity, though the causal nature of these relationships is unclear (Tolbert Kimbro et al., 2011; Tandon et al., 2012). The finding that screen-based activity and physical activity seem to be independent behaviours is particularly important for health promotion policies and should be underlined. Longitudinal data suggests that reducing the amount of time spent on digital devices will not automatically increase the time spent on physical activities (Gebremariam et al., 2013). Some authors argue that promoting physical activity independently may be a more useful strategy. This argument is supported by previous longitudinal studies on television viewing and physical activity in adolescence (Taveras et al., 2007).

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Quality versus Quantity:

The advocates of introducing young children to screen media contend that it is the ‘quality’ of what the children see on the screen – the content – that is critical. It is suggested that provided what the young child sees on the screen is ‘educational’ and ‘age-appropriate’ that screen media is at worst harmless. Moreover, there is an implicit message that not to expose young children to this screen material puts them at a developmental and educational disadvantage. There is also the strong belief that children have to start using screen technology early or they will in some way be intimidated by it, or be less competent at using it later on in life.  It is vital for them to learn to handle screen media, because this is the way they will work in the future. However, research has found that even monkeys are comfortable with, and capable of using, the same screen technology that children are exposed to (Deadwyler et al., 2008; Tulane University, 2006). In order to redress this misconception researchers at Harvard Medical School have stated, “There is no data to substantiate the claim that young children need to learn to become comfortable with screen technology. The fact that children like something, or parents think they do, does not mean that it is educational, or even good for them. Children like candy, too.” (Linn & Poussaint 1999). Just because children are interested in doing something, that does not mean that it is in their best interest to do it. And so this argument appears to be more of a commercial claim, as children and adults can acquire computer skills much later.

While this trend in introducing screen media in early childhood is gathering strength, a growing body of empirical evidence – most of it from beyond the domains of media studies, education and psychology is providing a very different account (Sigman, 2007, a, b; 2009; 2010). There seems to be a direct conflict between the advocates of screen media in early childhood, on the one hand, and the warnings arising from studies in paediatric medicine and biology, on the other. Specifically it is the age at which the child starts to watch screen media and the time spent during a child’s early years looking at and relating to the medium of the screen that is the central factor. It is the medium itself that should concern us, and not merely the content of young children’s experiences with screen media.

This concern is not based on an anti-technology or anti-television philosophy. The concerns are based purely on the premature use or overuse of screen media in children whose brains and bodies are not yet fully formed. And there are now sound medical reasons for delaying the introduction of screen media to children.

In 1999, the American Academy of Pediatrics (AAP) issued guidelines recommending that children under the age of two watch no screen entertainment at all because television ‘can negatively affect early brain development’ (AAP,1999). These early years are crucial in a child’s development. The Academy is concerned about the impact of television programming intended for children younger than age two and how it could affect your child’s development.’ (AAP, 2006) And in late 2011 they’ve gone further, ‘media —both foreground and background— have potentially negative effects and no known positive effects for children younger than 2 years.’ (AAP 2011b)

The Australian government is now considering a similar national policy guideline. And it is highly significant that the French government has recently banned French channels from airing all TV shows – ‘educational’ and otherwise – aimed at children under three years of age. It has declared:

‘Television viewing hurts the development of children under three years old and poses a certain number of risks, encouraging passivity, slow language acquisition, over-excitedness, troubles with sleep and concentration as well as dependence on screens … even when it involves channels aimed specifically at them.’ (High Audiovisual Council, 2008) Preschool institutions in Belgium, including those just down the street from the European Parliament, now have similar warnings posted on their walls.

There is emphasis on differentiating between different technology devices and their related activities: watching TV, playing computer games, surfing the internet, instant messaging, smart phones or any other screen exposure. Yet these are only different market sectors and while adults distinguish between these various activities, the young brain and body generally does not. Many of the effects occur whether the child is sitting in front of a smartphone or a TV and occur irrespective of what they are watching.

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Time spent in front of screens:

Much of the concern regarding screen media is based on the average number of hours a day children spend watching screen media, this is now often referred to as the ‘dose’ of screen media ‘consumed’.

Over the last thirty years social interaction (eye-to-eye contact) has gone down while eye-to-screen-contact has gone up. Just before the year 2000 life became literally virtual: people would spend more time in front of a screen than spending time interacting with other human beings as seen in the figure below:

Studies at Stanford University have led to a ‘displacement’ theory of internet use:

“In short, no matter how time online is measured and no matter which type of social activity is considered, time spent on the Internet reduces time spent in face-to-face relationships … an hour on the Internet reduces face-to-face time with family by close to twenty-four minutes.” (Nie et al., 2005)

Consumption of a high dose of screen media starts early in life. By 3 months of age 40 per cent of infants are regular viewers of television, DVDs or videos, and by the age of 2, this number increases dramatically to 90 per cent (Zimmerman et al., 2007b). In the United States as elsewhere, children under 8 are spending more time than ever in front of screens. A new study, Zero to Eight: Children’s Media Use in America, found almost half of infants watch daily “TV or DVDs, and those who do watch spend an average of nearly two hours doing so.’ Nearly one in three infants has a TV in their bedroom. (Zero to Eight, 2011)

The British Office of Communications has recently announced ‘TV viewing is still growing, with children watching more TV than ever …viewing figures increasing by 2 hours [per week] since 2007’. And so is other screen time: ‘8-11s are also spending more time playing on games players/ consoles compared with 2010 (an increase of nearly 2 hours).’ Seven in ten play computer and video games ‘almost every day, up from 59 per cent in 2010.’ (Ofcom, 2011)

Scientists are now witnessing compound effects. Children and teenagers are spending an increasing amount of time using ‘new media’ like smartphones, the internet, iPod videos and video games, without cutting back on the time they spend with ‘old’ media like television. Instead, because of the amount of time they spend using more than one screen at a time, they’re managing to pack increasing amounts of media content into the same amount of time each day, and at younger and younger ages (Kaiser Family Foundation, 2005; Childwise Monitor, 2008). The European range of average screen time lies between four to eight hours per day. One thing is clear: children have more screens available to them and they now spend more time watching TV, playing with smartphones and surfing the internet at younger ages.

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Are Touchscreens more Educational?

Pedagogic theory has long emphasized that interaction improves learning. This understanding has been the motivation for recommending coviewing of media, along with evidence that parent interaction increases young children’s engagement with media and understanding of content. The interactivity of new media via touchscreens allows apps to “know” whether a child is responding accurately and tailor responses, reinforcement, and next steps to the child’s input. Theoretically, this may increase educational potential by providing scaffolding to build skills at the child’s edge of competence.

Empirical evidence regarding interactive media use in infants and toddlers is sparse. At 24 months of age, a child can learn words from live video-chatting with a responsive adult or from carefully designed, interactive screen interfaces that prompt the child to tap on relevant learning items. Starting at 15 months of age, toddlers can learn novel words from touchscreens in laboratory-based studies (with specially designed, not commercial, apps) but have trouble transferring this knowledge to the 3-dimensional world, particularly if they regularly use touchscreen platforms to view entertainment media.

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Is Skyping Appropriate for Infants and Toddlers?

Many parents now use video-chat (eg, Skype, Facetime) as an interactive media form that facilitates social connection with distant relatives. New evidence shows that infants and toddlers regularly engage in video-chatting, but the same principles regarding need for parental support would apply in order for infants and toddlers to understand what they are seeing. Because video-chat episodes usually are brief, promote social connection, and involve support from adults, this practice should not be discouraged in infants and toddlers.

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Are “Educational” Apps and e-Books really Educational?

As content from PBS high-quality programs is translated into apps and game formats (eg, Martha Speaks, Big Bird’s Words, and Cookie Monster’s Challenge apps), educational benefits have been shown in preschoolers. Unfortunately, very few of the commercially available apps found in the educational section of app stores have evidence-based design input with demonstrated learning effectiveness. In fact, recent reviews of hundreds of toddler/preschooler apps labeled as educational have demonstrated that most apps show low educational potential, target only rote academic skills (eg, ABCs, colors), are not based on established curricula, and include almost no input from developmental specialists or educators. An additional concern is that the formal features (ie, bells and whistles) that are designed to engage the child in an interactive experience may actually decrease the child’s comprehension or distract from social interaction between caregivers and children during use, as has been shown for e-books, which is important, because active parent involvement in both digital play and book reading improves children’s learning from the experience.

One reason that children may be less socially engaged during digital play is that gaming design involves behavioral reinforcement meant to achieve a maximum duration of engagement, which may explain why interrupting children’s digital play leads to tantrums, particularly when games or videos are set on autoadvance. To address these concerns, academic and industry leaders have recently recommended creating digital products for children that are appropriately engaging, but not distracting; that are designed to be used by a dual audience (ie, both parent and child) to facilitate family participation in media use and modeling of more effective social and learning interactions; and that have automatic “stops” as the default design to encourage children and caregivers to pause the game use and turn to the 3-dimensional world.

One recent app, for example, demonstrates such an adult–child dyad-centered design. Bedtime Math creates a platform and a structure for parents and children to read stories and answer math problems together on a nightly basis. It is one of the few apps that has been tested in a randomized controlled community-based trial and shown benefits. Embedding, indeed requiring, social interactivity for functionality may hold great promise for even younger children as well. However, recent population-based surveys suggest that joint media engagement (and designs to facilitate it) is not as common as individual use.

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Is Media use linked to Obesity?

High levels of media use are linked to obesity and cardiovascular risk throughout the life course, but these associations are observed starting in early childhood. For example, heavy media use during preschool years is associated with small but significant increases in BMI, which sets the stage for greater weight gain later in childhood. The association between using ≥2 hours of media per day and obesity persists even after adjusting for children’s psychosocial risk factors or behavioral problems. Research in preschoolers often uses a 2-hour cut-off to define excessive media use, but a recent study of 2-year-olds found that BMI increased for every hour per week of media consumed.  Moreover, media use behaviors may explain some of the obesity risk disparities among young black and Hispanic children. None of these studies examined mobile media specifically, which may be more easily used during meals and, therefore, distract children from satiety cues. Fortunately, studies also suggest that making efforts to reduce children’s sedentary media use can have positive health effects. An intervention study focused on third and fourth graders worked with the participants to reduce time spent watching TV and playing video games. The study demonstrated that children in the intervention group reported reduced TV viewing and meals in front of the TV and had reduced BMIs, illustrating that interventions to reduce sedentary media use can positively impact health behaviors as well as BMI.

A study published in the American Medical Association journal Archives of Pediatric and Adolescent Medicine found an association between daily screen time (ST) (i.e. television/DVD/computer use) in mid-adolescence and risk factors for cardiovascular disease and type 2 diabetes. Analysing blood samples in adolescent boys revealed that those boys with ST of 2 or more hours per day on weekdays have twice the risk of abnormal levels of insulin and HOMA-Insulin Resistance compared with boys with ST of less than 2 hours per day on weekdays indicating a greater risk for developing cardiovascular disease and type 2 diabetes. (Hardy et al 2010)

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How does Media use affect Sleep?

There is a growing body of evidence that suggests that media use negatively affects sleep. Increased duration of media exposure and the presence of a TV, computer, or mobile device in the bedroom in early childhood have been associated with fewer minutes of sleep per night, especially among children of racial/ethnic minority groups. Later bedtimes after evening media use and violent content in the media also may be contributing factors, and suppression of endogenous melatonin by blue light emitted from screens is another possible cause. Associations between media and sleep are seen in infants as well; 6- to 12-month-olds who were exposed to screen media in the evening hours showed significantly shorter night-time sleep duration than those who had no evening screen exposure.

Studies of older children and teenagers have found that participants with higher social media use or who sleep with mobile devices in their room were at greater risk for sleep disturbances. One study of adults found that taking a phone into the bedroom led to longer sleep latency, worse sleep quality, more sleep disturbance, and more daytime dysfunction. This study illustrates the multiple mechanisms by which media use around bedtime, or during bedtime, can disrupt sleep and affect daytime function.

Daytime screen use may also affect sleep. According to a Norwegian study, daytime and bedtime use of electronic devices both affected sleep measures, with an increased risk of short sleep duration, long sleep onset latency, and increased sleep deficiency. A dose–response relationship emerged between sleep duration and use of electronic devices. Ensuring that children and teenagers obtain the necessary hours of healthy sleep is an important goal of a Family Media Use Plan.

Melatonin is a sleep-promoting hormone produced in the brain. As it grows dark melatonin levels rise and help facilitate sleep. Researchers have recently reported that when children aged 6-12 were deprived of their TV sets, computers and video games, their melatonin production increased by an average 30%. Exposure to a screen media was associated with lower urinary melatonin levels, particularly affecting younger children at a stage of pubertal development when important changes in melatonin’s role take place. The lead author speculated that girls are reaching puberty much earlier than in the 1950s. One reason is due to their average increase in weight; but another may be due to reduced levels of melatonin. Animal studies have shown that low melatonin levels have an important role in promoting an early onset of puberty. (Salti et al, 2006)

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Child Pornography and Child Abuse:

Unfortunately, the Internet has also created opportunities for the exploitation of children by sex offenders. Online predators can gain access to children and teenagers through social networking, chat rooms, E-mail, and online games. Cases of child trafficking, cybergrooming, and sexual abuse for private and commercial purposes have increased with the help of the anonymous cyberspace environment. For example, online grooming leads to establishment of a trusting relationship, often with the perpetrator misrepresenting himself as another child or teenager. This developing online relationship may lead to sexting or to convincing the child to meet the perpetrator in person. Children may be deceived, tricked, or coerced into engaging in sexual acts for the production of child sexual abuse materials (child pornography), which then can circulate online for years to come. Child sexual abuse images often involve young and very young children. Of 43,597 children assessed in sexual abuse images and videos, 49.6% appeared to have a sexual maturity rating of 1, and 28.7% appeared to have a sexual maturity rating of 2.144

Besides the adverse effects associated with child sexual abuse, victims who have had online sexual images (pornography and sexting) posted may experience significant anxiety and stress related to knowledge that the abuse images may be downloaded and viewed by millions of people for an indefinite period of time. Thus, the exploitation continues for months and years after the images were obtained.

Online child sexual exploitation also may involve recruitment and advertisement of children for prostitution and other forms of exploitation. The Internet may be used by human traffickers to facilitate movement of victims and to manage a criminal network.

Internet-initiated sex crimes involving offenders who meet and groom children online tend to involve adolescents rather than very young children: 99% of victims in one study were 13 to 17 years old, and 48% were 13 to 14 years old. Many of these crimes involve face-to-face sexual contact, which the victim perceives as “consensual.” Sexual relationships in early adolescence are associated with an increased risk of social, academic, and behavioral adverse outcomes.

Research has shown that parents underestimate the likelihood that their child might engage in online conversation with people they do not know. Therefore, it is critical that parents promote online safety with their children from an early age, monitor children’s Internet use, and use tools, such as parental control software, to maintain awareness of their child’s online activities. Pediatricians should consider asking appropriate questions to explore this possibility and to educate youth about protecting themselves from exploitation. All health care professionals should report any suspicions of sexual abuse/exploitation as per child abuse reporting laws.

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Screen Multi-Tasking:

The idea, that children should learn screen multitasking (using both the TV and the smartphone/computer at the same time) as soon as possible is an unsubstantiated assumption. There may even be damage to them by introducing it too early. Screen multitasking consists of:

• Constant attentional shifts
• Little sustained attention (concentration) and is
• Occurring at younger ages.

Most children today have more than one screen in their bedroom, and even with one screen, often switch between various windows, which leads to the question of what the effects of screen multitasking are.

Brain imaging reveals that screen multi-tasking activates a different brain region (the striatum) to the one used when you learn one thing at a time (medial temporal lobe), and this is a significant hindrance to learning. (Foerde et al., 2006). Studying with a television on makes learning less efficient, and renders what you manage to learn less useful. Homework can take 50 per cent longer to complete. Neuroscientists behind this research are describing the benefits of modern multi-tasking as ‘a myth. … The toll in terms of slowdown is extremely large – amazingly so … you will never, ever be able to overcome the inherent limitations in the brain for processing information during multitasking’ (Myers, 2006). A study of multi-tasking performance conducted at Stanford University, published in the Proceedings of the National Academy of Sciences, compared groups of young people assessed as being either ‘heavy’ or ‘light media multitaskers’. Ironically, they reported ‘the surprising result that heavy media multitaskers performed worse’. One of the researchers commented, ‘The shocking discovery of this research is that [high multitaskers] are lousy at everything that’s necessary for multitasking’ (Ophir et al., 2009).

The idea that children leaving primary school are becoming more and more intelligent and competent is also called into question by uncomfortable findings. After examining certain measures of cognitive development, the researchers concluded that, ‘An 11-year-old today is performing at the level an 8- or 9-year-old was performing … 30 years ago … ’. The decline was attributed in part to the growing use of computer games. Children, especially boys, are playing more in virtual worlds instead of ‘outdoors, with tools and things … ’ (Shayer 2006). A drop in higher-level-thinking-skills among adolescents has now been reported: 14-year olds today exhibit the higher level thinking skills of 12 year-olds thirty years ago. Half as many 14 year-olds now exhibit higher level (interpretive) thinking as opposed to quick (descriptive) thinking. The researchers believe “Everything in the past 30 years has speeded up. It’s about reacting quickly but at a shallow level … text messages and computer games are about speed and instant hits, rather than more profound or detailed ways of handling information.’  (Shayer & Ginsburg 2009)

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Screen Viewing leads to Less Reading:

Early exposure to, and increasing time spent watching screen technology is strongly linked to a significant continuing decline in time spent reading books as a regular pastime (Childwise Monitor, 2008). Pre-school children spend three times longer in front of a television or computer than they spend reading; and those with a screen in their bedroom are less likely to be able to read by age 6 (Rideout et al., 2003). A comparative study of children in 41 countries found that England has dropped from 3rd to 19th in the international reading literacy league table since 2001 (PIRLS, 2007) More than a third (37 per cent) of 10-year-olds in England play computer games for more than three hours a day, the study found – one of the highest proportions internationally; and researchers found a link between this use of computer games and lower attainment in reading and literacy. Interestingly it was the lower achievement of better readers that has had the most influence on the overall decline. A survey by Britain’s National Literacy Trust found that a third of children did not now enjoy reading and found it ‘boring’. And less than half of children aged 9–14 read fiction more than once a month; websites were far more popular. (National Literacy Trust, 2010)

The rapid decline in reading has led to the recent ‘million book giveaway’ launched in Britain on ‘World Book Night’, intended to entice people to read again.

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Empathy:

Although the media often crows about internet and computer use increasing people’s ability to make quick decisions and filter large amounts of information, new research is finding that this may come at the cost of the social and emotional skills central to civilised behaviour. In particular, there seems to be a decline in the subtle skills of reading the nuances of other’s emotions. A study of brain function in adults found that when using the internet, the areas of the brain associated with empathy showed virtually no increase in stimulation. ‘Young people are growing up immersed in this technology and their brains are more malleable, more plastic and changing than with older brains . . . As the brain evolves and shifts its focus towards new technological skills, it drifts away from fundamental social skills.’ (Small et al 2009)

A study published in Proceedings of the National Academy of Sciences (2009) examined the brain function and development which underlie qualities such as empathy. The scientists drew specific attention to the effects of electronic media: ‘The rapidity and parallel processing of attention requiring information, which hallmark the digital age, might reduce the frequency of full experience of such emotions, with potentially negative consequences.’ One of the authors explained the possible interference with this process by the speed of today’s media: ‘For some kinds of thought, especially moral decision-making about other people’s social and psychological situations, we need to allow for adequate time and reflection. If things are happening too fast, you may not ever fully experience emotions about other people’s psychological states.’ (Immordino-Yang et al 2009)

Neuroscientists now believe they have identified specialised brain cells called ‘mirror neurons’, which, when activated, literally make children and young people absorb, mimic and integrate social behaviours. They’re also thought to underlie our children’s ability to ‘adopt another’s point of view’. A child’s brain is likely to have multiple mirror neuron systems that specialise in carrying out and understanding not just the actions of others, but their intentions – the social meaning of their behaviour and their emotions.

People who rank high on a scale measuring empathy have particularly active mirror neuron systems. A study of the brain activity of ten-year-olds who observed and imitated emotional expressions and social skills found a direct relationship between the level of activity in the children’s mirror neuron systems and ‘two distinct indicators of social functioning in typically developing children’: empathy and social skills. In the journal Neuroimage, scientists report that the importance of observing and copying everyday social behaviours and the mirror neuron system ‘may indeed be relevant to social functioning in everyday life during typical human development’. It is not surprising, then, that these brain cells have acquired nicknames such as ‘empathy’ or ‘Dalai Lama’ neurons. Mirror neurons, by the way, work best in real life, when people are face to face; virtual reality and videos are pale substitutes. (Rizzolatti, 2008ab; Umiltà et al 2008; Pfeifer et al 2008)

Today’s university students are not as empathetic as those of the 1980s and 1990s. A University of Michigan and University of Rochester Department of Psychiatry study undertook a metaanalysis, combining the results of seventy-two different studies on empathy conducted between 1979 and 2009 among almost 14,000 university students. And there was little flattery for the young: ‘We found the biggest drop in empathy after the year 2000. College kids today are about 40 per cent lower in empathy than their counterparts of twenty or thirty years ago, as measured by standard tests of this personality trait.’

The researchers sought a second opinion too, and in a related but separate analysis they found changes in other people’s kindness and helpfulness over a similar time period in nationally representative samples of Americans. Many people see the current generation of university students – ‘Generation Me’ – as ‘one of the most self-centred, narcissistic, competitive, confident and individualistic in recent history … It’s not surprising that this growing emphasis on the self is accompanied by a corresponding devaluation of others.’

In looking for the culprit who stole the empathy, the fingerprints of electronic media were, yet again, everywhere. The investigators believe that the sheer increase in child and adolescent exposure to media during this time could be one very important factor. They noted that compared to thirty years ago, the average American is exposed now to three times as much non-work related information.

The University of Michigan study concluded that the rise of social media may also play a role in the drop in empathy, ‘The ease of having “friends” online might make people more likely to just tune out when they don’t feel like responding to others’ problems, a behavior that could carry over offline.’ Electronic media has also contributed to a social environment that works against slowing down and listening to someone who needs a bit of sympathy. (Konrath et al, 2010a,b; 2011)

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Smartphones and child injuries:

Nonfatal, unintentional injuries to children under five increased by 10% from 2006–07 to 2011–12 (CDC, 2012). Data shows that emergency department visits increased substantially for children under five but hardly at all for children five and older. This increase is puzzling because many investments over the past few years have gone towards improving child safety.

Could the rapid adoption of smartphones explain this puzzle?

In a Wall Street Journal article, Worthen (2012) advances the hypothesis, supported by many specialists, that smartphones distract parents from supervising their children, which increases the risk of injury. But he notes that no study has provided causal evidence linking smartphone use to child injuries. This paper is the first work towards establishing that causal evidence. Because smartphones— i.e. cell phones with the ability to browse the internet, stream videos, send and receive emails, and run various software applications—are a recent innovation that provide unprecedented access to information and distractions, our understanding of their impacts on caregiver-child relations are limited and need to be explored.

Distractions have always existed–whether it is reading a book, chatting with a friend, or using a phone–but smartphones provide access to a greater variety and frequency of distractions. Smartphone owners can browse the internet, check social media, and stream videos. Prior to smartphones, caregivers had infrequent access to distractions; text messaging and phone calls can distract only when the other party responds, but smartphones can always access the internet independent of other parties’ actions. Moreover, many smartphone content creators have engineered the content to explicitly capture the user’s attention in ways unavailable in other formats. The designers optimize content to keep the user engaged, and when the user stops, the content issues alerts to draw the user back.  By lowering the costs of accessing distractions, the smartphone increases the opportunity cost of supervising children, and therefore caregivers increase phone usage and decrease supervision.

Another mechanism to consider is that smartphones alter how and where users spend their time. If the distraction mechanism is like a substitution effect, this mechanism would be the income effect: because caregivers are no longer tethered to their place of work, they effectively have more time. For example, after getting a smartphone, a caregiver may take the child to the playground more instead of having the child watch television because the caregiver can now access e-mails there. The child might get injured more, but not because the caregiver is distracted but instead purely because the child goes to the playground more. The smartphone has changed the activities in which the child participates. Under this participation effect, smartphones do not have to distract caregivers to increase injuries: if caregivers and children participate more in activities that are risky, then mechanically the number of injuries will increase. However, data from the American Time Use Survey hints that the participation effect did not drive the increase in injuries. From 2003 to 2015 the average time adults spent in activities with children decreased (Hofferth et al., 2015). Thus, the main effect will come from the distraction mechanism.

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The impact of parents’ smartphone use on language development in young children:

Since their development in 2007, smartphones have become ubiquitous in our daily lives, including during parent–child interactions. Observations show that parents’ smartphone use is relatively low when a parent is with their child (Hiniker et al., 2015), but when parents do use their smartphone around their child, it tends to be used exclusively and not alongside other activities (Abels et al., 2018). This creates the risk of parents becoming absorbed in their smartphone, which causes technoference (Vanden Abeele et al., 2020): the interference of parent–child interactions due to parents’ use of technology (McDaniel & Coyne, 2016). Given the importance of parent–child interactions in the early years, technoference can be problematic for child development (e.g., Bordeleau et al., 2012). Because children are likely to spend a significant amount of time at home with their parents before starting school, the influence of technoference in the first 5 years is critical to explore (e.g., Smith et al., 2000). This technoference affects language development by disrupting processes critical to language acquisition—namely, gaze following, joint attention, and parents’ responsiveness. Newborns and young infants demonstrate a preference for faces accompanied with direct gaze (Farroni et al., 2002), this preference facilitates the development of gaze following (Farroni et al., 2004), and gaze following can initiate joint attention exchanges (Stephenson et al., 2021). Both gaze following and joint attention skills during infancy are related to later language outcomes (Brooks & Meltzoff, 2005). Parents’ responsiveness also facilitates language development (see Deans, 2020, for a review) because parents who respond to their child’s communicative efforts are also likely to share a common object of attention (Tamis-LeMonda et al., 2001), thus facilitating joint attention. Contingency, which is a key feature of responsiveness, also predicts language development in infants (Tamis-LeMonda et al., 2014). It is hypothesized that technoference may reduce gaze following, joint attention, and parental responsiveness, subsequently affecting later language outcomes.

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Should a child get a Smartphone?  

A smartphone is an indispensable device that embodies the digital age. As mobile technology evolves, there is no doubt smartphones will continue to change the way we live. It is redefining parenting and one tricky question parents are facing today is, at what age should a child get a smartphone?

As you have already seen, there is no definitive answer to this question. The onus is on the parent to decide when the time is right to hand their kid a smartphone. Ideally, or as we have seen tech founders do, the right age to give a child a smartphone is when they attain the age of 14 years. The longer you wait to give your children a smartphone, the better. Some experts said 12 was the ideal age, while others said 14. All agreed later was safer because smartphones can be addictive distractions that detract from schoolwork while exposing children to issues like online bullies, child predators or sexting.

However, this is not a rule that is set in stone. If a parent deems it right to wait until the child is 16 years, it is up to him or her. But whatever the age, parents must ensure that they are doing it for the right reasons. They should not cave in to pressure to give the child a smartphone because they want them to be tech-savvy or because their friends are doing it. To be on the safe side, formulate your own rules, and stick to them to a tee.

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Smartphone addiction is real. It can be hard to overcome this addiction in an era where internet use has become ubiquitous. So, naturally, parents are concerned about children having smartphones and often wonder what age should a child get a smartphone. The smartphone offers unfettered access to the internet and the good things and dangers that come with it. The challenge for parents is to determine when their kids are old enough to absorb the benefits while sidestepping all the negativities.

The Average Age children gets their own smartphone:

Data from Ofcom, the UK’s communications regulator, show that the vast majority of children in the UK own a smartphone by the age of 11, with ownership rising from 44% at age nine to 91% at age 11. In the US, 37% of parents of nine- to 11-year-olds say their child has their own smartphone. And in a European study across 19 countries, 80% of children aged nine to 16 reported using a smartphone to go online daily, or almost daily. According to a recent study by Common Sense Media, 53% of kids in the United States have their own smartphones by age 11 (Victoria & Michael, 2019). The same study found out that by the age of 12 years, more than a third of kids have their own smartphones. This age is poised to trend even younger in the coming years. Worried parents cannot help but wonder, should there be an age limit on cell phones?

Research suggests that there should be an age limit. But in reality, there are no legal guidelines to determine when parents should hand smartphones to their little one. As such, buying your child a smartphone should be a well-thought and meticulous decision.

On the one hand, many find it risky to let children have their own phone. After all, parental controls can only do so much to protect kids from applications and websites that they should not be exposed to. On the other hand, the use of smartphones can help reinforce schooling. In fact, interactive learning statistics revealed that 44% of parents in the United Kingdom believe its rapid access is a major boost for kid’s education.

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The Age at which Kids in the U.S. begin engaging with a Smartphone:

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Reasons why kids should have Phones:

A smartphone, as you know, is a gateway to inappropriate content and a lot of scary stuff associated with the web. But with a strong parental hand controlling device use, it does have perks. Some of the benefits of kids having phones include:

• Easy to track them. One good thing about smartphones is that they come with GPS apps or software. These solutions help parents monitor the movement of their children. In fact, 33% of parents in the U.S. say they use a smartphone to track their children’s location (Pew Research Center, 2020). The apps can also help children trace their way back home if they are lost or are in dangerous situations.
• Helps keep pace with Technology. Children need to be tech-savvy to succeed in school and in future jobs. Giving them smartphones at an early age helps them interact regularly with technology. This makes them comfortable with technology and gives them the skills they need to excel even as technology advances.
• Helps Create Indelible Memories. Smartphones come with powerful front and rear cameras. These devices give children the opportunity to take photos of things, hence create beautiful memories. In particular, when the child is on holiday with other family members he/she will capture every moment in photos and keep them forever.
• Aid their Education. Smartphones are not just for fun or for kids to communicate with parents and connect with friends. They are also academically beneficial. In fact, 53% of parents in the U.S. give their children smartphones to help them with education (Sellcell, 2019). If kids are learning from home, for example during today’s pandemic, they can download some of the best educational apps for kids. With these apps, children can start learning a new language, improve their math skills, and more.

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Disadvantages of exposing Kids to Phones Too Early:

Parents give their kids a smartphone for different reasons. While some feel a smartphone is a necessity to stay in contact with the kids, others see it as a way to keep kids entertained. Besides, some parents want to help kids stay in touch with their buddies. Interestingly, 40% of parents in the U.S. give their children smartphones to enjoy peace and quiet (Sellcell, 2019).

Whatever the need, parents should ensure that they give their children smartphones at the right age. This is because exposing the kid to phones too early does not bode well for the child’s growth and development. Some of the dangers of letting a kid use a phone too early include:

• Alters Brain Development. On average, children between 8 and 12 years old in the U.S. spend 4 hours and 44 minutes on the screen daily (Victoria & Michael, 2019). 31% of this time is spent on mobile gaming. Spending too much time on a digital screen impacts the brain development of the child. For starters, extended screen time can physically alter the brain. It results in a premature thinning of the cortex, which leads to lower cognitive skills (National Institute of Health, 2018).
• Impairs Social Skills Development. If a child spent more time on a smartphone than interacting with humans, their social skills development will be impaired (Scientific American, 2015). It can also prohibit the development of critical thinking, impulse control, and problem-solving skills.
• Exposes Kids to the Dark World of the Web. Smartphones offer unfettered access to the internet. When kids are allowed to use them unmonitored they can easily end up being redirected to inappropriate content without the parents’ knowledge. There is potential exposure to nudity and violence, all of which could come to haunt the child later in life. The kids can also access sites that promote over-reliance on peer validation, hence creating a way for cyberbullying, which in turn, causes the kids to feel rejected or ostracized.
• Technology addiction at an early age. Too much screen time can cause overstimulation and lead to the production of dopamine, which makes them highly addictive (Dresp-Langley, 2020). Technology addiction leads to depression, anxiety, and thoughts of suicide (Abi-Jaoude, Naylor, & Pignatiello, 2020). It also causes kids to have a low concentration in class and can greatly undermine family relationships.

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Hazards of smartphone overuse in children:

Smartphones today have become both a boon and a curse for youngsters. Smartphones have been a great tool that children of all ages used to study, (especially during the pandemic), in a fun and engaging way, and to express their creativity, while also staying connected with friends and family, for safety and security etc. On the other hand, excessive use of smartphones is bound to have a negative impact on your child’s overall health and development. The age at which children start viewing screens and the number of hours watched per day are increasingly linked to negative physiological changes and medical consequences. There appears to be a ‘dose-response relationship’ with more hours per day linked to greater likelihood that negative effects will appear, often years later, in the child. The blue light and radiation emitted by smartphones are harmful for both children’s eyes and brain, and it has the ability to damage their eyes and alter their thought process as well. As numerous studies have shown that excessive amounts of Screen Time damages brain structure by causing grey matter atrophy, reducing cortical thickness, compromising white matter integrity, impairing cognitive function and debilitating dopamine function. During use, mobile phones and cordless phones emit radiofrequency radiation. A child’s brain is too sensitive to withstand the effects of smartphones radiation. Smartphones are also psychologically addictive, and the radio frequencies emitted from them can affect the childhood brain development. It is high time to take screen time limits extremely seriously, as it is ultimately in the hands of parents to eliminate all these risks from their children’s development by being more watchful and by limiting screen time effectively. It is true that even as adults it is quite difficult at times to limit ourselves with our smartphone usages, which makes it all the more important to limit children’s screen time as they are much more susceptible to experiencing the above said problems.

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The following health hazards are likely to be faced by the children mobile phone users: 

-1. Medical issues: 

Smartphones promote sedentary behavior, which leads to obesity; using a smartphone, a tablet or any other form of screen media generally requires a lot of sitting in order to pay attention to it. Children addicted to technologies will always choose to engage in their addiction when given the choice of engaging in other activities, including physical activities. This puts them at risk for obesity and other illness, which can later develop into many harmful diseases such as diabetes, hypertension, heart disease etc. They can cause eye discomfort; staring at screens for long period of time can cause discomfort to the eyes. Both children and adults can experience it, but children may be more susceptible to developing symptoms commonly referred to as “digital eye strain”, symptoms usually include pain, fatigue, blurred vision, headaches and dry eyes. Smartphones use forces people to tilt heads down to look at them while moving their wrists and fingers in unnatural ways. Doing this frequently and for prolonged periods can cause pain and even permanent damage to bones and joints in the upper part of the body- especially the neck and spine.

-2. Disturbed Brain Activity:

Smart phones primarily function on electromagnetic waves for all forms of communication. In children, the waves from the phone can easily penetrate right into the interior parts of the brain, as they do not have a strong shield. Research has shown that by merely talking on the phone for 2 minutes, the electrical activity inside a child’s brain can be changed. This disturbed brain activity could impair mood patterns and behavioral tendencies.  It affects their learning ability; smartphones are a constant distraction for not only adults but children as well. Smartphones and tablets may replace the hand-on activities that are so important in the development of sensorimotor and visual motor skills. This impairs children’s ability to learn and read, and also limits creativity.

The federal government, through the National Institutes of Health, has launched the most ambitious study of adolescent brain development ever attempted. In part, scientists are trying to understand what no one currently does: how all that screen time impacts the physical structure of your kids’ brains, as well as their emotional development and mental health. At 21 sites across the country scientists have begun interviewing nine and ten-year-olds and scanning their brains. They’ll follow more than 11,000 kids for a decade, and spend $300 million doing it. The MRI’s found significant differences in the brains of some kids who use smartphones, tablets, and video games more than seven hours a day. There is premature thinning of the cortex. That’s the wrinkly outermost layer of the brain that processes information from the five senses. The interviews and data from the NIH study have already revealed something else: kids who spend more than two hours a day on screens got lower scores on thinking and language tests.

-3. Behavioral disorders (Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder etc.):

As smartphones are keeping the brain continuously busy without any rest, kids tend to be more annoying. They tend to become more violent and irritated even at the normal discussions. These children are so obsessed for their phone and become irritable if they have to be away from their phone for any period of time. Parents usually give a smartphones or tablet to calm down their kids in the midst of a temper tantrum. If these devices become the main way to calm and distract young children, they will have difficulties developing their own internal mechanism to regulate themselves. Parents should stop giving children smartphones or tabs to children to placate them because their use can affect their social interaction with others as well as cognitive function in the long term. Less than 5 percent of children in the U.S. were thought to have Attention Deficit Hyperactivity Disorder (ADHD) before the early 1990s, but in the following two decades since then, that figure has ballooned to 11 percent. The rapid increase likely has to do with sociological changes, including how kids use the internet and mobile devices for both educational and leisurely purposes. Screen-time is associated with inattention problems in pre-schoolers; Results from the CHILD birth cohort 2019 study found that increased screen-time in pre-school is associated with worse inattention problems. It’s good practice to avoid handing your kids a mobile device to quiet them down and distract them any time they act up. It may be pretty unpleasant to deal with, but focusing on teaching your kids to behave appropriately without technological distraction is far healthier for them in the long run.

-4. Academic Malpractice:

Many children carry phones along with them to their schools. Chatting with friends or playing games during school breaks or even in class, is increasing day by day. This results in children failing to pay attention in the class, missing out on important lessons, and consequently, being clueless about studies and examination. Using an inbuilt calculator in exams where it isn’t allowed, storing photographs or reference information to cheat in the examination, have been widely observed in various schools. Such behavior not only affects academic performance, but also results in a personality issue.

-5.Sleep Disruption:

Disturb sleep among adolescents seems to be a growing problem, children may stay up late talking to friends, playing games, or scrolling through social media, which over a period of time, causes fatigue and restlessness and troubles sleeping. Sleep also disrupts academic life, as kids are too sleepy to concentrate on what is taught in school.

-6. Mental Health:

Learning to interact with others is a critical component in our overall success as human beings. We learn these skills when we interact with one another starting at a young age. If children are spending more time with technology than interacting with others, they miss out on the development of those skills that are so essential to a rich and rewarding life. The pressure for teens to be available on social media 24 hours a day and seven days a week was attributed to low self-esteem, poor sleep quality, anxiety and depression.

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In 2016 American Association of Pediatrics (AAP) Updated their Recommendations about Children’s Media Use:

Age	Limited screen time
<24 months	Children should not have any screen time.
2 – 5 year	Limit their exposure to 1 hour per day. Parents should watch with their children so that they understand what they are seeing.
6 years and older	Limit their exposure to 2 hours per day and monitored to ensure that it does not take the place of sleep, physical activity and other activities essential to developmental health.

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Prevalence of problematic smartphone usage (PSU) and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence, a 2019 study:

Aims:

To conduct a systematic review and meta-analysis to examine the prevalence of PSU and quantify the association with mental health harms.

Methods:

A search strategy using Medical Subject Headings was developed and adapted for eight databases between January 1, 1st 2011 to October 15th 2017. No language restriction was applied. Of 924 studies identified, 41 were included in this review, three of which were cohort studies and 38 were cross sectional studies. The mental health outcomes were self-reported: depression; anxiety; stress; poor sleep quality; and decreased educational attainment, which were synthesized according to an a priori protocol.

Conclusions:

This review indicates that approximately 1 in 4 CYP are demonstrating problematic smartphone use, a pattern of behaviour that mirrors that of a behavioural addiction. A consistent relationship has been demonstrated between PSU and deleterious mental health symptoms including: depression; anxiety; high levels of perceived stress; and poor sleep. Younger populations are more vulnerable to psychopathological developments, and harmful behaviours and mental health conditions established in childhood can shape the subsequent life course. Further work is urgently needed to develop assessment tools for PSU, and prevent possible long-term widespread harmful impact on this and future generations’ mental health and wellbeing.

In a nutshell:

One in four children and young people could have problematic smartphone use, according to research that also suggests such behaviour is associated with poorer mental health.

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Role of parents:

Who put the smartphone in the kids’ backpack? The real problem is parents. Several parents are now asking questions such as:

‘What can I do to prevent my child from mobile phone overuse?’

‘How can I keep my child away from a mobile phone?’

‘How can I stop my child from turning into a mobile phone addict?’

While the problem is raising concerns worldwide, solutions are hidden in plain sight. It may initially seem like a good idea is to take their smartphone away from them, or drastically reduce the hours spent on their smartphones by limiting access significantly. While this may seem to be a good strategy at first, you are likely to receive some hostile feedback from your child over this. You may hear comments, such as ‘now I can’t talk to my friends’, or, ‘I’ll be the unpopular one’, as they are fearful that such actions may impact their social opportunities and how they are perceived by others. They may also become resentful of you and may even display more oppositional behaviour, resulting in family conflict. When use is significantly reduced, often a child or adolescents previous reliance on their device, results in some withdrawal symptoms such as irritability, racing mind and some report they even start hearing notifications from their smartphones when there has not been any (Rodríguez-García et al 2020) (Zhang, et al , 2020)(Li & Lin, 2019). This is because excessive use of smartphones has been linked to addictive behaviour and concerns that are seen with people with drug and alcohol addiction (Li & Lin, 2019). While the effects may not be as detrimental, the same strategies apply in order to help your child regulate their use of smartphones in a sustainable way.

Here are some useful tips that can help you get your child off the phone without them ‘hating’ you for it and also protect their eyes:

-1. Limits around screen time and duration and adhering to appropriate limits. The American Academy of Pediatrics (AAP) family media use plan and related reports target issues ranging from obesity to sleep problems linked with too much screen time. Although children’s screen time will understandably increase during the COVID-19 pandemic, the AAP encourages parents to do their best to help keep some balance between the digital and real world. The AAP recommends children not sleep with devices in their bedrooms, including TVs, computers and smartphones. In addition, the AAP recommends avoiding exposure to screens for 1 hour before going to bed. Using devices past bedtime, especially for violent video games or shows, can interfere with sleep. Studies also suggest the blue light given off by screens might also make it difficult to sleep.

-2. Turning off notifications, as they are physical cues that lure you in to check the phone and “feed the addiction.”

-3. Keep the smartphone at a distance when doing homework or during meal times, as physical proximity is in itself a cue.

-4. Make sure the environment and schedule around your child is stimulating, as unstimulating environments act as a precursor for checking behaviour to escape boredom.

-5. Provide short-term rewards for decreased usage, e.g. social outing with a friend.

-6. Encourage alternate activities (e.g. active play, team sports, scheduled activities).

-7. Set passwords: It is not always possible for you to be around your child to dissuade him from using a smartphone. In such a situation, technology can come to your rescue. Set a password on your phone so that your child cannot use it while you are away.

-8. Set a good example: Many parents spend a lot of time on their smartphones. In such cases, telling children to not use the mobile may not help, as they are bound to follow in their parents’ footsteps. So, be a good role model for your child by limiting your mobile phone usage. Monitor our own use as parents as we strongly influence our children’s socialisation and behaviour patterns. As such, consistency around household rules of smartphone use in children and their parents can make them collectively responsible for smartphone behaviour goal attainment. However, if your profession demands high mobile usage, explain it to your child.

-9. Bond with your child: Although most parents lead very busy lives, it is important to take the time out for bonding with children. Playing board games or engaging your child along with you in activities such as cooking or gardening will make her feel valued and useful. Thus she will stop using the smartphone to escape from loneliness. You can also encourage your child to pursue hobbies like doing simple science experiments, listening to music, reading, creative writing, art, or painting.  

-10. Children frequently get so absorbed in what they’re doing that they don’t notice symptoms of eye strain. Remind them to take breaks. The American Optometric Association recommends the 20/20/20 rule: look away from the screen every 20 minutes, focus on an object at least 20 feet away, for at least 20 seconds. In addition, children should walk away from the screen for at least 10 minutes every hour. A simple timer can help your child remember, and there are even software programs can help by turning off the screen in regular intervals.

-11. Remember to blink. Research published in The New England Journal of Medicine says staring at a computer can cut blinking rates by half and cause dry eyes. Encourage your child to try to blink extra, especially when they take breaks. Your pediatrician or eye doctor may recommend moisturizing eye drops or a room humidifier if your child continues to be bothered by dry eyes.

-12. Screen positioning. Make sure the screen on your child’s desktop or laptop computer is slightly below eye level. Looking up at a screen opens eyes wider and dries them out quicker. Some experts suggest positioning device screens based on the 1/2/10 rule: mobile phones ideally at one foot, desktop devices and laptops at two feet, and roughly 10 feet for TV screens (depending on how big the screen is). Adjusting the font size—especially on smaller screens—so it’s twice as big as your child can comfortably read may also help reduce eye fatigue.

-13. Spotlight on lighting. To cut down on glare and eye fatigue, consider the level of lighting in a room when using a computer or other screen. Ideally, it should be roughly half what it would be for other activities such as writing on paper or working on crafts. Try to position computers so that light from uncovered windows, lamps and overhead light fixtures aren’t shining directly on screens. Decrease the brightness of the screen to a more comfortable level for viewing. Some optometrists recommend special computer glasses with orange lenses that may also help reduce glare. Children who wear prescription eyeglasses may have an anti-reflective coating added, as well. Computer monitor hoods or shades that attach to the screen may also be an option.

-14. Get regular vision screenings. If your child is having blurry vision or similar eye problems, he or she may not speak up. That’s why regular vision screenings are important. The American Academy of Ophthalmology and the AAP recommend children have their eyes checked by a pediatrician at well-child visits beginning at birth. If a problem is found during one of these routine eye exams, your pediatrician may refer you to a pediatric ophthalmologist.

-15. Does my child need blue-light filtering glasses? You may have heard about special glasses that help filter blue light given off from computers and other screens. Especially with more online learning during the pandemic, many wonder if these glasses should be on their child’s back-to-school supply list. Although there is no evidence that blue-light is harmful to the eyes, it can make it harder for children to fall asleep and contribute to eye strain, However, turning screens off an hour before bed, using the 20/20/20 rule and the other tips above can help prevent this—no purchase necessary! 

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How U.S. Parents Monitor their Kids’ Smartphone Use:

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How to protect kids from smartphone radiation:

Apart from following the above-mentioned tips to keep your child away from the mobile phone, you can also do the following to protect him from the harmful effects of mobile phone radiation.

• Buy a mobile phone with a low radiation level: With the use of smartphones becoming unavoidable, it is better to buy one with a low Specific Absorption Rate (SAR) value. The SAR value is the amount of radiation absorbed per kilogram of body tissue. You can check a phone’s SAR value by dialing *#07#. The maximum SAR level allowed in India is 1.6 W/kg.
• Avoid use while traveling: Keep your smartphone away from your child while traveling in a moving vehicle, like a car, bus or train. A mobile phone in a moving vehicle keeps scanning for the signal and, in the process, emits more radiation.
• Opt for the land-line: Many times, it so happens that those with whom you are speaking may request you to let your child speak to them. Politely tell such callers that you will call them back from your landline phone and hand it over to your child to speak to them.

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Parents are now legally obligated to monitor their children’s screen time:

Taiwanese lawmakers approved the “Child and Youth Welfare and Protection Act,” which expanded existing legislation to allow the government to fine parents of children under the age of 18 who are using electronic devices for extended periods of times. The law follows similar measures in China and South Korea that aims to limit screen time to a healthy level. Citing health concerns, the Taiwanese government can fine parents up to $1595 ($50,000 Taiwanese Dollars) if their child’s use of electronic devices “exceeds a reasonable time,” according to Taiwan’s ETTV (and Google Translate). Under the new law, excess screen time is now considered to be the equivalent of vices like smoking, drinking, using drugs, and chewing betel nuts.

There are some parents who welcome a little help prying their children’s eyes off screens. Studies have shown that excessive media use can lead to attention issues, behavioral problems, learning difficulties, sleep disorders, and obesity. Too much time online may even inhibit a child’s ability to recognize emotions, according to a study by the University of California, Los Angeles. Despite these risks, as technology increasingly becomes a part of modern life, children are spending more and more time in front of screens. A recent study found that in the U.S. 8-year-olds spend an average of eight hours a day with some form of media, with teenagers often clocking in at 11 hour a day of media consumption. A 2013 study by Nickelodeon found that kids watch an average of 35 hours a week of television.

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Parental bonding and Smartphone addiction in children: 

Several studies have been conducted to investigate predictors for smartphone addiction by considering individual factors (gender, age, personality), family factors (family functioning, parental bonding) and social factors (peer relationship, social engagement). Of these, family factors have been widely studied in addiction and recovery. Since the family is considered to be the basic unit of any society or culture, it contributes greatly to all aspects of an individual’s development. For example, Korean delinquent adolescents have been reported to have come from troubled families, including those with dysfunctional marital dynamics, family violence, and poor family functioning.

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Among family factors predicting smartphone addiction, parental bonding had attracted considerable research interest. Parental bonding is defined as a process of performing a social role or behaving to facilitate the offspring’s growth and development. According to attachment theory, developed by Bowlby and Ainsworth et al., experiences of parental bonding in childhood which adequately meet children’s needs can help them develop secure representations of self and others. These representations act as “prototypes” or “working models”, constantly influencing children’s expectations, strategies, and behaviors through the whole life. Drawing from attachment theory, Parker et al. developed the Parental Bonding Instrument (PBI), which includes two dimensions: care and protection.

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The care dimension evaluates the perception of warmth, emotional closeness, and empathy, while the protection dimension evaluates the perception of control, intrusion, and level of independence and autonomy from parents. A longitudinal study from New Zealand found that low parental care and high parental protection during childhood were associated with impaired psychosocial functioning in adulthood, including depression, anxiety, and crime. Subsequently, a study conducted among Chinese college students showed that negative parenting styles, which consisted of parental rejection and overprotection, exacerbated the degree of smartphone addiction. Another study had suggested that addiction can be a coping mechanism for lack of relational intimacy and demonstrated that parental care could positively influence children’s self-identification and help them to forge intimate relationships with others. The self-medication hypothesis suggests that children, especially those who have experienced traumatic upbringings involving parental neglect, could eventually become addicted to smartphones to cope with existing strains of family dysfunction. On the other hand, studies have also revealed that overprotective parental behaviors may increase addictive behaviors in children. This may be partially attributed to the effect of parental overprotection on the development of the child’s autonomy, which had been listed as a protective factor for addiction behavior. The conflict between children’s desire for autonomy and parental overprotection may eventually lead to addictive behaviors such as problematic smartphone usage.

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Despite the aforementioned research on care and protection, studies have indicated that these two aspects should not be analyzed separately, because they interact with each other when affecting children’s addiction. For example, a previous study revealed that the combination of parental overprotection and low parental care (known as the affectionless control parenting style) was associated with perpetrating cyberbullying. A cross-study conducted in Brazilian medical students found that dysfunctional parenting styles, including affectionless control (low care and high protection), affectionate constraint (high care and high protection), and neglectful parenting (low care and low protection) were associated with mental anxiety, depression, suicidal ideation, and low self-efficacy. Another implication from the literature is that the effects of maternal and paternal parenting on children’s psychosocial functioning may differ. For instance, only maternal and not paternal overprotection was found to be associated with mood disorders in a study of European countries.

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Exploring the connection between parental bonding and smartphone addiction in Chinese medical students, a 2022 study:

This study examined the relationships between maternal/paternal parenting and smartphone addiction in Chinese medical students and revealed the high prevalence of smartphone addiction among Chinese medical students. Importantly, associations between parental bonding and smartphone addiction in Chinese medical students differed for mothers and fathers. Maternal protection increased the probability of smartphone addiction, and maternal care enhanced the estimated effect of protection on smartphone addiction. On the contrary, paternal care was associated with lower odds of smartphone addiction. Medical educators seeking to implement smartphone addiction interventions or to mitigate the potential negative effects of smartphone addiction in their medical students may want to pay closer attention to students who have experienced maternal overprotection and poor paternal care.

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Relationship among family environment, self-control, friendship quality, and adolescents’ smartphone addiction in South Korea: Findings from nationwide data, 2018:

Results:

Adolescents who had experienced domestic violence (OR = 1.74; 95% CI: 1.23–2.45) and parental addiction (OR = 2.01; 95% CI: 1.24–3.27) were found to be at an increased risk for smartphone addiction after controlling for all potential variables. Furthermore, on classifying adolescents according to their level of self-control and friendship quality the association between domestic violence and parental addiction, and smartphone addiction was found to be significant in the group with adolescents with lower levels of self-control (OR = 2.87; 95% CI: 1.68–4.90 and OR = 1.95; 95% CI: 1.34–2.83) and friendship quality (OR = 2.33; 95% CI: 1.41–3.85 and OR = 1.83; 95% CI: 1.26–2.64).

Conclusion:

Our findings suggest that family dysfunction was significantly associated with smartphone addiction. We also observed that self-control and friendship quality act as protective factors against adolescents’ smartphone addiction.

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Effects of parent’s smartphone addiction on child’s smartphone addiction:

The more parents demonstrate addictive behaviors with smartphones, the more difficulties they have in regulating their young children’s use of the devices. Excessive smartphone use also is associated with the stress of parenting. Parents distracted by their phones tend to communicate less with their children in the moment, and parents with smartphone addiction symptoms are less likely to actively mediate their child’s smartphone use.

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According to the mirror neuron theory, neurons activated as if performing another person’s behavior when they perceive that behavior is called ‘mirror neurons’. They convert the viewed behavior into a neuronal signal, and the other person’s mental state can be gleaned through ‘mirroring’ and empathized with it. An analysis examining the correlation between parents and children in the 2016 survey on smartphone overdependence found that when the parents are in the at-risk group, the percentage of adolescent children in the at-risk group is 36.0%, and the percentage of infants and children in the at-risk group is 23.5%. It was revealed that when the parents are in the at-risk group, the proportion of their children in the at-risk group reaches 60.0%. In particular, it has been found that if parents are obsessed with smartphones, demonstrated by behavior such as frequent habitual checking of smartphones and becoming anxious without smartphones, it can lead to problematic behavior in young children.

 

In addition, the phenomenon of smartphone addiction between parents and children can be investigated based on the social learning theory’s concept of ‘modeling’ for parents. Bandura argued that social learning theory states that human learning is accomplished simply by seeing the behavior of a certain model. This means that behavior is acquired by imitating and observing the behavior of others within a social context. In behaviorist theory, one of several theories used to explain changes in learning and behavior, it is said that the imitation of learning and behavior occurs only through direct reinforcement and punishment. In social learning theory, it is said that learning is accomplished simply by looking at the behavior of the model without reinforcement and punishment. This is also called observational learning theory, modeling, or imitative learning. In addition, in the process of observing and learning the behavior of modeling, real models appeared to have the greatest impact, followed by media, such as movies and videos. As students are highly receptive to practical models, they are greatly influenced by teachers and parents, and learn more easily accordingly.

It was revealed that parents’ behaviors of using the internet or technology in their homes influenced the frequency of their children’s and adolescents’ internet and technology usage behavior, addictive usage habits, and related knowledge. This effect would be much the same for smartphones. If parents use smartphones obsessively, it is highly likely that children will have easy access to smartphones and imitate their parents by also using smartphones obsessively.

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The Effects of Korean Parents’ Smartphone Addiction on Korean Children’s Smartphone Addiction: Moderating Effects of Children’s Gender and Age, a 2021 study:

Materials and Methods:

This study was carried out using the Korean Children and Youth Panel Survey 2019 conducted by the National Youth Policy Institute. The total number of participants was 4656 youths (2290 in grade 5 and 2366 in grade 8), and the dependent and independent variables were smartphone addiction in children and parents, respectively. Multiple regression analysis was conducted by Stata 15.0 SE.

Results: First, the level of parents’ smartphone addiction affected that of children and adolescents. Second, the children’s and adolescents’ age affected the level of smartphone addiction, while their gender did not affect it. Third, the relationship between the levels of parents’ and children’s smartphone addiction was not moderated by the genders and ages of the children and adolescents.

The study model of parents’ smartphone addiction on that of their children is shown in figure below.

Conclusions: It was confirmed that as parents’ smartphone addiction increased, that of children increased, and smartphone addiction was found to increase in the second grade of middle school (12 years old) rather than grade 5 of elementary school (10 years old). Parents’ and children’s smartphone addiction was not moderated by children’s and adolescents’ gender and age.

As parents’ smartphone addiction significantly affects that of their children, parents also need to be aware of the significance of the problems that smartphones pose. For interventions with children, it is essential to consider the age of the children. For instance, more active intervention is necessary for middle school students, and public education for middle school students to prevent smartphone addiction can be crucial. As gender does not have a significant effect, education can be delivered to both genders at once. As the moderating effects between parents’ and children’s smartphone addiction are not significant, children’s gender and age do not need to be considered when intervening in children’s smartphone addiction caused by parental smartphone addiction.

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Section-7

Teen smartphone overuse:

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Although smartphone addiction is observed across all age groups, it tends to be more prevalent among adolescents as they find smartphones captivating. Adolescence, a developmental window and transition period between childhood and adulthood, entails tumultuous physical, psychological, and social changes. Therefore, adolescents are more likely to demonstrate risk-taking and novelty- and sensation-seeking social interactions and play behaviors in response to life stresses or changes in the brain’s structure and function; thus, adolescents are particularly susceptible to developing addictions. Excessive smartphone usage in adolescents could be indicative of such addictive behavior. Smartphones have become a popular means of mobile communication, and they provide a platform for internet-based applications among adolescents; furthermore, they a means of managing adolescents’ stress and help them cope with friends- and school-related problems. However, recent studies have highlighted the negative psychosocial and physical effects of smartphone addiction. Moreover, internet use through smartphones has been considered to cause problematic behaviors such as violence, influenced by game-playing and cyber-bulling through social network services (SNSs); furthermore, as the internet was also considered an easily accessible source of pornography for adolescents.

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Globally, there is an appreciable argument on addiction and excessive use of smartphones among adolescents and its subsequent impact on their health. Smartphone addiction can damage not only interpersonal skills but also cause major health concerns and have a severe psychological impact on teenagers. Smartphones have gained popularity among adolescents and young adults due to the tendency to choose the virtual world, which is more entertaining than being with their friends and parents. For social interaction, social networking services (SNS) like messenger, email, Facebook, WhatsApp, Twitter, Snapchat, etc. Browsing websites and apps like YouTube, Google, Yahoo, porn websites, etc. are also used frequently. Also, shopping portals, reel apps, and gaming apps are more commonly used by a vast number of smartphone users, who are majorly adolescents and young adults.

Smartphone addiction has caused dysfunctional impulsivity to regularly check mobile phones. Average people spend about 5 hours a day on their phones. More time is spent than eating, exercising, and socializing with friends. Common indicators include maintaining their social media persona, responding to messages quickly, being active on social media, using headphones frequently, and having sleeping issues.

Adolescence plays an important role in grooming a person, making them capable enough to adapt to their surroundings. Smartphone usage primarily impacted adolescents and young adults by predisposing them to mental health issues, insomnia, cyberbullying, anxiety, depression, obesity, false prestige, self-control issues, physiological stress, vision problems, mind-wandering, attention deficit-hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). Smartphone addiction decreases life satisfaction and increases the chances of potential health risks and negative thinking styles in adolescents.

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Substantial efforts have been dedicated to determining predictors for excessive smartphone use in adolescents by considering individual (psychological), family, peer, and other factors (i.e., depressive state, parenting style, friendship satisfaction, smartphone contents). Of these, adolescents’ family environment could be important in shaping adolescent behaviors regarding smartphone use. The family is the fundamental unit of the society, and most adolescents are born and raised in this unit; it is under its influence that they develop their personalities. Thus, when adolescents are a part of troubled families, it can affect the development of their problematic behaviors (i.e., illicit drug use, alcohol abuse, and risky sexual behavior). Indeed, greater family stress has been shown to be a significant predictor of problem behaviors in adolescents.

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The National Information Society Agency (NIA) reported that 23.3% of smartphone users in 2020 suffered smartphone addiction in South Korea. Specifically, adolescents showed the highest figure of 39.6%, which was higher than in other countries. Smartphone addiction in adolescence can cause problems in various aspects. For example, excessive use of smartphones threatens physical health by causing sleep disturbance; reduced vision; pain in the cervical spine, wrists, and shoulders; and secondary problems due to lack of exercise. It has negative effects on mental health such as depression, anxiety, increased aggression, and poor concentration. In addition, social problems such as decreased academic performance, accidents, family conflicts, and increased exposure to pornography due to excessive use of smartphones are also emerging.

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Research has revealed that there are a few adolescent personality traits associated with Internet addiction, which is closely related to smartphone addiction. These traits include:

• High harm-avoidance.

-These individuals tend to be worrisome, fearful, pessimistic, and shy.

• Altered reward dependence.

-The teen becomes dependent on rewards associated with the internet or cell phone as opposed to natural rewards such as spending time with friends and family, getting good grades, or partaking in hobbies.

• Low self-esteem.
• Low cooperation.

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Doctors, teachers, and parents have long said that teens spend too much time on their phones. But now, even some people in the tech industry fear their products may be too difficult to put down. Recently, representatives of two of Apple’s biggest investors posted a letter online to the tech company. They pressured Apple to help combat what many people see as a growing health crisis among young people: phone addiction. The investors—who collectively own about $2 billion worth of Apple —called on the company to add stronger parental controls to its devices.

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Predictors of Excessive Smartphone-Use:

The main factors predicting excessive smartphone use were being female, preoccupation, conflict, and use for ubiquitous trait whereas the protective factor was use for learning. Excessive use of smartphones was correlated with impairment in the function of the family and relationship with friends, impulsiveness, and low self-esteem in South Korean adolescents. Finally, smartphone gaming was associated with excessive smartphone use among adolescents.

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Sensation Seeking and Boredom:

Turgeman et al. have reported an interaction between high sensation seeking and abstinence whereby abstinence for 1.5 h increased excessive smartphone use ratings in high sensation seeking students. This may be explained by boredom, avoidance of uncomfortable situations and the need for entertainment. Lepp et al. have found an association between excessive smartphone use and living sedentary life or being an active couch potato. Ben-Yehuda et al. have investigated the effects of involvement and of interest in three conditions: state of boredom, passive activity and active activity in counter-balanced order in University students. Excessive smartphone use was not influenced by any interest or involvement in the lecture, indicating a compulsive behavior. Finally, Li et al. have demonstrated that individuals with an external locus of control had less control over their smartphone use and therefore could have more negative effects such as poor sleep quality, lower academic achievements, and lower ratings of well-being.

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Insecure Attachment, Poor Cognitive-Emotional Regulation and Communication Problems:

Insecure attachment positively correlated with problematic smartphone use in students with unhealthy family function but not with mother-infant bonding or maternal mental health. Eichenberg et al. showed an association between excessive smartphone use and an insecure attachment style in Problematic adolescent users. A following study reported high scores in maladaptive Cognitive-emotion regulation (CER) strategies such as self-blame, blaming of others ruminating and catastrophizing thoughts. Experiential avoidance (i.e., attempts to avoid thoughts, feelings, memories and physical sensations) has been associated with excessive smartphone use and social networks. Childhood emotional maltreatment correlated with problematic smartphone use in adolescents, and it was mediated by body image difficulties, depression, and social anxiety. Emotion regulation difficulties, unregulated eating, restrained eating, food addiction, and higher percent body fat were associated with excessive smartphone use among adolescents. Mahapatra showed a strong association between both lack of self-regulation and loneliness on problematic smartphone use among adolescents that ultimately resulted in family, interpersonal conflicts, and poor academic performance. Among students, problematic smartphone users have shown high measures of worry and anger whereas excessive reassurance seeking behavior mediated the association between rumination and problematic smartphone use. Poor communication skills were shown in medical students who preferred to communicate emotions through texting rather than verbal communication and they correlated with excessive smartphone use. Excessive use of the smartphone has negative impacts on people’s lives by reducing face-to-face interactions, and increasing loneliness.

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Impaired Cognitive Function:

Problems in inhibitory control mechanisms in excessive smartphone users were reported. The Go/No-go task is great for measuring impulsiveness. Researchers have reported that while performing on the Go/NoGo task excessive smartphone users showed a negative N2 event-related potentials (ERPs) component showing reduced inhibitory control. There is further evidence for impaired attention, reduced numerical processing capacity, increased impulsivity, hyperactivity and negative social concern in heavy smartphone users. Heavy smartphone users showed inattention problems correlated with Transcranial Magnetic Stimulation (TMS) evoked potentials in the right prefrontal cortex. Wegmann et al. have found no correlations between problematic social networks use and executive function and inhibitory control measured by the Go/NoGo task. However, regression analyses showed that increased problematic social networks use is associated with higher impulsivity, especially if executive functions or specific inhibitory control were impaired.

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Social Media Use and Personality:

Problematic social media use has been shown to be associated with “fear of missing out” (FOMO). FOMO mediated relations between both fear of negative and positive evaluation with both problematic and social smartphone use. Withdrawal and FOMO ratings were higher among participants with 72 h restricted access to smartphones compared with those without. There was a correlation between social communication use and excessive use of smartphones. FOMO mediated the relationships between anxiety and depression with problematic smartphone use. Excessive smartphone use has been associated with social comparisons on social networking sites and perceived stress. Personality factors such as conscientiousness, openness, emotional stability and neuroticism have been associated with problematic smartphone use whereas impulsivity, excessive reassurance seeking, but not extraversion related to problematic smartphone use in other studies.

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Comorbidity With Anxiety, Depression, OCD, ADHD and Alcohol Use Disorder:

There are several studies on the comorbidity of excessive smartphone use and mental disorders and its association with sleep problems, reduced fitness and pain. Excessive smartphone use has been associated with depression, anxiety and social anxiety shyness and low self-esteem low psychological well-being and low mental well-being. Excessive reassurance seeking correlated with problematic smartphone use severity, and its combination with rumination mediated the relationship between depression and anxiety severity with problematic smartphone use. Anxiety during the COVID-19 epidemic correlated with severity of problematic smartphone use, depression and generalized anxiety.

Early problematic smartphone use was found as a significant predictor of depression in a three-year longitudinal study from adolescence to emerging adulthood. Excessive mobile use was associated with high levels of depressive moods, with loneliness serving as a moderator of this mediation particularly in men. Depression and anxiety were significantly associated with both excessive smartphone use. Depressive mood and suicidal ideation were associated with social network smartphone use. Interestingly, the time spent in excessive smartphone use has predicted the level of stress in users who hardly used the smartphone for self-disclosure whereas those who engaged in disclosure of their emotions and problems online, this reduced their emotional problems. Problematic smartphone use has been associated with psychological distress and emotion dysregulation and emotion dysregulation was shown as a mediator in the relation between psychological distress and problematic smartphone use. Excessive smartphone use has been also associated with Obsessive Compulsive Disorder symptoms and ADHD.

History of alcoholism and father’s education level explained 26% of the variance of problematic smartphone use. In addition, alcohol use disorder, impulsivity (Barratt scale and ADHD) and elevated occurrence of PTSD, anxiety, and depression were associated with excessive smartphone use. Finally, the relationship between PTSD severity and problematic smartphone use was mediated by negative urgency (a component of impulsivity).

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Teen Cell Phone Addiction Statistics:

Results of a 2016 Common Sense Media Report found that 50% of teens “feel addicted” to mobile devices, while 59% of parents surveyed believed that kids are addicted to their devices. This survey also showed that 72% of teens and 48% of parents felt the need to immediately respond to texts, social-networking messages, and other notifications; 69% of parents and 78% of teens checked their devices at least hourly. A 2018 Pew Research Report showed that 45% of teens said they use the Internet “almost constantly,” and another 44% said they go online several times a day. According to this report, 50% of teenage girls are “near-constant” online users, compared to 39% of teenage boys; 95% of teens have access to a smartphone.

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Signs of Teen Cell Phone Addiction:

As with other behavioral addictions, there will be certain signs the teen displays. Signs of a teenage cell phone addiction might include:

• Teen cannot carry on a live conversation.
• Teen is always scrolling and clicking around on their phone.
• Teen is not able to be without their phone, even for a few minutes.
• Teen shows signs of depression the more they are on their phone.
• Teen becomes obsessed with selfies and their social feels.
• Teen is having sleep problems.
• Teen’s grades drop, due to reduced time for studying or homework.

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If you suspect that your teenager is suffering from an addiction to his or her smartphone, there are some signs and symptoms to be on the lookout for in your teen:

• Anxiety.
• Depression.

-Significant weight change.

-Change in diet.

-Change in sleep patterns.

-Fatigue.

-Depressed or irritable mood.

-Flat affect or facial expression.

-Little interest in activities they once found enjoyable.

-Difficulties paying attention.

-Withdrawal from social interaction or activities.

• Low self-esteem.
• Neglecting other activities and is constantly on his or her phone.
• Sore neck or headaches.
• Experiencing anxiety when without his or her cell phone or service.
• Experiencing “phantom vibration syndrome,” which means checking his or her phone when it hasn’t vibrated or rung.
• Using his or her cell phone while driving or crossing the street.

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Effects of Teen Smartphone Addiction:

• Decreased brain connectivity in parts of the brain that regulate emotions, decision-making, and impulse-control.
• An increased likelihood to consume alcohol and use tobacco.
• An increased likelihood to have poor dietary habits.
• Increased levels of social loneliness.

Additionally, addiction to a cell phone could lead to a number of harmful ramifications such as:

• Text neck.

-Neck pain associated with looking down at a cell phone for too long. Young chronic neck pain patients with overuse of smartphones had higher Cervical Disc Degeneration.

• Digital eye strain.

-Burning and itching of eyes and blurred vision associated with looking at a screen for at least 2 hours.

• Car accidents.

-Research has revealed that texting and driving is just as dangerous as drunk driving.

• Excessive smartphone use was associated with poorer sleep quality and higher perceived stress, lowered physical activity, lower muscle mass and higher fat mass.
• Other medical conditions include acute acquired comitant esotropia (AACE), increased ocular symptoms, headache complaints and headache duration and frequency in migraine patients.
• Excessive smartphone users had higher median nerve Cross sectional areas (CSA’s) in their dominant hands.
• The dangers of the smartphone also include those related to the sexual sphere. Social platforms can also alter the perception of the sexual sphere. Exposure to sexual material online, even through pop-up windows or advertisements, is a real risk and can predispose to the development of depression, suicide and substance abuse.

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Figure below shows harms due to exorbitant use of smartphones on teens:

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Smartphones & Sleep Deprivation in Teens:

Excessive smartphone use was associated with reduced sleep time and sleep quality in adolescents. The association between media use in bed before sleep and depression was mediated by sleep disturbance. Furthermore, there was an association between excessive screen time and problems in sleep onset, insufficient sleep, and insomnia. Long-term problematic mobile use predicted new incidences of sleep disturbances and mental distress, which was ameliorated by its discontinuation. Excessive mobile phone use correlated with disturbed sleep pattern and quality.

Only 20% of adolescents get nine hours of sleep a night, as recommended for school nights. Parents are concerned that smartphones and mobile devices may be a factor in the rise of sleep deprivation in their kids. Are their concerns justified?

Sleep experts have found that artificial light from smartphones and tablets suppresses melatonin, making it hard to fall asleep and affecting a person’s biological rhythms of sleep. Research has shown that the radiofrequency electromagnetic field emitted by mobile devices can increase brain activity at night and interrupt non-REM sleep.

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What happens when Teens Don’t Sleep:

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The Impact of Teen Social Media Addiction on Mental Health:

During the teen years, the brain is still under construction. The teen brain is more vulnerable to things that could lead to an addiction, like video games and social media. A recent study explains how the reward system in the teenage brain works. It shows the same type of dopamine release in response to social media likes as one might have to a drug. The study also points out that the teen will show “withdrawal” symptoms, like irritability and anxiety. This happens when they are not allowed to use their cell phone or social media. But anxiety and depression in themselves can be a result of too much cell phone use. Studies show that teens that spend large amounts of time on social platforms suffer from higher levels of mental health issues. This is due to the time spent on social apps, which can fuel low self-esteem, body dysmorphia, and bullying. Also, excess time on smartphones means a lack of in person contact with friends and family. Face-to-face time is traded off for huge amounts of time chatting online with strangers. These interactions are shallow and do not lead to any real human connection. Over time, this can result in feelings of loneliness and depression. The existing literature reported that smartphone overuse can lead to social isolation or reduce face-to-face communication. A recent study from Kuwait demonstrated a significant relationship between a high level of social isolation and smartphone addiction among university students.

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More and More Children and Adolescents with ‘Social Depression:

The Sip (Italian Society of Paediatrics) presents the results of a study on children and social networks based on 68 scientific papers conducted over 18 years:

-1. The more time children and adolescents spend on social networks, the higher the risk of developing depressive symptoms.

The new phenomenon is called ‘social depression’ and has exploded especially with the pandemic, which has produced a real boom in the use of the internet, smartphones and social media. A new review of the scientific literature conducted by the Italian Society of Paediatrics (Sip), published in the scientific journal International Journal of public health research, revealed this and investigated its dimensions. The Review analysed 68 scientific papers conducted from 2004 to 2022 with the aim of investigating the risks related to the use of social media in under-18s, particularly in the pre- and post-Covid-19 period.

-2. In 19 studies, or 27% of all those reviewed, a significant association was found between depression and social use.

“It is not yet clear whether social use leads to greater depression or whether these depressive symptoms cause people to seek out social media more (which could feed a vicious cycle). What is unequivocal from the work, however, is that the more time children and adolescents spend on digital devices, the higher levels of depression are reported. And this happens without great geographical distinction: from Sweden to Egypt,’ says Rino Agostiniani, Sip national advisor. “Depression is linked to a rapid increase in digital communication and virtual spaces that replace face-to-face contact with excessive use of smartphones and online chats. Children and adolescents surf the Internet mostly alone, consulting social media assiduously like Instagram, Tik-Tok and YouTube. With inevitable consequences on their lives: from social and interpersonal interactions to physical and psychosocial well-being, adds Elena Bozzola, Sip national advisor.

Not only depression:

Eating disorders and cyberbullying (found in 15 studies, respectively, accounting for 22% of those examined), psychological problems, sleep disorders, addiction, anxiety, sexual problems, behavioural problems, distortion of the perception of one’s own body, reduced physical activity, online grooming, eyesight problems, headaches and dental caries: these are all problems associated with the use of social media that emerge from the new Sip study. In many cases, these risks increase with increasing time of use: from psychological discomfort to headaches, from visual and postural disorders to tendonitis to the so-called ‘texting thumb’.

-3. Worrying influence of social media on eating disorders: 

Children ‘bombarded’ by advertisements for unhealthy food and pro-anorexia messages. Children, the Review notes, are exposed to the marketing of unhealthy foods that induce unhealthy behaviour. Children are more vulnerable to sponsored content and influencers and social media platforms have proven ineffective in protecting them from junk food marketing. During the pandemic, the severity risk of poor eating habits has increased, so much so that in a previous report the Sip investigated the phenomenon of ‘covibesity’.

On the other hand, social media is a risk factor for pro-anorexia messages. These messages, the Sip study points out, are no longer limited as in the past to websites that can be easily monitored, but have been transferred to Snapchat, Twitter, Facebook, Pinterest. As a result, content conducive to eating disorders is more easily accessible.

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Cyberbullying and teen smartphone overuse: 

Research on cyberbullying sponsored by Opennet has found that teenager who are ‘heavy cell phone users’ are more likely to engage in the practice of bullying online, as well as become bullied themselves.

According to the survey, mobile devices such as phones, tablets and notebooks that have wireless capabilities can be linked to cyberbullying rates among young people. The survey was conducted online in 2011 through a sample of 503 U.S. 13 – 17 year olds, who stated they had use of a cell phone.

The more extensively teenagers use their cell phones, the greater their risk of exposure to both experiencing and engaging within inappropriate mobile activity. Teens who are heavy cell phone users are more likely than ‘average’ users to be cell phone mis-users, become cyberbullies or experience harassment themselves. Heavy cell phone users are defined as teens who send more than the ‘average’ number of texts in a typical school day (60 or more).

Some conclusions the research suggests are:

• 46 percent of heavy users experience cyberbullying on their cell phones, a much higher rate compared to just 23 percent of teenagers who are within the ‘normal usage’ bracket.
• 88 percent of cyberbullies indicate they have been bullied themselves across wireless networks.
• Teenage girls are more likely than boys to make attempts at hiding their cell phone activity from their parents, such as deleting texts or hiding online activity. Yet, it is teenage boys who are more likely to have parental rules for cell phone usage.
• Generally, it is heavy cell phone users and mis-users that are more likely to hide their cell phone activity from their parents.
• 70 percent of parents set rules for cell phone usage, with 14 percent installing parental control software.
• Strong parent-teen relationships with high trust levels may help in steering off inappropriate cell phone activity.

The web facilitates the spread of cyberbullying, with an increasing dissemination in recent years of hostile and aggressive messages via electronic devices in the form of messages, pictures and videos shared on social media. This results in internalising and externalising disorders, such as anxiety, depression and even attempted suicide. In this context, the problematic use of social media has now been recognised in the literature as an important risk factor for cyberbullying, especially in 13-15 year olds.

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Brain Imaging of excessive smartphone users:

The effects of excessive use of the media including TV, computer screens and smartphones is raising serious concerns among health and educational authorities due to deleterious effects of such use in children and adolescents. A recent study has shown an association between increased screen-based media use and lower microstructural integrity of brain white matter tracts that are associated with language and literacy skills in 5-year-old pre-school children. A large study of 4,277 adolescents has shown a negative correlation between screen media activity and cortical thickness in fMRI implying premature aging of the brain. A recent study has used diffusion MRI for assessment of white matter structural connectivity, and it has shown a positive association between activity in the right amygdala and excessive smartphone use in adolescents. Excessive smartphone users have shown impairment in cognitive control during emotional processing of angry faces and social interaction in fMRI. They also showed reduced functional connectivity in regions related to cognitive control of emotional stimuli including reward. Reduced Gray Matter Volume (GMV) was shown in problematic smartphone users and negative correlations between GMV in the right lateral Orbito Frontal Cortex (OFC) and measures of smartphone addiction. Lower activity in the right anterior cingulate cortex (ACC) and a negative correlation between individuals with excessive smartphone use and both ACC GMV and activity was reported. Furthermore, the strength of the resting state functional connectivity (rsFC) between several brain regions in fMRI positively correlated with smartphone time in bed. Finally, exposure to smartphone pictures in fMRI was associated with activation of brain regions associated with drug addiction and correlations of these regions with smartphone addiction scores were reported.

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Parent Guidelines to reduce Teenager Cell Phone Addiction:

Parents can help limit their teen’s cell phone use in several ways. It is likely a waste of time to forbid them to be on their phones, but you can set rules. Remind the teen that having a phone is a privilege, not a right, and that you are paying for it. Of course, guidelines for a 13 year-old will be different from that of a 17 year-old.

Consider these tips for parents:

• Set limits on time for phone use. Set up screen-free periods during the day, with a place for the phone to be stored during that time.
• Tell the teen the phone will be shut off if their grades drop.
• Have your teen shut down their cell phone at a certain time each night.
• Keep communication open and bring up any concerns if you think they might be bullied on social media.
• Have clear consequences should the teen break your cell phone rules.
• Suggest your teen take breaks from their cell phone to enjoy an outdoor activity.
• Teach the teen about online predators.
• Limit the types of social media platforms they can use.

Because social media isn’t going anywhere, it is best for parents to take the offense and partner with their teen to help them negotiate the challenges and emotional landmines together. Learning ways to reduce the chances for teenage cell phone addiction can help your teen avoid risks to mental health.

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Assessment of Smartphone Addiction in Indian Adolescents: A Mixed Method Study by Systematic-review and Meta-analysis Approach, 2014:

There is a considerable debate on addiction and abuse to Smartphone among adolescents and its consequent impact on their health; not only in a global context, but also specifically in the Indian population; considering that Smartphone’s, globally occupy more than 50% of mobile phones market and more precise quantification of the associated problems is important to facilitate understanding in this field. As per PRISMA (2009) guidelines, extensive search of various studies in any form from a global scale to the more narrow Indian context using two key search words: “Smartphone’s addiction” and “Indian adolescents” was done using websites of EMBASE, MEDLINE, PubMed, Global Health, Psyc-INFO, Biomed-Central, Web of Science, Cochrane Library, world library – World-Cat, Indian libraries such as National Medical Library of India from 1 January, 1995 to March 31, 2014 first for systematic-review. Finally, meta-analysis on only Indian studies was done using Med-Calc online software capable of doing meta-analysis of proportions. A total of 45 articles were considered in systematic-review from whole world; later on 6 studies out of these 45 related to Smartphone’s addiction in India were extracted to perform meta-analysis, in which total 1304 participants (range: 165-335) were enrolled. The smartphone addiction magnitude in India ranged from 39% to 44% as per fixed effects calculated (P < 0.0001). Smartphone addiction among Indian teens can not only damage interpersonal skills, but also it can lead to significant negative health risks and harmful psychological effects on Indian adolescents.

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Factors Associated with Smartphone Addiction Tendency in Korean Adolescents, 2021 study:

This study aims to identify the factors associated with smartphone addiction tendency in Korean adolescents. A convenience sample of 502 students from four middle schools participated in the survey for the assessment of demographic, personal factors (resilience and academic stress), environmental factors (parental support, teacher support, friend support, and bullying victimization), as well as smartphone addiction tendency. Smartphone addiction tendency was determined based on the Smartphone Addiction Proneness Scale for Youth (SAPS) criteria developed by Kim et al. The collected data were analyzed using descriptive statistics, chi-squared test, t-test, Pearson’s correlation coefficients, and hierarchical logistic regression. Among the adolescents, 17.9% were in the smartphone addiction tendency group. The factors associated with smartphone addiction tendency were subjective economic level, academic stress, parental support, and bullying victimization. Based on the findings of this study, it is considered necessary to approach smartphone addiction management considering personal factors as well as environmental factors.

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Excessive Smartphone Use Is Associated With Health Problems in Adolescents and Young Adults, a 2021 study:

Results: Comorbidity with depression, anxiety, OCD, ADHD and alcohol use disorder. Excessive smartphone use is associated with difficulties in cognitive-emotion regulation, impulsivity, impaired cognitive function, addiction to social networking, shyness and low self-esteem. Medical problems include sleep problems, reduced physical fitness, unhealthy eating habits, pain and migraines, reduced cognitive control and changes in the brain’s gray matter volume.

In Conclusion: Excessive smartphone use is associated with psychiatric, cognitive, emotional, medical and brain changes that should be considered by health and education professionals.

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Section-8

Smartphone overuse and education: 

With advancements in mobile and Internet technologies, smartphones, and other devices have become increasingly prevalent, offering functions such as games, videos, and messaging and the ability to process large amounts of information. Given the high accessibility of such devices, primary and middle school students now have more opportunities to use them. A study in US found a smartphone use rate of 89% among those aged 13–17. Smartphone use among Chinese adolescents rose from 27.2% in 2011 to >70% in 2017. A study in Hong Kong reported that 98.9%, 56.3%, and 50.9% of students had a computer, TV gaming console, or mobile gaming device at home, respectively, and spent 21.96 h of week on computer-related activities. Meanwhile, a 2019 study in Spain found that screen time among adolescents averaged three and a half hours a day.

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Teachers increasingly use smartphones and other electronic devices to arrange, collect and check homework. McDonald et al. found that the most common reason for using smartphones and computers among children was to do homework. To some degree, therefore, smartphone or device use time might represent homework quantity, which could increase academic stress. Other primary reasons for smartphone/device use among adolescents include social activity and entertainment. One study found that one in three children used smartphones and other devices for social purposes. Spending a lot of time using electronic devices for social activity or entertainment may take away from study time and might therefore increase academic stress.

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Smartphone use has been exponentially increasing among university students worldwide, a recent global consumer survey found that 93% of adults aged 18 to 24 had the highest smartphone ownership. Smartphones are being considered an integral part of daily life, importantly, smartphones afford students ample opportunities to obtain useful information anytime, anywhere. Students use this device to access teaching content and collaborate with both teachers and peers. However, it has been also observed that instead of attending lectures, students continue texting throughout and are unable to recall the lecture content. In fact, smartphone overuse discourages face-to-face interaction, which can precipitate or exacerbate various physical and mental disorders. Studies reported that smartphone ownership among students was particularly high in certain countries; most notably, Ghana (74%), Australia (81%), the UK (83%) [9], the US (91%) [10], and 94–99% in Saudi Arabia.

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Due to the flexibility and mobility of smartphones, students can access the internet anywhere; this allows them to search for their study-related materials or obtain general information. Smartphones provide a platform which facilitates learning through the use of specific applications which support university education. Communication applications and social networking sites likewise foster the rapid dissemination of important information, while faster communication between students and faculty staff enhances effective study and productive collaboration. Mobile learning is arguably the next phase of e-learning. The level of awareness and adoption of modern technology is gradually increasing as mobile technology brings about a new mode of learning for people with a higher level of flexibility. Rapid development in the functionalities of mobile technology has stimulated the performance of a variety of tasks on a smartphone device. The reduction in the cost of smartphones has further encouraged using smartphones for education purposes.

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Technology has undergone significant progression that benefits many, including educational stakeholders. Smartphones, the Internet-enabled devices incorporated with computer applications and software, are among the eminent breakthroughs in this latest century. It is not right to deny the existence of technology because most employers now seek graduates who are digitally literate (The Star, 2014). A lot of research has been done to investigate students’ preparedness to incorporate learning with mobile devices. Positively, the respondents in many studies welcomed the integration of learning with mobile gadgets. Hussin et al. (2012) researched student readiness for mobile learning in four aspects: basic, skill, psychological and budget. They found that Malaysian university students were not yet ready for mobile learning. However, it is assumed that with the growing development in smartphones, mobile learning would be made possible as many companies are very competitive in manufacturing smartphones, incorporating up-to-date apps, sold at low prices. Subsequently, this technology can reach even low-income households.

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Norries, Hossain, and Soloway (2011) in their study demonstrated that students’ achievement increases significantly when students use mobile learning devices, including smartphones, during learning time. This is because their time-on-task completion will increase as they have the device at hand. Norries et al. (2011) also found that students were constantly using the smartphone camera to take pictures of abstract concepts taught in class so that later they could relate them with the concrete ideas. Similarly, Woodcock et al. (2012) reported that respondents in their research believed that smartphones had allowed them to improve productivity and eventually their learning performance. Kumar (2011) indicated that students were downloading online lectures and reading from e-books to improve learning.  Another study conducted by Mtega, Bernard, Msungu, and Sanare (2012), shows the respondents in their study do not just use traditional mobile learning applications, such as text messages and calls, but they utilize mobile learning applications such as GPS, camera, voice calls, emails, Google drive, and so forth, to create, upload, download and share academic resources with their friends. All the above mentioned research illustrated that smartphones have created sophisticated avenues for students to learn and it is undeniable that more students are spending more time using mobile apps. This is positively correlated with the higher rate of smartphone ownership among higher education students (Bowen, Kyle, & Mathew, 2012).

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Though many current studies have shown smartphone usage benefits in learning, Woodcock et al. (2012) demonstrated contrasting findings. Students were found always using their phones more for playing games and other leisure activities than for learning. Among the identified factors preventing widespread adoption of smartphones for education are physical, technical and psychological limitations. White and Mills (2012) also found that students were increasingly adopting smartphones with the focus on personal use rather than education. In this study, students were asked if they used smartphone applications in categories in education, dictionary, games and maps.  Similarly, Anzai, Funada, and Akahori (2013) investigated mobile device use for mobile photo note-taking, in order to examine the effect of this trend on vocabulary retention. The study found no significant difference in short term vocabulary retention. 

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In recent years, more studies were carried out on smartphone use in relation to academic performance. For instance, Jacobsen and Forste (2011) in their study found a negative relationship between calling, texting, and self-reported grade point average (GPA) among university students in the United States. On the other hand, Hong, Chiu, and Hong (2012) found that calling and texting were positively correlated with a self-reported measure of academic difficulty among a sample of female Taiwanese university students. Yet in another research, Lepp, Barkley, and Karpinski (2015) reported that students who used the cell phone more on a daily basis were likely to have a lower GPA than students who used it less. Basing their conclusions on a sample of 536 undergraduates from 82 self-reported majors at a large public university, the researchers suggested a vital need to sensitize students and educators about the potential academic risks associated with high cell phone use.

More studies were carried out to investigate the causes behind a negative relationship between electro media use and academic performance; multitasking has emerged as a possible explanation (Jacobsen & Forste, 2011; Junco & Cotton, 2011; 2012; Karpinski et al., 2013; Kirschner & Karpinski, 2010; Rosen et al., 2013; Wood et al., 2012). Obviously, as smartphone use is not only limited to texting and calling but Internet use, email, and social-networking sites such as Facebook, it can potentially increase multitasking and task switching during academic activities. This ultimately leads to decrease in academic performance. Despite the prevalent smartphone usage among tertiary level students, the extent to which this technology has contributed to their academic achievement is still inconclusive.

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Characterizing smartphone use in formal and informal learning contexts: 

The approaches that young people take in their learning are an important dimension in learning with smartphones. Marton & Säljö (1976a, b, 2005) suggest that when presented with similar learning opportunities, learners approach their learning in different ways. To investigate how learners conceptualized their learning, Säljö (1979) asked university students this fundamental question: ‘What do you actually mean by learning?’ He discovered five conceptions of learning and Marton et al. (1993) added a sixth conception of learning: learning brings a change to the learners themselves. The three conceptions of learning: learning as increasing of knowledge; learning as memorising; learning as applying facts and knowledge are considered by Marton et al. (1993) to be primary reproduction of information and engender surface approaches to learning. The other three conceptions: learning as involving change in a person, learning as understanding, and learning as perceiving something in a new light are believed to represent deep approaches to learning. 

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In the context of mobile technologies, Gee (2007, p. 172) believes that well-designed games can engender deep learning: learning that can produce “real understanding, the ability to apply one’s knowledge and even to transform that knowledge for innovation.” Lankshear & Knoble (2011) have argued that people’s urge to engineer unique meaning and creativity for themselves has consequently extended the locus of mobile learning to settings outside the classroom: museums (Sharples, Taylor & Vavoula, 2007; Yatani, Onuma, Sugimoto & Kusunoki, 2004), field trips (Chen, Kao, Yu & Sheu, 2004; Stanton, O’Malley, Ng, Fraser & Benford, 2003), and use of educational games in a combination of settings (Facer, Joiner, Stanton, Reidz, Hullz & Kirk, 2004; Klopfer & Squire, 2008; Spikol & Milrad, 2008). However, whilst smartphones facilitate such migration to diverse learning spaces as well as the expansion of the learning sphere for individual users to an extent currently unparalled with other mobile devices, to date, there has been a paucity of research on smartphone learning in conceptual and temporal spaces that extend from formal learning institutions such as schools and universities and how and whether learners view these as pedagogical or social spaces (Looi, Seow, Zhang, So, Chen & Wong, 2010). Frequently, learning is visible and tangible, but as a result of its multidimensional and context-dependent nature, it is also often automatic, subconscious and undetectable (Gee, 2008; Pachler et al., 2010). Little is known for example of how learners on the move pack their learning into the gaps of everyday life, how learners’ attention switch from one topic to another, how learners appropriate content from peers (Stald, 2008), how hierarchies of what is learned are assembled in the interstices of time (Helsper & Eynon, 2013), and how such everyday learning accumulates over time (Merchant, 2012). This type of learning that occurs is often fragmentary, not immediately obvious or clearly delineated in the intermissions between activities.

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Advantages of Cell Phones in School:

Carrying cellphones in school is both beneficial and arguable at the same time. Parents can know their kids’ whereabouts, and kids can use their phones to access knowledge apart from their books. But allowing cell phones in school during periods oftentimes seems arguable. Cellphones are an easy way to get your kids distracted amid their classroom lectures. There has been a lot of controversy about the use and presence of cell phones in schools. Schools and parents are often caught in a situation why students are allowed or not to be allowed to bring their phones into school. What should happen if there is an incident with them and there’s no one around. Today’s society revolves around technology, so having access to your mobile device can be beneficial in terms of safety. In addition, smartphones enabled with GPS are more convenient for parents. Mobile phones also give students the ability to find out answers quickly during class which saves time.

Advantages of Cell phones in school:

-1. Students can be reached in case of emergency

You can be reached in case of emergency; all you have to do is hit 911 in case you can’t reach out to your parents. This is especially important for young children who might not have a designated guardian to get them home if they need help or when parents are unavailable because of work schedules.

-2. Opportunity to learn

Cell phones allow students the opportunity to learn about what’s happening outside their classroom. They also provide a way to stay up-to-date on current events and topics that may come up during class. This knowledge outside the books helps with homework too. Finally, since cellphones are so widespread these days, many people use them as an educational tool by looking something up online while it comes up in discussion (e.g., math problems).

-3. Good for Teachers

Teachers can teach the students when they are not on-site. For example, during the COVID-19 pandemic, millions of colleges started taking online classes connected with students through their phones.

Having access to students outside of school hours also means that teachers will know how to virtually manage classroom sessions and lesson plans. Texting or calling out to an individual is much less disruptive than shouting across the room to get someone’s attention.

-4. Child Safety is one of the main Advantages of Cell Phones in School

As a concerned parent, looking after your kids is your prime responsibility. That’s one of the reasons why you may allow your kids to carry cell phones in school. According to reports, around 2000 kids are abducted in the US every year. Even though Kids are rarely abducted from school grounds, but to make sure they are in a safe place, many parents use GPS locator apps on mobile phones.

-5. Increased Parental Involvement

Cellphones keep kids connected with their parents outside school hours, increasing parental involvement at school time and after-school activities such as homework help or sports practices. This helps them feel more invested in what they’re doing to have better grades and enjoy themselves more overall.

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Disadvantages of cell phones in school:

After hearing so many arguments about cell phones in school, you should be more open-minded to the idea. Also, you should be more concerned about your kids’ well-being. Kids carrying cell phones in school find ways to get distracted by the online world, such as social media. Other than that, you should also consider the following disadvantages of cell phones in schools.

-1. Online Safety

Safety concerns such as cyberbullying and being targeted by strangers on social media are major disadvantages of cell phones in school. Although this may seem like a valid argument, there are already laws in place for that.

Another reason why students should not be allowed to have cell phones in school is addiction. According to a report, around 50% of parents feel their kids are addicted to their cell phones. The report also showed, that 78% of teenagers check their phones at least hourly.

-2. Distraction is one of the major disadvantages of cell phones in school

There’s also another problem with carrying cell phones in school; it would make students’ lives even more stressful by distracting them when trying to focus on learning. Around 72 percent of teens feel the need to respond to texts, messages on social networks, and other notifications immediately. This can be enough to distract your kids while they are in the classroom and trying to concentrate on one task instead of two different ones simultaneously (texting while taking notes).

-3. Encourage Cheating

Cell phones can be a distraction even to teachers and encourage students to cheat in their exams. Cheating or looking up answers online is what students do when they are unsure of themselves. This may help students get better grades but degrade their capability to learn. Most importantly, it’s against morals.

-4. Health Concerns

In the past few decades, cell phones have significantly impacted society due to their ease of use and efficiency. However, experts are now questioning if they’re having an adverse effect on people’s health. For teenagers addicted to mobile phones from an early age, it’s even worse to imagine. Tons of research studies have concluded with similar health effects of excessive mobile use, ranging from text neck to myopia.

-5. Classroom Disruptions

Cell phones in the classroom can be distracting to other students and teachers. Even a single beep of incoming notifications can disrupt the flow of an entire session. If mobile phones are not kept on silent mode, they can hamper the entire learning process.

In addition, if schools allow cell phones in schools, teachers will lose control of their classrooms because they cannot prevent cell phone use among students who are bored or feeling left out.

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Impact of Smartphone on Education:

Teaching and learning in higher education over the past few decades has incorporated information and communication technology (ICT) as it is seen as a crucial component to be adapted in the development of social environment (Rung et al., 2014). The most popular trend in term of ICT use can been seen by the growth of dependency on mobile-connected devices as it is not limited for daily tasks but also been utilized in educational environments (Koszalka & Ntloedibe-Kuswani, 2010).  Educational activities that incorporate smartphone use are accessing of course content, inspiring sharing and discussion session between teachers and students and retrieving information regarding students’ performances (Cochrane, 2010). Therefore, smartphone use may lead to important influence in enhancing students’ performance as this device might boost teaching and learning experience. 

Woodcock et al. (2012) stated that various area of students’ lives would change by increasing smartphone use as students begin to utilize this device to increase their learning knowledge. Smartphones use in learning context can further lead students to be aware of the benefits they might encounter such as are able to learn anything at anywhere and anytime as well as encourage students to involve in learning activities. This shows that technology able to open and increase student’s prospect especially in their academic. 

Froese et al. (2012) conducted a self-report survey to investigate students’ mobile phone activity in classes and the potential effect of the activities on students learning performance. The result indicates that the use of mobile phone distracts students learning process and students believe that their classroom learning is disrupted during texting. 

Another study conducted by Tindell and Bohlander (2012) to understand the use and misuse of smartphone in college lecture setting. The finding shows that students are not paying attention to their class lecturer as they are spending too much time on texting. Study conducted by Elder (2013) shows that students who used mobile phone in class score lower than students who did not use mobile phone and they even not able to recall much information from the lecture. 

Alfawareh and Jusoh (2014) study revealed that students do not fully utilize smartphones for learning motive but utilize it to make calls, taking pictures and browsing internet. Furthermore, Hanson et al. (2011) stated that students prefer to use instant messaging, email and web-surfing in library rather than looking into library online resources. 

Moreover, students have difficulty in balancing their study life with their need for social support although they want to make their learning as a priority. Students seem to be motivated on updating their status on Facebook rather than downloading their class assignment.

Smartphone has impacted students life in various areas especially education, smartphone use for education purposes introduce students to world of knowledge as students are able to obtain various information by a click. Smartphone equipped with internet enabled feature provide students the ability to be connected always and is easier for them to obtain academic related materials online anytime.

Sarwar and Soomro (2013) stated the positive impact of smartphones in education context, it enables society to access various learning resources and provide opportunities for individuals to continue their education by distance learning. 

However, utilizing the smartphone for a long period or continuously might affect a person health; the person might experience headache and frequent messages and calls lead to interruption on students concentration and focus on completing their coursework which will effect negatively on their academic (Abu-Shanab, 2015). Study by Samaha and Hawi (2016) reported that the risk of smartphone addiction can be associated to life satisfaction via academic performance and perceived stress. It shows that students that achieve low academic performance will likely experience less life satisfaction and more likely prone to smartphone addiction.

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Impact of Smartphone on Psychological Health of students:

Problematic smartphone use might lead to development of certain behavioural and mental problems. The attachment that youth in this era has with their smartphone made them to feel they cannot live without their smartphone around them.  Students tend to surf internet and play online games as way to release their mental stress from the stress that they experience in term to escape from problems that they face from their friends or their school work (Kim, 2013). Students in the past depend on computer to surf internet to cope with their stress problem however in today’s society, students tend to depend more on smartphone due to the easy accessibility of internet. Study by Kibona and Mgaya (2015) shows that most of the students utilize smartphone for social activities (65%) compared to education activities (20%). Moreover, 65 percent of the students agreed that they utilize smartphone to surf social networking sites (Twitter, WhatsApp, Instagram, facebook) while doing their academic assignment. 48 percent of them spent around 5 to 7 hours per day on smartphone. This study further identified 85 percent of the students are addicted to their smartphones.

Study conducted on smartphone users revealed that users that overuse smartphone experience higher level of depression, trait anxiety and state anxiety compare to normal smartphone users (Hwang et al., 2012). Berger (2013) study shows that students who utilize mobile phone more tend to achieve lower grades and have higher anxiety and felt less happy than students who do not utilize mobile phone frequently. 

Study by Smith (2013) had also shown that students tend to have high anxiety and their GPA was low when they tend to use their phone more. The students mention that they had anxiety when they had to be away from their phone for certain amount of time as they are dependent on their phone. 

The increasing frequency and time spend (Lee et al., 2014) beside of dependency on smartphone among youth can be seen as an indicator of development of smartphone use from a habit to an addiction (Roberts et al., 2014).

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Impact of Smartphone on Social Interaction of students:

Communication plays a vital part of human life. This indicates technology changing rapidly to match human necessities. In the modern society, communication becomes easier with the development of technology and it influences the style of communication between individuals. The unique and multiple application features of smartphones make it different from other phones. However, social engagement between individuals is jeopardized with its unique application by limiting their face to face interaction and develop more chat rooms communication. It might cause lack of real life social interaction that contribute to relationship issues to arise, and interference in students’ academic work (Kuss & Griffiths, 2011). 

Society is moving towards smartphone world, therefore obviously it can be seen that individuals are investing most of their time on the screen chatting and engaging in social media than meeting face to face with their friends and families. Although the application of smartphones increases the ability to interact with social mates easily and freely but it poses danger on relationship between human. Even though individuals are able to create groups of friends and communicate through various social platforms, but oral communication is seen to be lack. The finding based on study conducted to investigate the relationship between the qualities of in person social interaction with the presence of mobile devices shows that conversations without mobile devices were significantly superior compared with interaction with presence of mobile communication technologies (Misra et al., 2014). Lower levels of empathy concern were reported when communication did in presence of mobile devices while higher level of empathy is seen in individuals who communicate in absence of mobile devices (Misra et al., 2014).  Another study conducted on the influences of mobile communication technology presence on the quality of human face to face interaction shows that used of mobile devices cause negative effects on individuals’ conversation quality, closeness and connection especially noticeable during conversation related to personally meaningful topics (Przybylski & Weinstein, 2012). 

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Table below shows Studies on positive and negative effects of smartphone use on students:

Study	Positive	Negative
Conchrane, 2010	Boost teaching and learning experience (sharing and discussion between teacher and students)	–
Hanson et al., 2011	–	Motivated on updating status on social media rather on learning purpose
Kuss & Griffiths, 2011	–	Lack of real life social interaction (cause relationship issues to arise, and interference in students’ academic work)
Woodcock et al., 2012	Increase students learning knowledge (involve in learning activities anywhere, anything and anytime)	–
Froese et al., 2012	–	Distract learning process (during texting)
Tindell & Bohlander, 2012	–	Do not pay attention during lecturer (too much texting)
Hwang et al., 2012	–	Experience higher level of depression, trait anxiety and state anxiety (overuse)
Przybylski & Weinstein, 2012	–	Negative effects on individuals’ conversation quality, closeness and connection
Elder, 2013	–	Score low (unable recall much information taught during lecturer)
Berger, 2013	–	High anxiety and felt less happy (overuse)
Smith, 2013		High anxiety (overuse)
Sarwar & Soomro, 2013	Access to various learning resource and provide opportunities for distance learning.
Alfawareh & Jusoh, 2014	–	Do not utilize for learning (use for making calls, snap pictures)
Roberts et al., 2014	–	Development of smartphone use from a habit to an addiction
Misra et al., 2014	–	Lower levels of empathy concern when communication done in presence of mobile devices compare to absence of mobile devices
Abu-Shanab, 2015	–	Experience headache and interruption on students concentration and on completing their course work (frequent messages and calls)
Kibona & Mgaya, 2015	–	Addicted to smartphones
Samaha & Hawi, 2016	–	Smartphone addiction negatively impacts academic performance and life satisfaction

Based on the studies above, it seems that the negative impacts of smartphone use among students are tremendous and positive impacts are minor. Although smartphones offer students with several conveniences in their life (provide various learning resources) but it also affects students negatively by distracting their learning process, lower their academic performance, developing psychologically problems (feel anxious, develop addiction toward smartphone) and social problems (lack of real life social interaction, arise of relationship issues).

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Smartphone use and academic performance: 

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Positive Effects of Smartphones on Students’ Academic Performance:

Considering the negative effects of smartphones there are also some beneficial points for using a smartphone which we can find below:

• Smartphones help students in finding information about assignments or their school-related work easily by providing Internet facilities with both Wi-Fi and 3G/4G/5G/6G connection.
• Smartphones also help students in doing their homework quickly and properly. In this age of technology, everything is becoming easy because of the availability of smartphones with thousands of applications that can be useful for different purposes like calculators, note-taking apps for writing assignments or lectures notes, etc.
• Students can have access to their teachers through video calling facilities such as Skype or Google Hangouts where they can share information related to assignments and projects with ease.
• It has also been reported that mobile phones are helpful while using public transport and traveling from one destination to another because most people use them for communication purposes via calls and messages. Therefore, it becomes easier to communicate while on the move rather than standing on the roadside or in railway stations to find a way to get to the destination.

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Negative Effects of Smartphones on Students’ Academic Performance:

Several studies have found a negative association between cellphone use and academic performance (Judd, 2014; Karpinski, Kirschner, Ozer, Mellott, & Ochwo, 2013; Rosen, Carrier, & Cheever, 2013). In particular, a link has been identified between smartphone multitasking and a decline in academic performance (Rosen et al., 2013). In a sample of 451 US college students, a study identified a negative relationship between the use of social networking sites and GPA, and this relationship was moderated by multitasking (Karpinski et al., 2013). Similar results were obtained from studies on US university students, which revealed that use of Facebook and text messaging while doing schoolwork or attending class were negatively related to college GPAs (Junco & Cotten, 2012; Wood, et al., 2012).

Various Studies show Negative Impact of smartphones on Academics: 

-1. “The Impact of Mobile Phone Usage on Student Learning”

Key Finding: College students who were not using their cell phones wrote down 62% more information in their notes and scored a letter grade and a half higher on a multiple choice test than students who were actively using their phones.

Ref: Kuznekoff, et al. (2013) Communication Education V. 62, 233-252.

-2. “Ill Communication: Technology, distraction & student performance”

Key Finding: When schools in England banned mobile phones, the test scores of 16-year-old students increased by 6.4%. These effects were twice as impactful on the scores of low-achieving students and had little to no impact on already high-achieving students.

Ref: Louis-Philippe Beland, et al., “Ill Communication: Technology, distraction & student performance,” Labour Economics, Volume 41, 2016, Pages 61-76, ISSN 0927-5371.

-3. “An Empirical Examination of the Educational Impact of Text Message-Induced Task Switching in the Classroom: Educational Implications and Strategies to Enhance Learning”

Key Finding: While college students watched a videotaped lecture, they were randomly interrupted by text messages. Based on the number of texts sent and received, three “texting interruption” groups were defined as Low, Moderate and High. A recall test measured the impact of the texting distractions on students’ memory. The high texting group scored significantly worse (10.6% lower) than the low texting interruption group.

Ref: Rosen, et al. (2011) Psicologia Educativa,163-177.

-4. “Texting as a Distraction”

Key Finding:  This study observed the difference in performance on a lecture quiz between students who were randomly assigned to text message during the lecture and those who were not supposed to text at all. Those who text messaged throughout the lecture scored significantly lower on the quiz.

Ref: Dietz, Stephanie, et al. (2014) Computers and Human Behavior V. 36, 163-167.

-5. “Brain Drain: The Mere Presence of One’s Smartphone Reduces Available Cognitive Capacity”

Key Finding: Participants turned off their phones. While they performed memory tasks, some could keep their phone with them and some had to put it in the other room. Those who had the phone with them did significantly worse on the tasks. The attention and energy it takes to not check a phone seems to cause “brain drain.”

Ref: Ward, et al. (2017) JACR, 140-154.

-6. “The Mere Presence of a Cell Phone May be Distracting: Implications for Attention and Task Performance”

Key Finding: College students did various cognitive tests with phones present and with them out of sight. The presence of phones negatively impacted attention and task performance.

Ref: Thorton, et al. (2014) Social Psychology V. 45, 479-488.

-7. “Non-academic Internet Use in the Classroom is Negatively Related to Classroom Learning Regardless of Intellectual Ability”

Key Finding: Introductory psychology students were asked about the frequency and duration of their use of portable electronic devices and how it affected their learning. Higher rates of internet use were found to be linked to lower test grades.

Ref: Ravizza, Susan M., et al. (2014),  Computers & Education V.78, 109-114.

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The effects of smartphone addiction on learning: A meta-analysis of 2021: 

Research on smartphone use among college students is extensive. Although numerous studies have examined the relationships between mobile phone use and academic achievements, many such studies have yielded mixed findings. Hence, the overarching goal of this meta-analysis was to comprehensively synthesize existing research to investigate the effects of smartphone addiction on learning. The authors included 44 studies (45 effects) in the analysis yielding a sample size of N = 147,943 college students from 16 countries. The results show that smartphone addiction negatively impacts students’ learning and overall academic performance (Q (43) = 711.87, p < .001, r = −0.12). Further, findings suggest that the greater the use of a phone while studying, the greater the negative impact on learning and academic achievement. Additionally, the results suggest that skills and cognitive abilities needed for students’ academic success and learning are negatively impacted.

Highlights:

• Smartphone addiction has negative impacts on student learning and overall academic performance.
• The greater the use of a phone while studying, the greater the negative impact on learning.
• The skills and cognitive abilities students needed for academic success are negatively affected by excessive phone use.
• The results of this meta-analysis implied that addicted users show a diminished level in learning.

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Cell Phone in Student’s Head:

A 2017 study found that cell phones that were turned off and stashed away silently reasserted themselves—distracting working students anyway. Many studies have investigated the so-called “downstream” effect of cell phone presence on learning. Students who split their attention between a learning task and texting on their cell phones or accessing Facebook, for example, perform poorly when compared to students who are not dividing their attention. But recent research from the Journal of the Association for Consumer Research suggests that cell phones might have a negative “upstream” impact on learning, too. The authors propose that the mere presence of a cell phone, even when it is silenced and stored out of sight, might be undermining our ability to focus. “The presence of one’s smartphone enables on-demand access to information, entertainment… and more,” the study concludes. “However, our research suggests that these benefits—and the dependence they engender—may come at a cognitive cost.” A bevy of other studies, meanwhile, clearly indicate that environments or activities that divide our attention can hurt us when taking tests and especially when encoding new learning. Taken together, there’s increasing evidence that the presence and usage of cell phone in the classroom—while not necessarily detrimental in all contexts—should be carefully monitored, intentionally structured, and even restricted in some cases.

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Education Programs for Preventing Overuse of Smartphones by Students:

In order to prevent excessive use of smartphones by students, several education programs are introduced by different educational institutes:

• In schools, school managements take several initiatives to help students such as using smartphones for academic purposes only or restricting their access to the internet during classes.
• Teachers make a timetable for students in order to monitor their smartphone usage and restrict those playing games on their phones during lectures so they can give better attention to their studies. They also encourage students not to use mobile phones in the classroom if it is meant for communication purposes only.
• Parents play a major role in this regard where they have been asked to discuss this issue with children at home so that they do not indulge themselves too much in excessive use of smartphones which may affect their mental health as well as academic performance at school.
• Educational institutes also take some initiatives to educate parents about this issue so they can transfer their knowledge about smartphones and the internet to children in a positive way.

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Recommendations for Preventing Overuse of Smartphones Among Students:

In order to prevent excessive use of smartphones by students, the following considerations are recommended:

• Schools should introduce different education programs for students which promote academic-related activities such as better management of time, restrictions on using mobile phones in the classroom, etc.
• Parents play an important role in deciding whether their child will be indulged too much in excessive smartphone usage when they monitor his/her daily routine and activities properly especially during holidays or vacations.
• Teachers should pass information to parents through school newsletters, emails, etc. about the latest advancements in this regard so they can take necessary measures to prevent overuse of smartphones among children where it has been reported that students mostly use mobile phones for entertainment purposes rather than academic reasons.
• Mobile phone companies should produce cheaper smartphones with quality features that do not cause distractions while studying at school or college and restrict them from playing games on their mobiles during lectures as well as monitor their excessive usage which may affect their health adversely.
• Educational institutes must introduce different education programs for parents about this issue so they can transfer knowledge about smartphones and the internet to children in a positive way where both educational institutions and parents play an important role toward achieving the goal of minimizing the negative impact of smartphones on student’s academic performance.

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Is banning phones in schools the answer?

A 2015 London School of Economics and Political Science paper found that “student performance in high stakes exams significantly increases” with a ban on mobile phones. The improvements were largely seen among the students who were normally the lowest achieving. “This suggests that restricting mobile phone use can be a low-cost policy to reduce educational inequalities,” the study found.

A study from South Korea conducted on teenagers with internet and smartphone addiction demonstrated that their brains had higher levels of a neurotransmitter that slows down neurons, resulting in reduced levels of control and attention and rendering people more susceptible to distractions.

However, trying to enforce ban is a contentious issue for many students, parents and teachers. Mobile phones are now so entwined in our daily lives that, even if banned at school, teenagers will be on their phones for long periods at home.

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Cellphones are banned in Ontario classrooms during instructional time starting in 2019-20. Education Minister Lisa Thompson said “Ontario’s students need to be able to focus on their learning — not their cellphones. By banning cellphone use that distracts from learning, we are helping students to focus on acquiring the foundational skills they need, like reading, writing and math.” Some schools already have similar policies, but the province will issue a directive to all public schools for the 2019-20 school year. How to enforce the ban would be up to individual boards and schools. Exceptions would be made for when teachers want to use cellphones as part of their lesson, for medical reasons and students with special needs.

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France bans smartphones from schools:

French children will have to leave their smartphones and smart devices at home or switched off when they are at school. The ban on smartphones as well as other kinds of internet-connected devices, such as tablets, applies to schoolchildren between 3 and 15 years of age, and was passed by lawmakers. French high schools, or lycées, with students 15 and older, will get to choose whether to adopt the phone ban for their pupils. “We know today that there is a phenomenon of screen addiction, the phenomenon of bad mobile phone use… Our main role is to protect children and adolescents. It is a fundamental role of education, and this law allows it,” said Education Minister Jean-Michel Blanquer on French news channel BFMTV. More than 90% of French children between the ages of 12 and 17 had mobile phones in 2016, up from 72% in 2005, according to French telecoms regulator ARCEP.

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Section-9

Smartphone overuse at workplace:  

Cell phones have changed work and personal life in significant ways, and as with any tool, they can be used for good or bad. Companies see this first-hand as their employees can be both more distracted and more productive thanks to these devices. Here are some stats on cell phones at work:

• 66% of American employees admit to using their cell phones at work several times a day.
• 55% of employees say personal messaging is the top reason they use their cell phones at work.
• Highly mobile employees spend an average of 33% of their workdays on their cell phones.
• The average employee spends almost eight hours per workweek on their cell phones doing non-work-related activities.
• 87% of companies now expect their teams to use their personal devices.

The existing research shows that although allowing employees to use Smartphones in the workplaces could have negative impacts like lowering productivity, disconnecting people from their real lives, bringing stress to their lives, and creating bad manners in a company, Smartphones also have the potential to promote employees engagement and they can be used as a social connection tool. For instance, Smartphones can promote autonomy, relationships with peers as well as superiors, and knowledge sharing, which can lead to job satisfaction and contribute to work efficiency.

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Workplace Productivity and use of the Internet/smartphone:

Smart phones were introduced in the work place due to various reasons and the most important reason was to stay in touch with the employees. The other reasons are listed below-

• In order to increase productivity, all the big and small companies make use of technology. The companies developed different kinds of tools for internal communication. For example, micro-blogging platforms, wikis, internal social networks, and internal instant message service. These tools are private and secure which help to reach the employees of an organization without hassle. These tools save on a lot of time and energy of the employees. Smartphones were allowed on the work-place because these tools work best on the platform of smart phones and can be utilized at its fullest because employees carry their smart phones everywhere.
• Smartphones helps to improve relationships with both peers and superiors.
• Workers can seek online help from smart phones and get in touch with experts any time for their assignments. It helps in expanding knowledge and encourages knowledge sharing in the workplace.

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Montag (2015) outlined in a German publication that the association between smartphone usage and productivity might resemble an inverted U-function. The right amount of technological use indeed makes us more productive, but clearly technology could be overused.

Figure below depicts the hypothesized association between smartphone/online usage and productivity.

When does productive use become overuse? It begins when we are getting distracted on a minute-to-minute basis: messages via WhatsApp or other messenger applications or emails are just overwhelming us. Constant interruptions lead to greatest productivity loss, rather than the total time spent on the phone.

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Stress due to work related smartphone use: 

A recent study showed that many people who use their smartphones for work-related communications tend to have a difficult time psychologically detaching from their jobs. This, in turn, makes them vulnerable to work-related exhaustion. Daantje Derks, Heleen van Mierlo, and Elisabeth B. Schmitz of Erasmus University Rotterdam theorized that intensive work-related smartphone use during the evening — fueling an implicit demand for 24/7 availability — disturbs a person’s ability to psychologically disengage from the stress of the job. “The increased productivity associated with staying connected to work in the evening hours is often achieved at the cost of mental health, yielding higher stress levels which may lead to poor recovery, impaired performance, fatigue, and sleep complaints,” they wrote in the Journal of Occupational Health Psychology.

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Negative effects of Smartphone usage at workplace:

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A recent survey performed by Screen Education showed that employees waste, on average, more than two hours per day using their phones. That’s more than 2 hours where work for your business isn’t getting done. And it isn’t just productivity at stake – 14% of respondents said workers distracted by mobile devices had caused workplace accidents, many of which resulted in injury or even death.

A 2017 study by Robert Half Talent Solutions and OfficeTeam uncovered just what it is staffers are doing on their phones instead of their workplace responsibilities: Most are using their mobile device to check their personal email, while an additional 28% surveyed admitted to perusing social networks. Sports or entertainment sites, mobile games and online shopping are among the other things workers admitted they use their mobile devices for on the clock. 

Given people’s attachment to their phones, it’s hardly surprising that these devices are such a common source of distraction at work.  It’s understandable that employees may occasionally use their mobile devices or attend to personal tasks during business hours. But these activities can easily become big distractions.

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Cell phones are driving many of us to distraction—and taking a toll on productivity in the workplace. Nineteen percent of employers think their workers are productive for less than five hours a day, and more than half believe that cell phones are to blame. Indeed, every beep, buzz and glow emanating from our personal devices are designed to lure us in while hijacking our time and disrupting our concentration. A short call or text message here or there may not harm productivity in a noticeable way, but excessive use can become a big problem. How much time actually is stolen from everyday life due to technology use becomes clear when looking at some new numbers from a large-scale smartphone investigation (Montag et al., 2015a). In this study, more than 2,400 participants were tracked for four weeks and their smartphone usage was recorded. The average user spent >160 min every day on the smartphone with WhatsApp (about 20% of this time) and Facebook (about 10%) applications as the major driving forces (taking the median into account instead of means, the numbers differ somewhat). Clearly, much of the time spent on smartphone is not actually needed but is wasted. This poses particular problems when you need to concentrate on complicated processes at work. A state of deep concentration characterized by positive emotions accompanying flow (Csikszentmihalyi & LeFevre, 1989) cannot be reached when we are constantly getting distracted.

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Mobile technologies devices impact performance, culture and the structure of the company itself (Meeker et al, 2010). Some people believe that mobile phones improve communication, thus, will have positive impact on their work. Others think that episodic cell phones use at work will distract them from their jobs, which negatively influence their productivity. These types of interruptions at work make employees lose their focus and consequently, they would not meet their project deadline (Donya and Kumah, 2011). When employees receive a call or their cellphone rings, it will have a negative effect on their productivity, whether they answered it or not. During the few seconds spent on the decision to take or ignore that call, the flow of concentration is interrupted and it takes time to re-establish efficiency (Yihong, et al 2010). An external interruption refers to an event such as email, phone call, instant message or notification that alters work evolution. By contrast, an internal interruption identifies changes in work tasks that are self-initiated (Ellwood, 2005). One study found that employees working in the manufacturing sector had a problematic mobile phone use which negatively influenced their productivity (Wahla and Awan, 2014). 

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In addition to distraction, side effects of mobile use could negatively influence efficiency at work. A study on Saudi Arabian participants, mentioned that 44.4% complained of headache, concentration deficiencies, memory loss, hearing loss, and exhaustion were related to their mobile phone use (Khan, 2008).  Moreover, another study showed that 3-4% of mobile phone users suffered problems such as fatigue and dizziness, and more than 20% developed headaches (Al-Khlaiwi and Meo, 2004). These medical health hazards might later relate to absenteeism and requests for sick leaves. In addition, other negative outcomes could result from the overuse of mobile phones such as financial problems, sleep disturbance and behavioral addiction. 

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So, how can you stop employees from using cell phones at work? Do you need a cell phone policy at work? How to deal with Overuse of personal Cell Phones in the workplace?

Below are a few tactics to help you exert some measure of control over cell phones in your workplace.

-1. Face the Reality

Cell phones are here to stay. This means creating a “no texting while working” policy isn’t ideal. Ninety-five percent of Americans now own a cell phone of some kind, and family-friendly employers know that even though work comes first and foremost, personal devices are vital for employees who need to check in with their children and attend to important personal matters during the day.

Smartphone ban at workplace will not work for two reasons:

First, bans on using private smartphones are not easily enforceable. For an employer, it is difficult to ensure that employees adhere to the ban. This differs from the more common form of cyberloafing when employees use their desktop computers for browsing the internet. In this case, there are ways to monitor, sanction and even technically rule out employee misbehavior.

Second, there is another reason why smartphone bans might not be effective in improving workplace performance. Employees might perceive a ban as a signal of distrust, even if the ban is not accompanied by measures to monitor or sanction violations. If employees have the impression that their employer does not trust them, they might be less motivated and exert less effort.

Unless there are safety concerns, creating a “no cell phone use at work” policy can be perceived as punitive. In fact, posting a “mobile phones not allowed in workplace” notice will likely lead to morale problems. And although blocking cellular signals within your workplace may be a tempting solution, it’s not practical. Disabling Wi-Fi can impede your own business communications, and a cell phone jammer, which can effectively shut down signals throughout your business area, is not only dangerous, it is also illegal in the U.S.

It’s better to accept cell phones as a part of modern-day work life and establish policies for their use. As long as you enforce your “cell phone use at work” policies, you should see usage settle at levels that are reasonable for your business.

-2. Set Limits

Chances are that you’re going to see an employee on their cellphone here and there. That’s why you’ll want to set limits or mobile phone restrictions at work depending on:

• The nature of your business
• Each employee’s job
• The types of issues you’ve experienced

For example, cell phone use is typically prohibited under the following circumstances:

• During meetings, training sessions and conferences
• When employees are interacting with customers
• In production areas and kitchens or while operating heavy equipment as cell phone use at work can present a safety hazard
• While driving, except when a Bluetooth connection is available or when the driver is pulled over to the side of the road.

Your cell phone policy could also define:

• When cell phone use during work hours is acceptable, such as during breaks and lunchtime
• The frequency and length of calls permitted during working hours
• If headsets are permitted
• Where to store personal devices. Keeping phones out of sight, such as in a desk drawer, is an effective way to keep distractions to a minimum.
• Appropriate use during business hours. For example, business calls and brief conversations or texts with family members may be okay, but playing games or downloading music is not.

Just make sure that the limits for your smartphone policy for employees are fair and flexible. While establishing a zero-tolerance cell phone policy isn’t the best route, you can always tighten up your policies if necessary.

-3. Define Etiquette for Personal Cell Phones in the workplace

Not only do cell phones distract their owners, but calls can be especially annoying to the employees sitting close to the talker. These guidelines can minimize disruptions and help keep the peace, even when employees are on their phones:

• Set cell phones to vibrate and ringtones to silent
• Speak quietly
• Keep calls short
• Take personal calls in private
• Avoid offensive language
• Use texting as a quick and quiet alternative to talking on the phone
• Do not use cell phone cameras (to protect everyone’s privacy)

-4. Designate go-to spots. Establish quiet spaces in the office and offer time-management workshops. Workers may be less tempted to look at their phones if they’re able to work in a peaceful environment.

-5. Provide break rooms. Encourage your employees to turn off their non-work-related notifications when they are in the office so they aren’t reminded of what’s waiting for them later. You can also set up short break times when your staff can use their phones.

-6. Encourage your employees to be productive. With easy access to texts, social media and clickbait content, it’s no surprise that personnel can waste time on their phones. While it can be tempting to simply ban employee phones in the workplace, these are just one of the many distractions employees face. Consequently, it’s important for good managers to do what they can to reduce distractions and help employees be productive to achieve their workplace goals.

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Over-connected? A qualitative exploration of smartphone addiction among working adults in China, a 2019 study:

Smartphones currently dominate people’s lives and interests due to their increased affordability and functionality. However, the negative aspects of smartphone use, such as smartphone addiction, have recently been brought up. This study utilized a qualitative approach to explore the symptoms of smartphone addiction among working adults in China and the psychological factors that affect such addiction. This study identified four typical symptoms of smartphone addiction, namely, withdrawal (e.g., experiencing negative feelings when having no access to smartphones), salience (e.g., constant checking and thinking about smartphones), conflict (e.g., smartphone use interferes with family and work life), and phantom phone signals (e.g., illusory perception of a phone vibrating or ringing). Conscientiousness, neuroticism, and extroversion increase the likelihood of smartphone addiction. Notably, this study found that conscientious workers are likely to develop smartphone addiction, a finding that is contrary to those of the majority of existing studies on technological addiction.

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Counterview:

Counter study: smartphones lead to higher work efficiency:

Smartphones in the workplace: Changing organizational behavior, transforming the future, a 2013 study:

In the past decade, Smartphones have been developed and increasingly integrated with people’s lives not only for social use, but for professional use as well. Many researchers claim that Smartphones can have negative consequences in the workplace such as lowering productivity, separating people from their realities, bringing stress from personal issues to work, and creating bad manners. Companies, however, have a difficult time mandating a policy in regards to prohibiting the use of Smartphones. Therefore, CEOs and corporate leaders should encourage their employees to use their Smartphones as tools for increasing their company’s efficiency. This research aims to examine the results of the use of Smartphones in the workplace as integrated internal connection tools. Using Smartphones in the workplace can be valuable in three ways: promoting autonomy, strengthening relationships with peers as well as superiors, and improving knowledge-sharing. Moreover, these three main factors can increase employee job satisfaction, which leads to better efficiency in the workplace. Organizations will be better able to successfully adapt with changes that are occurring every day by integrating the use of Smartphones in the workplace.

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Smartphones can benefit at workplace in three ways by promoting autonomy, strengthening relationships with peers as well as superiors, and encouraging knowledge sharing. These factors are related to job resources from Bakker’s model, which can lead to work engagement, and consequently to work efficiency. Therefore, this model can be illustrated by figure below. Autonomy, relationship, and knowledge sharing appear to be important factors in terms of leading employees to whether job satisfaction (passive state) or work engagement (active state). These factors are three main potential benefits from the Smartphone lead employees to have higher job satisfaction or work engagement, so when employees are highly satisfied and/or engaged with their jobs, it leads a company to have higher work efficiency.

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“We are here in the world to change the world”, it can also be said that Smartphones, like other technology, are here in the world to also change the world, especially in the organizational area. There are many research, which have been illustrating both good and bad sides of Smartphones. However, as human beings, we are the one who have control over this technology. The Smartphone is device that can potentially help people in the business world. Corporate leaders will get benefits from their employees who use Smartphones for the purpose of work, and employees will benefit from Smartphones in terms of developing their satisfaction and engagement at work. Business leaders should use the Smartphone advantage by integrating Smartphone usage with workflow in order to increase the level of work efficiency, so leaders can develop their businesses. During this time, technology has merged with people’s lives. It is impossible to eliminate technology like Smartphones, but it is possible to control the negative usages and promote the positive usages in order for businesses to be successful. 

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Section-10

Social effects of smartphone overuse:  

As the digital age sparks increasing debate about what new technologies and increased connectivity are doing to our brains, comes this chilling examination of what our smartphones are doing to our relationships. People are increasingly functioning without face-to-face contact. For all the talk of convenience and connection derived from texting, e-mailing, and social networking, what humans still instinctively need is each other, and so they encounter dissatisfaction and alienation among themselves: teenagers whose identities are shaped not by self-exploration but by how they are perceived by the online collective, mothers who feel texting makes communicating with their children more frequent yet less substantive, Facebook users who feel shallow status updates devalue the true intimacies of friendships. What was meant to be a way to facilitate communications has pushed people closer to their machines and further away from each other. With the recent explosion of increasingly sophisticated cell-phone technology and social networking websites like Twitter and Facebook, a casual observer might understandably conclude that human relationships are blossoming like never before. But that assumption would be sadly wrong. 

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Atrophy of the social mind due to overuse of smartphone devices:

Smartphone overuse not only might cause addiction, furthers pathologies and wastes time, but even worse, it has the potential to cause damage to social functioning. Do not use your muscles for only one week and you’ll see the result. If we do not use what evolved over millions of years as biological social interaction, including reading a person’s face, observing someone’s postures and gestures, listening to the tones of speech melody, and processing further non-verbal information, then social capacity might shrink to the size of rather isolated organisms that have forgotten what it means to look into each other’s eyes. In a recent study, Riedl, Mohr, Kenning, Davis, and Heekeren (2014) observed that humans can better assess trustworthiness in human faces compared to avatars which are more and more often used as interaction partners on diverse online platforms. This underlines the need for real human interaction compared to virtual social interactions.

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About six million years ago, when some of our ancestors’ offspring started exploring the wide savannah lands, the evolution toward human species began. Today, about 240.000 generations afterwards (see Walla & Dal-Bianco, 2010), homo sapiens stands upright with significant intellectual capacity. The far sight in the savannah naturally selected individuals with upright locomotion (Darwin, 1859) and free hands allowed sophisticated tool use. However, besides numerous further anatomical adaptations, it has been to a large extent the social living style that made humans what we are today. Living in a group turned out to be advantageous compared to a lonely isolated life. One can share tasks in a group and also better defend offspring and oneself. As a consequence of a social life style, a number of emotion-related capacities, such as reading expressions in someone’s face and listening to varying affective speech melody while being actively engaged in direct communication with a conspecific, evolved. As mentioned above, we gradually might be about to lose those capacities and thus also lose the ability to comprehend and even detect emotions, our own and somebody else’s. Genuine emotion recognition depends on all those reads, while smilies and smugglies (or other emoticons) are no better than a “nice try” as alternatives to true emotions. Outlining this a bit further: if we are on WhatsApp or Facebook, we are mainly confronted with text or pictures. As a consequence, we are not training our social abilities such as reading emotions from vivid (and moving) faces or listening to the sound of the giggling of the interacting partner. We are depriving ourselves of several kinds of communication levels by this kind of media use. Our deeply subcortical brain structures processing affective information indeed respond more negatively (or less positively) to digital social interactions compared to real face-to-face interactions. Even when people believe that a smiley can be as emotional as a true smiling face, it has often been shown that explicit responses do not always match up with implicit responses that can only be accessed via objective physiological technology (e.g. Grahl, Greiner, & Walla, 2012; Koller & Walla, 2015; Walla, Koller, & Meier, 2014). Teenagers are about to lose various aspects of a natural social lifestyle due to overreliance on digital communication via smartphones.

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Overuse of mobile phones may be associated with negative outcomes on mental and physical health, in addition to having an impact on how users interact socially. Some people are replacing face-to-face conversations with cyber ones. Clinical psychologist Lisa Merlo says, “Some patients pretend to talk on the phone or fiddle with apps to avoid eye contact or other interactions at a party.” Furthermore,

70% check their phones in the morning within an hour of getting up.

56% check their phones before going to bed.

48% check their phones over the weekend.

51% constantly check their phones during vacation.

44% reported they would feel very anxious and irritable if they did not interact with their phones within a week.

This change in style from face-to-face to text-based conversation has also been observed by Sherry Turkle. Her work cites connectivity as an important trigger of social behavior change regarding communication; therefore, this adaptation of communicating is not caused only by the phone itself. In her book, Alone Together: Why We Expect More from Technology and Less from Each Other, Turkle argues that people now find themselves in a state of “continual co-presence.” This means that digital communication allows the occurrence of two or more realities in the same place and time. Subsequently, person also live in a “world of continual partial attention,” the process of paying simultaneous attention to a number of sources of incoming information, but at a superficial level. Bombarded with an abundance of emails, texts, messages, people not only find themselves divesting people of their human characteristics or individuality, but also increasingly treating them as digital units. This is often referred to as depersonalization.

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According to Elliot Berkman, a psychology professor at the University of Oregon, the constant checking of phones is caused by reward learning and the fear of missing out. Berkman explains that, “Habits are a product of reinforcement learning, one of our brain’s most ancient and reliable systems,” and people tend, thus, to develop habits of completing behaviors that have rewarded them in the past. For many, using mobile phone has been enjoyable in the past, leading to feel excited and positive when receive a notification from phones. Berkman also iterates that people often check their smartphones to relieve the social pressure they place upon themselves to never miss out on exciting things. As Berkman says, “Smartphones can be an escape from boredom because they are a window into many worlds other than the one right in front of you, helping us feel included and involved in society.” When people do not check their mobile phones, they are unable to satisfy this “check habit” or suppress the fear of missing out, leading to feel anxious and irritable. A survey conducted by Hejab M. Al Fawareh and Shaidah Jusoh also found that people also often feel incomplete without their smartphones. Of the 66 respondents, 61.41% strongly agreed or agreed with the statement, “I feel incomplete when my smartphone is not with me.”

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Critics of smartphones have especially raised concerns about effects on youth. The presence of smartphones in everyday life may affect social interactions amongst teenagers. Present evidence shows that smartphones are not only decreasing face-to-face social interactions between teenagers, but are also making the youth less likely to talk to adults. In a study produced by Doctor Lelia Green at Edith Cowan University, researchers discovered that, “the growing use of mobile technologies implies a progressive digital colonization of children’s lives, reshaping the interactions of younger adults.” Face-to-face interactions have decreased because of the increase in shared interactions via social media, mobile video sharing, and digital instant messaging. Critics believe the primary concern in this shift is that the youth are inhibiting themselves of constructive social interactions and emotional practices. Engaging in a strictly digital world may isolate individuals, causing lack of social and emotional development.

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Too much smartphone use can hurt your family relationship:

A growing body of research is highlighting the various drawbacks of overusing cell phones and other mobile devices, including—ironically—the fact that all this communication technology is actually pulling us farther apart and negatively affecting our interpersonal relationships. One increasingly-talked-about downside to constantly being attached to a cell phone is phubbing, or “phone snubbing,” a trend that is unfortunately on the rise. Phubbing is basically defined as looking at a cell phone rather than interacting with the person you are with, and research shows that it can damage your relationship with your romantic partner and may also harm your bond with your kids.

Checking smartphone once in a while is unlikely to be harmful (after all, we all need to occasionally wait for an important email from work or answer a text from a friend about something urgent or timely). But the problem occurs when you check your texts and email every few minutes or several times an hour, and all these “just gonna check my messages” moments add up to a large amount of time spent on the phone.

Before you know it or realize it, you might be using a good chunk of the time you’re supposed to be spending with your partner or children focusing on your phone instead of on your family.

And considering how busy families are today, all the time we spend on phones is a heavy price to pay. “The more precious your time is, the more you need to be vigilant about how you spend it,” says James A. Roberts, Ph.D., professor of marketing at Baylor University and the author of Too Much of a Good Thing: Are You Addicted to Your Cell Phone? His advice is: We have to set spouse-to-spouse or parent-to-child time that’s free of cell phones.

When you are with someone and he is constantly checking, scrolling, texting, or engaged with the cell phone in his hand, it can feel like you are not really fully with that person. “When you have a conversation, it sends a clear message that you are playing second fiddle,” says Dr. Roberts. Not only is this behavior rude, but it can damage the quality of that relationship.

Dr. Roberts’ study on phubbing, conducted at the Hankamer School of Business at Baylor University, in Waco, Texas, found that nearly half the adults surveyed reported being phubbed by their partner, more than a third said that they felt depression as a result of this behavior, and almost a quarter said that it caused conflict in their relationships.

“Relationships are the cornerstone of our happiness,” says Dr. Roberts. “Phubbing makes us feel bad, but even worse, it leads to unhappiness and depression.” There’s even an evolutionary explanation for why we feel so uncomfortable when we’re with someone who’s not fully there with us in that moment.

“It’s a violation of social conditioning,” says David Greenfield, Ph.D., founder of The Center for Internet and Technology Addiction and an assistant clinical professor of psychiatry at the University of Connecticut School of Medicine, in Farmington, Connecticut, “It’s an uncomfortable feeling when behavior is not predictable. When someone is in a room with us and is on the phone, we feel like we are in an unsafe situation on a primitive level.”

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A new study by Chinese smartphone company Vivo has found that 88 per cent of married couples in India feel overuse of mobiles has hurt their relationships. About 90 per cent individuals also said that time spent on smartphones was their “most preferred way” to relax. The study also noted that wives and husbands spend close to 4.7 hours on average every day on their smartphones. Users also admitted that excessive use of smartphones was reducing the quality time they spent with their loved ones. Only 55 per cent of surveyed couples felt they were spending quality time with family and friends without getting distracted by their phones. About 67 per cent “confessed” to being on the phone “when spending time with their spouses”, the study said.

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Socially Connected but Still Isolated: Smartphone Addiction Decreases Social Support Over Time, a 2017 study:

Recent literature has suggested that smartphone addiction is negatively associated with users’ psychosocial well-being. Much of the research on this subject, however, is of a correlational nature, which has been pointed out as an important limitation that does not allow distinguishing the antecedents of the consequences. In this study, 416 smartphone users were followed for 1 year (three waves separated by 6 months each) to assess the relationship between smartphone addiction and social support. Cross-lagged model results indicated that social support predicts later addiction to the smartphone and that smartphone addiction decreases social support over time. Growth mixture model results indicated that the decrease in social support during the follow-up year was higher for users with greater smartphone addiction at the beginning of the study. Multivariate and univariate analyses of variance indicated that some personal characteristics of users (extroversion, neuroticism, and sensation-seeking) could affect the evolution of social support related to smartphone addiction. In general, these results suggest that the extensive use of a social communication technology such as the smartphone could have the paradoxical effect of diminishing the psychosocial well-being of its users.

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In the present study, authors analyze the relationship between the excessive use of the smartphone, a social technology that allows social connectivity in real time, and the potential negative implications it has on the social world of the user. To that end, authors followed-up during a year to 416 smartphone users and they studied the relationship between their smartphone addiction and social support over time as well as its association with the psychological distress of users.

The study of the addiction to the smartphone has increased substantially in the last years and has led to substantial knowledge of some of its antecedents and associated consequences. Despite this, it is worth noting that much of this scientific evidence comes primarily from correlational studies. Although such studies are ideal for tentatively contrasting relevant work hypotheses, they are not intended to analyze in depth the directionality of these hypotheses. From this point of view, this study allows authors to identify some influences that also take into account the time dimension.

First, the results of the study make it possible to clarify the relationship between smartphone addiction and social support: Both are negatively affected over time. The greater the addiction, the less social support in the future, which in turn is associated with an increase in addiction again.

Second, those participants who experienced a decline in social support over time due probably to their addiction to the smartphone present a clear personality profile: They are more extroverted, score higher on neuroticism, and are more sensation seekers. Thus, they are more engaged with the external world and enjoy interacting with people (extroversion). Also, they present higher emotional instability and present problems to think clearly, make decisions, and cope effectively with stress (neuroticism). For these participants, there is a stronger drive for sensation seeking that lead them to pursue higher levels of stimulation in order to avoid perceiving the situations as unpleasant (sensation seekers). According to data here, this type of participant has greater chances of showing smartphone addiction and, probably as a consequence, a decline in social support over time.

Third, this decline in social support over time seems to be associated with increased smartphone addiction at the end of the 1-year period analyzed in this study as well as higher levels of psychological distress.

Finally, a significant presence of response biases (i.e., social desirability) was not observed, which allows us to expect a greater generalizability of study results.

Overall, the present study has provided empirical evidence on the paradoxical potential effects of the smartphone on the psychosocial well-being of the person. For some study participants, excessive use of a social communication tool—the smartphone—led to addiction which ultimately negatively affected how socially connected they felt with people important to them. According to results, a decrease in social support should be expected—feeling less connected with the important people in their lives—along with an increase in both smartphone addiction and psychological distress. And, it does not seem to be a process that characterizes specific social groups based on their sex, age, or educational level. It is a general process that could affect the entire population equally. Hence, it is of great relevance.

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Counterview:

Smartphones reduce the negative psychological and physiological consequences of social exclusion:

Humans are an interpersonal species with an innate desire to belong and be accepted by their peers, and when excluded by others, negative psychological, physiological, and health consequences often follow. The acute stress induced by social exclusion can result in downstream health implications. Previous evidence shows that individuals often retreat to the comfort of their smartphones when faced with socially stressful or awkward encounters, and this may inadvertently be done in an effort to reduce stress. In light of the empirical evidence illuminating a wide variety of effective stress buffers, it is plausible that smartphones may also be used to protect against the harmful effects of social exclusion. When an individual engages with a mobile phone, they sometimes drift into a state of “absent presence” where the physical body is present in the here and now, but cognitive awareness is somewhere else. This phenomenon may be quite subtle; simply having a smartphone present has been shown to interfere with the dynamics of a social interaction because of its symbolic representation as a communication tool. Phones serve as symbol of a person’s larger social network and can create a micro-fragmented context in which an individual’s consciousness is split between external social connections and in-person interactions. This temporary escape has usually been considered a negative by-product of technology use, but that same diverted focus might be beneficial in other contexts such as social exclusion. Specifically, shifting attention away from negative environmental stressors and toward symbolic connections offered by phones may mitigate the negativity stemming from social stress and provide a source of felt security. In these instances, a smartphone may symbolically operate as a “digital security blanket” that reduces the stress of exclusion. These effects may be analogous to how a young child uses a security blanket to improve resilience in intimidating environments. Alternatively, a smartphone may enable avoidance coping by distracting an individual from the exclusion experience and offering alternative activities, which may provide potent short-term benefits. Smartphone use in these circumstances may operate as a negative reinforcer and ameliorate the negative feelings of exclusion. This behavior may partially explain why phone use is so pervasive in social situations and why people seem to be so often engaged in the virtual world at their fingertips.

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No other recent technological breakthrough has transformed the nature of social interactions as profoundly as the smartphone. Smartphones are undoubtedly altering many psychosocial processes, but researchers are only beginning to examine them and disentangle their positive and/or negative impacts on well-being. Most research has concentrated on the negative ramifications of technological engagement such as poorer psychological and physical health and worse health behaviors. However, it is imperative that we consider the potentially positive impact of these devices on our lives. For example, phones can augment and maintain social capital and aid in healthcare. Authors hypothesize that a smartphones’ ability to symbolically tie a person to others and/or allow actual connection with others outside of the immediate surrounding may have at least one specific benefit: reducing the negative psychological and physiological consequences of social exclusion.

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The Use of Smartphones as a Digital Security Blanket: The Influence of Phone Use and Availability on Psychological and Physiological Responses to Social Exclusion, a 2018 study:

Objective:

Mobile phones are increasingly becoming a part of the social environment, and when individuals feels excluded during a socially stressful situation, they often retreat to the comfort of their phone to ameliorate the negativity. This study tests whether smartphone presence does, in fact, alter psychological and physiological responses to social stress.

Methods:

Participants (N = 148, 84% female, mean age = 20.4) were subjected to a peer, social-exclusion stressor. Before exclusion, participants were randomized to one of the following three conditions: (1) phone-present with use encouraged, (2) phone-present with use restricted, or (3) no phone access. Saliva samples and self-report data were collected throughout the study to assess salivary alpha amylase (sAA), cortisol, and feelings of exclusion.

Results:

Participants in both phone-present conditions reported lower feelings of exclusion compared with individuals who had no access to their phone (F(2,143) = 5.49, p = .005). Multilevel modeling of sAA responses revealed that the individuals in the restricted-phone condition had a significantly different quadratic trajectory after the stressor compared with the phone use (ϒ = −0.12, z = −2.15, p = .032), and no-phone conditions (ϒ = −0.14, z = −2.64, p = .008). Specifically, those in the restricted-phone condition showed a decrease in sAA after exclusion, those in the no-phone condition showed a gradual increase, and phone users exhibited little change. Cortisol responses to the stressor did not vary by condition.

Conclusions:

Taken together, these results suggest that the mere presence of a phone (and not necessarily phone use) can buffer against the negative experience and effects of social exclusion. In a nutshell, the results show that the presence of a smartphone can alter negative psychological and physiological responses associated with social exclusion. Phones are increasingly becoming integrated into our lives, and as the philosopher Marshall McLuhan once foreshadowed, we may be moving toward an age where technological devices serve as “extensions of our central nervous system,” pervading all aspects of our lives and surreptitiously influencing the functions of our physical and psychological being. Further research must be conducted to unpack the intricacies of these relationships, but this study demonstrates one way in which smartphones are beneficial through their ability to act as digital security blankets and stress buffers.

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Section-11

Smartphone overuse and physical health:   

Specific issues:

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-1. Smartphones may serve as vectors for health care transmission of microorganisms:

The mobile phone use is highly prevalent among medical staff playing a significant role in day-today life and contributes positively to their ability to communicate concerning hospital affairs. However; this referred only to technical aspects and gives no consideration of their possible role in transmission of infections. Whereas strict attention is paid to changing clothes, removing jewellery, covering hair, undertaking hand hygiene measures, storing personal objects in changing rooms to reduce the transfer of microorganisms from the external clinical environment into the operating environment, most expensive mobile phones often accompany staff into the operating environment as no local policy restricting the use of mobile phones in clinically sensitive areas was in place. This lack of attention may be referred to little awareness about potential risks posed by mobile phones microbial contamination and their role as vehicle for transmission of infections.

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Brady et al. showed that 89.7% of mobile phones were contaminated by bacteria. Ulger et al. stated that 94.5% of phones showed evidence of bacterial contamination and the isolated microorganisms were similar to hand isolates. They found that 49% of phones grew one bacterial species, 34% grew two different species and 11.5% grew three or more different species and no bacterial growth was found in 5.5% of phones. S. aureus strains isolated from mobile phones and from hands were 52.0% and 37.7% meticillin resistant respectively. While gram-negative strains isolated from mobile phones and from the hands were 31.3% and 39.5% ceftazidime resistant respectively. Jeske et al. found that the rate of bacterial contamination of HCWs’ hands was 95% while that of mobile phone was 90%. Tambekar et al. stated that 95% of mobile phone showed bacterial contamination and among S. aureus isolates 83% were meticillin resistant. Snigh et al. reported that out of 50 mobile phones that were cultured, 98% were positive. On the same context, Goldblattfound that, one fifth of the cellular phones used by HCWs harboured pathogenic microorganisms and may serve as vectors for health care transmission of microorganisms.

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Mobile phones and nosocomial infections, a 2012 study:

The use of mobile phones inside hospitals especially in clinically sensitive areas is a subject of controversy because it may improve the quality of healthcare but also can transmit health care associated infections. To determine the potential role of mobile phones in harboring microorganisms and to evaluate their role in transmission of microorganisms from the mobile phone to the hand of health care personnel, 32 staff members (12, 8 and 12 were neurosurgeons, anesthetists and nurses respectively) were enrolled in this study. A questionnaire was submitted to all participants to collect information on the extent of usage of mobile phones, the location of use, the use of headsets, the awareness of disinfection practices of mobile phones and the frequency of hand washing after using their phones. They were asked to disinfect their hands using an alcohol based hand rub and fingers of both hands were cultured. Then, they were asked to do a short phone call from their personal mobile phones. Sampling was repeated from the hand used to make the call and from each participant’s mobile phone. Following the hand rub, no growth was detected. After the use of a mobile phones, the rate of bacterial contamination on the hands increased to 30 ⁄ 32 (93.7%) same as that found from the mobile phones (93.7%). The use of mobile phones in clinically sensitive areas should be weighed against the risk for contamination and transmission of infections.

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Smartphone hygiene:

Smartphone hygiene has become a significant issue since 2020 when the pandemic started and sanitation took the spotlight. It has recently been found out that your smartphone can be dirtier than a public toilet seat. Yes, you read right. Since your smartphone touches thousands of surfaces daily, it is a hub of all bacterial misdemeanours.

How to clean your smartphone? The answer is pretty simple.

The first and most common way to clean smartphone is to use disinfecting wipes. Next, people have been found using isopropyl or ethyl alcohol to clean the surface of their smartphones. 70% isopropyl alcohol and 75% ethyl alcohol should be used. The diluted solutions should be sprayed on the cloth first and then the screen should be wiped. The last and perhaps the most expensive solution on our list is to get a UV smartphone cleaner. Yes, it does cost a little extra but it is a really good investment. UV smartphone cleaners use 360-degree UV-C bulbs to kill all bacteria and viruses (99.9%). The portable sanitizer also acts as a charging port.

Now that you know all the ways you can clean your phone, here are a few things you should be careful of.

(1. Never use cleaning sprays to clean smartphone. These include bleach, hydrogen peroxide, and similar cleaning solutions.

(2. Never use compressed air to blow out your smartphone.

(3. Never leave cables plugged into your smartphone when cleaning it.

(4. Do not submerge your smartphone in any cleaning solution. 

(5. Keep the openings of your smartphone clear of any sprays and cleaning solutions.

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-2. Smartphone overuse and improper nutrition/physical inactivity:

Smartphone Addiction/ Overuse and Its Effect on Dietary Behavior and Lifestyle -A Systematic Review 2020 was conducted in accordance with the principles of systematic review. Four databases were searched and found total 62 studies, and only 12 relevant observational, open access studies were extracted that included participants with smartphone addiction/overuse, and its effect on dietary behaviors, the sleep habits and physical activity or exercise pattern.  All the studies stated negative correlation between smartphone addiction/overuse and dietary behavior, sleep pattern and physical activity. Investigations of all the included studies stated that, due to excessive use of smartphones, students had poor eating behavior, and were more likely to develop nutritional deficiencies and might suffer from health consequences and psychopathologies. Students who had smartphone addiction adopted a sedentary lifestyle, and were more prone to suffer from physical fitness and might develop non-communicable diseases like CVD and obesity in future.

Another study done in 2020 by kyoung Min et al. has revealed the association between smartphone usage time and consumption of specific foods in adolescents. Higher consumption rates of healthier foods, such as, fruits, vegetables and milk were shown in reduced smartphone users, whereas, elevated rates of consuming unhealthy foods including, fizzy drinks, sugary beverages, junk food, noodles, & snacks, were found among adolescents who use their mobile phones excessively.

Another factor touched by the smartphone use is the physical activity of the youth. Due to the use of smartphones, the risk of reduced physical strength has increased because of reduced physical activity leading to increased risk of non-communicable diseases, particularly CVD and metabolic diseases. The findings of the studies conducted by Andrew Lepp 2013 and a similar study done in 2015 by Sung-Eun Kim et al. respectively revealed that quality of physical activity, including a little walk, decreases in high-risk and dangerous-risk smartphone users.

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-3. Smartphone overuse and early puberty: 

A new study has made certain interesting revelations about smartphone usage and its links towards health of children. The results of a rat study, which were presented at the 60th Annual European Society for Paediatric Endocrinology Meeting, suggest that regular exposure to blue light from tablets and smartphones may affect hormone levels and raise the risk of premature puberty. The research states that longer period of exposure to blue light was linked to the early onset of puberty in female rats, who also displayed decreased melatonin levels, elevated levels of several reproductive hormones, and physical alterations to their ovaries. This is important as the use of mobile devices that emit blue light has already been related to children’s sleep patterns being disturbed, but current results imply that there may be additional dangers for fetal development and future fertility.

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It is worth noting that the increasing usage of devices that generate blue light, such as tablets and smartphones, has been linked to poorer sleep quality in children and adults. Blue light slows the rise in melatonin levels that occurs in the evenings to prepare our bodies for sleep and rest, which is thought to interfere with our body clock. Pre-puberty has generally higher melatonin levels than puberty, which may contribute to the postponement of the onset of puberty and the intricate process of puberty necessitates the coordination of numerous bodily functions and hormones.

Notably, several studies in recent years have reported an increase in the beginning of early puberty in girls, particularly during the Covid-19 epidemic and the increased screen time, as that experienced during the pandemic restrictions, may be contributing to this reported rise, as the relationship between blue light exposure and reduced melatonin levels suggests.

However, evaluating this in kids is quite challenging and researchers from Ankara, Turkey, Dr Aylin Kilinc Uurlu and colleagues, used a rat model to examine the effects of blue light exposure on levels of reproductive hormones and the timing of puberty development. Three groups of six female rats each received either a normal light cycle, six hours of blue light, or twelve hours of blue light. Both groups were exposed to blue light, and both groups’ first signs of puberty started noticeably earlier. The longer the duration of exposure, the earlier the beginning of puberty. In addition, rats exposed to blue light saw morphological changes in their ovarian tissue, decreased melatonin levels, and higher levels of two particular reproductive hormones (oestradiol and luteinizing hormone). These alterations are all consistent with the start of puberty. Rats exposed for 12 hours also exhibited some evidence of ovarian inflammation and cell damage. We have discovered that blue light exposure, which is sufficient to change melatonin levels, is also capable of changing reproductive hormone levels and causing earlier puberty onset in our rat model, said Dr Aylin Kilinc Uurlu. Additionally, the sooner they start, the longer the exposure.

Despite the fact that Dr Aylin Kilinc Uurlu warned, “since this was a rat study, we cannot be certain that these findings would be duplicated in children,” the data point to blue light exposure as a potential risk factor for earlier puberty onset. Although it is challenging to simulate in rats the same levels of blue light exposure as a child using a tablet, the age at which rats reach puberty is fairly comparable to that of humans when taking into account the shorter lifespan of rats. Female rats go through similar hormonal and ovulation changes as humans during pre-puberty and puberty. Therefore, despite the study’s limitations, these findings are in favour of future research into the potential effects of blue light exposure on hormone levels and the start of puberty in young people.

Despite the lack of proof, Dr Aylin Kilinc Uurlu added, “we would advise limiting the usage of blue light emitting devices in pre-pubertal children, especially at night when exposure may have the most hormone-altering effects.”

Over the past decade or so, as covered by Jessa Gamble for Nature, researchers have been noting how girls on average have been entering puberty at earlier and earlier ages. There have been reports of girls developing breasts as early as six years of age. The concern is this may be the result of the increasing amount of artificial bleep around us such as more and more chemicals in the environment, more and more things being added to food, and more and more blue light.

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-4. Smartphone overuse and skin damage: 

How smartphone overuse harms skin is narrated as follows:

(1. Premature ageing:

Research suggests excessive blue light can accelerate the oxidation process, causing hyperpigmentation. Experts say the oxidative effects evoke inflammation and ruin the skin barrier, making it more prone to pigmentation, increased uneven skin tone, signs of ageing, fine lines and wrinkles.

(2. Acne

Your smartphone is quite probably one of the dirtiest things you come in contact with everyday, containing as much bacteria as your toilet seat. Your mobile phone, which is in your hands all day, gets exposed to germs and bacteria. This can lead to accumulating of dirt on your skin, ultimately resulting in breakouts.

(3. Dermatitis

Common materials, such as nickel and chromium, used to create phone casings have been shown to cause dermatitis, also known as eczema. Dermatitis can be caused by a number of health conditions, including allergies, genetic factors and irritants. You can try opting for a phone case that can give better protection from radiation emitted by the phone.

(4. Tech neck

‘Tech neck’, a general term for neck pain caused by technology use, can cause wrinkles around the neck and under the chin. The fact is that gazing downward to look at your phone constantly can cause the skin on your neck to prematurely age.

(5. Dull skin

Smartphone overuse disrupt your body’s natural sleep cycle. A good sleep is important for overall health, including your skin health. Besides other health issues, not getting enough sleep can lead to poor water balance, which may result in under eye circles, dulling of the skin, as well as more visible wrinkles.

(6. Radiation effect

Some studies reported an increase in temperature, hypersensitivity of warmth, facial dermatitis, angiosarcoma of the scalp, and burning sensations in the facial skin after mobile phone use on the exposed side and more within the auricle and behind/around the ear. 

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Section-11A

Smartphone overuse and radiation hazards:

Cellular (cell or mobile) phones first became widely available in the United States in the 1990s. Since then, along with the large and still growing number of cell phone users (both adults and children), the amount of time people spend on their phones has also risen sharply. A smartphone is a cellular telephone with an integrated computer and other features not originally associated with telephones such as an operating system, web browsing, and the ability to run software applications.  Cell phones give off a form of energy known as radiofrequency (RF) waves, so the safety of cell phone use has raised some concerns. The main concerns have focused on whether cell phones might increase the risk of brain tumors or other tumors in the head and neck area, as these areas are closest to where the phone is usually held while talking or listening on a call.

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Cell phones send signals to (and receive them from) nearby cell towers (base stations) using RF (radiofrequency) waves. This is a form of energy in the electromagnetic spectrum that falls between FM radio waves and microwaves. Like FM radio waves, microwaves, visible light, and heat, RF waves are a form of non-ionizing radiation. They don’t have enough energy to cause cancer by directly damaging the DNA (genes) inside cells. RF waves are different from stronger (ionizing) types of radiation such as x-rays, gamma rays, and ultraviolet (UV) rays. Ionizing radiation can break the chemical bonds in DNA, which might lead to cancer.

The electromagnetic spectrum illustration below shows the possible frequencies of electromagnetic energy, ranging from extremely low frequencies (such as those from power lines) to exposures from extremely high frequencies (x-rays and gamma rays), and includes both non-ionizing and ionizing radiation.

At very high levels, RF waves can heat up body tissues. But the levels of energy given off by cell phones are much lower, and are not enough to raise temperatures in the body.

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With the appearance of technology therefore increasing mobile phone use it has been a topic of great interest among researchers to find out how mobile phones have an effect on human anatomy and human brains but there haven’t been several studies regarding the same. A study done by Ju Hwan Kim et al titled as “Possible effect of radiofrequency magnetic field exposure on central nervous system” has found that Radiofrequency-EMF can induce changes in central nervous system nerve cells, together with neural cell apoptosis, changes within the function of the nerve myelin and ion channels; moreover, RF-EMF act as a stress source in living creatures. although these are animal-based studies and there is inadequate information on biological hazards to provide to produce answer to potential health risks.

Figure above shows possible effects of Electromagnetic field on the Central nervous system.

Several studies done by different researchers have shown some positive or negative impact of smartphone or its radiation on human system.

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The RF waves come from the cell phone’s antenna, which is part of the body of a hand-held phone. The waves are strongest at the antenna and lose energy quickly as they travel away from the phone. The phone is often held against the head when a person is on a call. The closer the antenna is to a user’s head, the greater their expected exposure to RF waves. The body tissues closest to the phone absorb more energy from RF waves than tissues farther away.

Many factors can affect the amount of energy from RF waves that a person is exposed to, including:

• The amount of time the person is on the phone.
• Whether the person is holding the phone close to the head, or is instead using the speaker mode or a hands-free device. The farther away from a person’s body the phone is, the less they are exposed.
• The distance and path to the nearest cell phone tower. Cell phones adjust their power to use the minimum amount for a good signal. Being farther away from the tower requires more energy to get a good signal, as does being inside a building.
• The amount of cell phone traffic in the area at the time. Higher traffic (from many people using cell phones) may require more energy to get a good signal.
• The model of phone being used. Different phones give off different amounts of energy.

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Cell phone specific absorption rate (SAR):

The specific absorption rate (SAR) is the amount of RF energy from the phone absorbed by the user’s body. Different cell phones have different SAR levels. Cell phone makers are required to report the maximum SAR level of their product to the US Federal Communications Commission (FCC). This information can often be found on the manufacturer’s website or in the user manual for the phone. The upper limit of SAR allowed in the United States according to FCC safety guidelines is 1.6 watts per kilogram (W/kg) of body weight. But according to the FCC, comparing SAR values between phones can be misleading. The listed SAR value is based only on the phone operating at its highest power, not on what users would typically be exposed to with normal phone use. The actual SAR during use varies based on a number of factors, so it’s possible that a phone with a lower listed SAR value might sometimes expose a person to more energy from RF waves than one with a higher listed SAR value.

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Short-term effects:

Tissue heating is the principal mechanism of interaction between radiofrequency energy and the human body. At the frequencies used by mobile phones, most of the energy is absorbed by the skin and other superficial tissues, resulting in negligible temperature rise in the brain or any other organs of the body. A number of studies have investigated the effects of radiofrequency fields on brain electrical activity, cognitive function, sleep, heart rate and blood pressure in volunteers. To date, research does not suggest any consistent evidence of adverse health effects from exposure to radiofrequency fields at levels below those that cause tissue heating. Further, research has not been able to provide support for a causal relationship between exposure to electromagnetic fields and self-reported symptoms, or “electromagnetic hypersensitivity”.

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Long-term effects:

Epidemiological research examining potential long-term risks from radiofrequency exposure has mostly looked for an association between brain tumours and mobile phone use. Because cell phones usually are held near the head when a person is on a call, the main concern has been whether the phones might cause or contribute to tumors in this area, including:

• Malignant (cancerous) brain tumors, such as gliomas
• Non-cancerous tumors of the brain, such as meningiomas
• Non-cancerous tumors of the nerve connecting the brain to the ear (vestibular schwannomas, also known as acoustic neuromas)
• Tumors of the salivary glands

Many studies have been done to look at this issue. A few studies have also looked at possible links to other types of cancer. Based on a review of studies published up until 2011, the International Agency for Research on Cancer (IARC) has classified RF radiation as “possibly carcinogenic to humans,” based on limited evidence of a possible increase in risk for brain tumors among cell phone users, and inadequate evidence for other types of cancer.

More recently, the US Food and Drug Administration (FDA) issued a technical report based on studies published between 2008 and 2018, as well as national trends in cancer rates. The report concluded: “Based on the studies that are described in detail in this report, there is insufficient evidence to support a causal association between radiofrequency radiation (RFR) exposure and tumor formation.”

So far, the National Toxicology Program (NTP) has not included RF radiation in its Report on Carcinogens, which lists exposures that are known to be or reasonably anticipated to be human carcinogens.

According to the US Federal Communications Commission (FCC):

“Currently no scientific evidence establishes a causal link between wireless device use and cancer or other illnesses. Those evaluating the potential risks of using wireless devices agree that more and longer-term studies should explore whether there is a better basis for RF safety standards than is currently used.”

Overall, the evidence suggests that the radiofrequency (RF) electromagnetic energy (EME) emissions of mobile phone handsets are not harmful to the user.

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If you would like to reduce your exposure, here are some tips for doing so. You can reduce your exposure to radiation from your mobile phone in three simple ways:

-1. Distance:

The most effective way to reduce the exposure is to increase the distance between your mobile phone and your head or body. You can do this by:

• using a wired ear-piece/microphone hands-free accessory
• using the phone on speaker mode
• texting rather than talking
• keeping the phone a distance from the body, as recommended in your phone’s user manual
• even placing your thumb between the phone and your ear.

-2. Time:

You can reduce your exposure time by keeping voice calls short, especially when you are not using hands-free.

-3. Power:

Usually a phone in an area with good reception will transmit at much lower levels than in an area with poor reception like a lift or deep within a large building. You can limit the amount of power your phone uses by:

• using your phone in good signal areas where possible (shown by lots of bars on the reception indicator)
• avoiding using your phone in poor signal areas such as lifts and moving vehicles. (Note: There are laws in place restricting the use of mobile phones while you are driving a motor vehicle.)

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Section-11B

Smartphone overuse and musculoskeletal pain:  

Technological advances, particularly, the invention of smartphones, have revolutionized our way of life. A smartphone operates analogously to computers with an operating system and numerous software applications. It is not only used for communication but also entertainment purposes, such as messages, music, media, internet access, photos, and games.

Musculoskeletal disorder is defined as damage to the musculoskeletal structures as a result of repetitive motions, forces, and postures adopted during the execution of certain activities. Smartphone forces an individual to look at their phone’s small monitor and perform repetitive movements in an awkward posture for a prolonged duration, which can cause musculoskeletal disorders. I have already discussed overview of musculoskeletal disorders in section 2.

A recently published study showed that cell phones that promoted only thumb or only one finger usage during texting were associated with a high prevalence of musculoskeletal disorders. Another study reported an 18.5% prevalence of musculoskeletal disorders in the upper extremity associated with smartphone usage with the most significant symptom found in the thumb. Another study conducted in a Canadian university population revealed that 84% of participants reported pain in at least one part of the body with the thumb being the most common site.

Smartphone users vary in age, ranging from students to elderly people. However, students use smartphones for longer periods due to easy availability, low cost, portability, and multiple usabilities, combined with easy internet access. The combination of repetitive movements and poor posture can lead to musculoskeletal disorders, which, if ignored, may lead to long-term damage.

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A woman in China recently found she couldn’t move her fingers after a week-long “cellphone binge”.

According to this report, the incident took place in China’s Hunan province. The unnamed woman from the city of Changsha had to rush to hospital before she regained normal movement in her hand. Incessant use of the phone left her fingers stuck in the smartphone-holding position, unable to bend. Doctors at the hospital told her that she was suffering from tenosynovitis caused by repetitive movements.

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Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: A systematic review of 2017:

Highlights:

• The prevalence of musculoskeletal complaints reported by mobile device users ranges from 1.0% to 67.8%.
• Neck complaints have the highest prevalence rates ranging from 17.3% to 67.8% among mobile device users.
• There is some evidence that a neck flexion posture, as well as frequency of phone calls, texting and gaming are associated with musculoskeletal complaints reported by mobile device users.

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Musculoskeletal disorders following excessive smartphone usage – a review article of 2020:

Smartphone usage is growing exponentially in recent times. Smartphone usage requires users to be in awkward postures for long periods of time which increases the chances of musculoskeletal disorders. In this review article, authors have tried to assess the musculoskeletal disorders occurring due to excessive smartphone usage. The results show increased muscle activity of the upper trapezius and the neck muscles along with an increase in the head tilting and head flexion. Frequent smartphone usage also leads to fatigue and pain in the hand. So in conclusion, it can be said that increased smartphone usage leads to pain and musculoskeletal disorders.

The findings of the studies on smartphone usage can be divided into the following categories:

Head and neck movement:

Lee et al. in their study mentioned that the cervical flexion angle was more while texting as compared to other activities. Also, this angle increases while sitting as compared to standing. Another study observed that the neck flexion angle was more in cases with neck pain. While another study observed that the head tilt and the neck flexion angle was more in user using a smartphone as compared to those not using the phone. Jung et al. in his study observed that with the increase in the smartphone usage the scapular index and the craniovertebral angle also increased as compared to the infrequent smartphone users.

Pain:

Measurement of pain was done by the VAS (Visual Analogue Scale) scoring in 5 studies. Shin & Kim realized in their study that the VAS score increased while using the smartphone on the desk and increased further when used on the lap. Inalet al. in their study concluded that the pain was comparable in infrequent users and non-users, but increased in frequent users. Two studies concluded that the pain threshold of the upper trapezial muscles also decreased in frequent users. Lee et al. in their study found that the pain was more in users with single hand usage as compared to 2 hand usage. In users who frequently texted it was seen that the texting hand had more pain as compared to the other hand.

Exertion and discomfort:

Discomfort and exertion were analyzed in 2 studies. The first study compared the use of large buttons and small buttons. The smaller buttons increased the exertion on the first digital interosseous but decreased the exertion on the abductor pollicis longus and brevis, the other study mentioned that the discomfort and exertion were more after texting especially in the symptomatic patients.

Thumb – finger – hand performance:

4 studies assessed TFH performance. Xiong et al. in their study indicated the use of small buttons led to shorter fatigue times. The speed of usage was slower in flexion/extension as compared to the adduction/abduction of the thumb. Inalet al. in their study found a weak negative correlation between the pinch strength and the smartphone addition score and the Duruoz hand index score. Eapenet al. in their study found a significant reduction in the tip and lateral pinch grip strength of the patient with thumb pain while texting.

EMG:

Four studies assessed the Electromyography for muscle activity while using smartphones. Xiong et al. in their study found that using small buttons led to increased activity of First Dorsal Interossei and decreased activity of Abductor Pollicis Brevis muscle. Kim et al. found that the median frequencies decreased in the brachioradialis muscle after smartphone usage. Lee et al. found that the Upper trapezial, Extensor Pollicis Longus, and Abductor Pollicis were being used more in single-hand typing as compared to 2 hand typing. Xieet al. found that smartphone usage with a single hand led to more muscle activity in the forearm. Also, it was seen that in patients with neck pain there was increased muscle activity in the neck and shoulder due to increased muscle spasm.

Tendon – nerve diameter:

Three studies evaluated the tendon and nerve thickness in symptomatic and asymptomatic patients. Eapenet al. found fluid in the tendons of thumb at wrist level in 19% and at thumb level in 2% of symptomatic patients. 2 studies showed that frequent smartphone users had significantly larger Flexor PollicisLongus tendons and median nerves.

Conclusion and recommendations:

(a. Use of both hands while using smartphones

(b. Hold the phone at the high level

(c. Control the neck flexion angle

(d. Reduction of frequency of usage

(e. Take a break in between long usage

(f. During the break not only move the hand and wrist but the cervical spine and the shoulder

(g. Usage of phones with bigger buttons

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Optimal neck posture while on smartphone:

Head tilting and neck flexion increases when smartphones are used and is further aggravated with increase in the duration of smartphone usage. It has also been observed that users with cervical pain use smartphones with a more flexed position of the neck which further worsens the neck posture and increases the symptoms, forming a vicious cycle. This can be explained by the alteration in the motor control of the neck due to excessive smartphone usage leading to greater neck flexion. The neck flexion changes with the way of holding the smartphone and the task at hand. Sitting posture causes a greater neck flexion angle as compared to standing. This is because while standing if the head-neck angle exceeds a certain value then it causes postural instability which does not allow the flexion of the neck to exceed a certain limit; this does not occur in sitting posture.

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A recent study demonstrated that smartphone users with and without neck pain should try to keep their neck flexion angle between 0° and 15° when using their smartphone. This reduces neck muscle activity and the risk of developing neck disorders associated with smartphone use. 0-15 degrees of neck flexion is akin to having your head squarely over your shoulders or just slightly forward.

Figure below shows that effective weight on the spine increases as head tilts forward: 

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Effect of neck flexion angles on neck muscle activity among smartphone users with and without neck pain, a 2019 study:

This study examined the differences in neck muscle activity at various neck flexion angles in smartphone users with and without neck pain. Forty-four participants performed texting tasks for 1 min and 30 s. Neck muscle activity and pain in the neck were measured at different neck flexion angles. There was a difference in neck muscle activity for each of the neck flexion angles; the Cervical Erector Spinae (CES) muscle activity increased while the Upper Trapezius (UT) muscle activity decreased when at increased neck flexion angles. At neck flexion angle of 0°-15°, the activity of both CES and UT muscles were acceptably low. Smartphone users with neck pain had slightly higher muscle activity levels than smartphone users without neck pain. In conclusion, smartphone users should consider adopting neck flexion angles between 0 and 15 degrees during smartphone use as there is an association between this neck flexion angle range and reduced CES muscle activity.

Conclusion: This study demonstrated that both smartphone users with and without neck pain should try to keep their neck flexion angle between 0° and 15° when using their smartphone. This would reduce neck muscle activity and the risk of developing neck disorders associated with smartphone use.

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Neck pain associated with smartphone overuse: cross-sectional report of a cohort study among office workers, a 2020 study:

The prevalence of neck pain among the office workers was 30.1%. Significantly more female (33.3% vs. 24.5%) and younger (42.2 vs. 43.2 years) employees reported to have neck pain. Overall in 326 (20.3%, 95% CI: 18.4%–22.4%) of studied subjects had, SAS score ≥ 31 and ≥ 33 for male and females, respectively, and so smartphone overuse (SO) was diagnosed. The results of multiple logistic regression model revealed that those with SO were approximately 6 times more likely to have neck pain (95% CI: 4.44–8.09, P < 0.001).

Conclusions:

Smartphone overuse in office workers significantly increases the chance of neck pain by 6 times. Hence SO has been associated with, not only somatic complaints, but also psychological distress such as anxiety, stress, and depression. This may necessitate adherence to neck-school, when smartphone use is associated with neck pain.

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Can smartphone cause carpal tunnel syndrome (CTS)?

Association between smartphone use and carpal tunnel syndrome: A case-control study of 2021 found that 4 hours or more per day of smartphone use was associated with CTS. Moreover, those who held the smartphone with both hands had 7.8 times higher odds of developing CTS than those who held it with one hand. People who spend lots of time on their smartphones may be scrolling, tapping and swiping their way to carpal tunnel syndrome, a painful wrist and hand disorder. The carpal tunnel is a narrow and hard pathway of bone and ligament found at the base of the hand. It contains tendons, which enable finger-bending, as well as the so-called “median nerve,” which runs from the forearm to the palm and provides feeling to some fingers. Carpal tunnel syndrome can gradually develop following repeated pressure to the point where the median nerve passes into the hand and meets the wrist. A common cause is work conditions that call for “repetitive, forceful or awkward hand movements, for example, when typing.” And the result is often pain (sometimes extending up the arm), numbness, finger tingling and weakened grip strength.  The most common reason for carpal tunnel syndrome is idiopathic — it just happens and we cannot point to a specific cause. Carpal tunnel syndrome is associated with other diagnoses such as diabetes or hypothyroidism, but there is limited evidence that any specific physical activity actually causes carpal tunnel syndrome. That being said, certain physical activities may exacerbate symptoms of carpal tunnel syndrome — and one such activity is holding a cell phone to your ear. Many patients will note the onset of symptoms of carpal tunnel syndrome (numbness/tingling in the hand) as they are talking on their cell phone. Smartphones can cause wrist pain if the wrist is held in an awkward position for a long time. If you’re going to hold your cell phone for a prolonged period of time, try to keep your wrist in a neutral position — wrist neither flexed nor extended.

How is cubital tunnel syndrome different from carpal tunnel syndrome?

In cubital tunnel syndrome the ulnar nerve gets pinched back behind the elbow and gives you tingling & numbness in the small and ring finger, whereas carpal tunnel syndrome gives you tingling & numbness in the thumb, middle and index finger due to pressure on median nerve. They are similar because it is pressure on the nerve, but there is difference in the anatomy.   

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Section-11C

Smartphone overuse and eyes:

We spend a lot of time staring at our phones, but can phone screens damage our sight? Overuse of electronic gadgets like smartphones, computers, and laptops is a major reason behind the increasing burden of eye diseases. Spending too many hours staring at a screen can cause eye strain. You tend to blink less while staring at the blue light from a screen, and the movement of the screen makes your eyes work harder to focus. We typically do not position the screen at an ideal distance or angle, which can cause added strain. All these issues add up and can lead to lasting effects on your vision, especially in children. The average person looks at their smartphone 150 times or more per day. All that staring from frequent phone use, computer use, and TV-watching can all lead to eye strain, an eye health issue that, when found in this context, is often called Computer Vision Syndrome. It’s predicted that 2 out of every 3 Americans will experience eye strain caused by excessive phone use. Computer vision syndrome can lead to blurred vision, dry eyes, sore eyes, and headaches.

Here are the main reasons how phone use can cause eye symptoms:

• Blinking Less Often: Blinking helps your eyes redistribute moisture, keeping them from getting dry, and also acts as a natural defense against excessive exposure to outside elements like dust and sunlight. You should blink about 15 times per minute. That number goes down by half when you stare at your smartphone, giving your eyes much less time to recover.
• Squinting: You may not mind reading smaller text on a smartphone screen, but your eyes sure do. Squinting at on-screen text and videos overworks your muscles around your eyes, neck, and shoulders, and is a major cause of eyestrain and blurred vision.
• Excessive Glare: Our eyes aren’t meant to stare directly at light for long periods of time, which is why the glare from the light of your cell phone screen can cause eye strain. Using your phone in the dark to check your emails or social media only exacerbates these negative conditions.
• The screen is too small: Due to the small screen size of the mobile phone, it puts a strain on your eyes. As a result, not much text fits on a screen and you turn pages more often. This ultimately causes watering of the eyes and irritation.
• The font is too small: There are still a lot of people who think, that an e-book is a fixed pdf document and that you need to scroll and zoom a lot. Doing all this can harm your eyes to some extent.

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Eye-related problems due to excessive screen time:

• Dry eyes

Staring at the screen for long hours prevents us from blinking as frequently as we should. This exposes the film of tears protecting the surface of the eyes and causes dryness and irritation.

• Eye Fatigue

Asthenopia, ocular fatigue, or eye fatigue is a condition where the eyes are tired from intense use. Your eyes can get tired from intense use causing double vision, headaches, and concentration difficulties. It is a common effect of staring at a computer screen or smartphone for long periods and can go away with rest.

• Loss of focus flexibility

Typically, loss of focus flexibility happens as we age, but excessive screen time can impact our ability to adjust our eyes to see at all distances quickly.

• Age-related macular degeneration (AMD)

AMD affects the central vision and is quite common in aged people. Since heavy exposure to blue light from the screen damages the retina, it triggers an early onset of AMD and eventually loss of vision. According to the American Optometric Association, children are more likely than adults to experience when exposed to this high-energy light.

• Near sightedness

Myopia or near sightedness is a condition where distant objects are difficult to see or appear blurry, while objects near you are clear. Staying indoors and staring at the screen for long periods make your eyes focus only on objects kept at less than arm’s length, thus making you vulnerable to near sightedness.

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Blue light & macular degeneration:

Very preliminary research from the University of Toledo warns that the blue light emitted from our devices might be increasing cases of macular degeneration. Macular degeneration occurs when our eye’s photoreceptors cells being to die. According to the University of Toledo statement, the blue light from our phones triggers an eye molecule called Retinal, which in turn creates chemical reactions that damage and kill photoreceptor cells. That said, University of Toledo representatives stipulate that the blue light emanating from our devices may not be strong enough to cause extreme damage to our eyesight. The Sun also produces blue light to a much greater degree and is by far the primary candidate for causing macular degeneration.

Protection from Blue Light:

How can we protect ourselves from blue light of our phones and laptops?

The answer is that it’s not easy, but there are many options. One is simply to reduce screen time, and put the device away.  This is especially important at night time since the energy from transmitted blue light can be more focused, intensified, and channeled to cause more damage to our retinas. Several tech companies have already made attempts to reduce the risks of blue light. The “night shift” setting is a special setting offered by Apple on iphones, while Samsung has “blue light filter” designed to reduce the blue light that is displayed on the screen.

In general, it’s a good idea to reduce time spent on all of these electronic devices and give your eyes a break . Simply closing your eyes, or looking away from the screen for a short period of time can provide much need eye rest.

Blue light also has been implicated as a factor which can suppress secretion of melatonin, reducing your ability to fall and stay asleep at night.  Lack of proper amounts of sleep has been linked to coronary artery disease, type 2 diabetes, anxiety and depression, as well as obesity.

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Smartphone use at night:

Are you in the habit of using your mobile phone after you put off the lights, lying in bed? If so, have a re-think, as ophthalmologists say continuous use of mobile phones before bedtime in the dark can cause extensive strain to your eyes. This habit can initially cause dry eyes, and strain your eyes. Direct glare of over 30 minutes can even cause irreversible eye macular degeneration, resulting in rapid deterioration of vision.

The concern for this stems from the fact that the mobile devices expose us to high energy visible (HEV) light or blue light, which in certain experiments in laboratory with high dose of exposure has shown to kill photoreceptor cells in the retina. The HEV light or blue light is also part of sunlight. However, we are not exposed to this for long hours as we rarely stare at these sources of light for a long time. Eyes could be affected only after continuous and prolonged use of mobile phones in the dark. This habit may not cause enough damage that can lead to permanent vision loss if a person uses it occasionally. But it would definitely strain the eyes. We must maintain a comfortable working distance from the device — be it a mobile phone or computer and ensure that the screen is bright enough and the fonts big enough to read comfortably.

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Transient Smartphone Blindness:  

Transient Smartphone Blindness (TSB) is a recent phenomenon characterized by acute, painless, transient vision loss associated with smartphone usage while lying down in the dark. While it is usually monocular, it can rarely present bilaterally. As it can masquerade serious, more well-established pathologies, it is important to rule out ischemic retinal and optic nerve disorders, when evaluating a patient with painless, transient vision loss for TSB.

TSB is believed to be due to temporary discrepancy in bleaching of photopigment and ultimate light adaptation between the fellow retinae. The prevailing hypothesis is that while in the lateral recumbent position, one eye is blocked (such as with a pillow, bed sheets) and subsequently becomes dark-adapted while the other eye exposed to the bright screen of the device becomes light-adapted. After the screen of the device is deactivated and the room is once again with low ambient light, the light-adapted eye is perceived to have poor or no vision. The vision returns to the patient’s baseline after several minutes.

It has been suggested that patients should only use smartphones in well-lit rooms and to assure that neither eye is occluded. Patients should conversely be advised against smartphone usage in dark settings (e.g. before bedtime or early morning before dawn) in order to prevent recurrence. Incidentally, this would also be expected to improve the patient’s sleep hygiene. Given the transient etiology of this phenomenon, the prognosis has thus far been uniformly promising, with full resolution of symptoms.

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Smartphone use and myopia:

The high mortality associated with Covid-19 has masked a quieter ‘pandemic’ sweeping across the globe: digital eye strain (DES). The calling card of this shadow pandemic is myopia or near-sightedness, especially among children. Myopia is as old as mankind, but what is new is its rapidly rising numbers. Two studies done by L V Prasad Eye Hospital, Hyderabad, roughly 20 years apart, underline why myopia qualifies as a public health crisis. In 2000, only three or four out of 100 children had myopia, but 2021 estimate is almost 20%, or one in every five children.

There is no doubt among doctors that the Covid pandemic worsened the myopia crisis with DES mainly due to “creations of artificial settings in which children were at home and in front of screens for long durations”. A study, Digital Eye Strain Among Kids (DESK), from Rajasthan and Madhya Pradesh published in the indexed ‘Journal of Ophthalmology’ highlighted that the screen time of children increased sharply from 1.9 (± 1.1) hours earlier to 3.9 (± 1.9) hours during the pandemic. And myopia progressed in 62.4% of the children in the study during the pandemic as compared with 45.9% before the pandemic.

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With the continuous rise in youth digital media consumption, the incidence of ocular problems has also dramatically increased. A large portion of the population currently suffers from visual impairment, especially in Asian countries, with a rapidly increasing prevalence and younger age of onset. It has been estimated that 49.8% (4.8 billion) and 9.8% (0.9 billion) of the global population will have myopia or high myopia by 2050. A recent study indicated that about 60 years ago, only 10%-20% of the Chinese population was nearsighted, but the percentage reached up to 90% of teenagers and young adults in 2015. Consistently, a school-based retrospective longitudinal cohort study (N=37,424 participants) found that the prevalence of myopia significantly increased from 56% in 2005 to 65% in 2015.

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Research has shown that increased “near work” or a closer working distance, such as where we hold our phones, tablets, or computers, can increase myopia progression. Overuse of mobile devices by young children can cause myopia (short-sightedness). A child’s eyesight can deteriorate due to continuous, prolonged staring at mobile and computer screens. With young children increasingly playing for hours on end with mobile devices such as smartphones and tablets, this might grow to be a problem for them as well. Furthermore, the earlier a child develops short-sightedness, the higher the risk of severe myopia in later life. Besides myopia, there are also less common eye conditions that may arise after a prolonged period of near work. These include convergence or accommodative insufficiency, in which the ability of the eyes to converge (turn inwards towards each other) or to focus well on near objects is impaired. This may cause symptoms like eye fatigue and sometimes even double vision.

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Reading books on smartphones:

Reading books on the phone is one of the latest trends. Do you like reading books and novels? Is reading your hobby? If yes, then you might be reading these articles on your smartphones. But wait! Have you ever wondered or thought of the disadvantages of reading books on the phone? It is a never-ending debate, but yes reading books on phone bad for eyes as it can damage your eyes to some extent (vide supra). 

In recent years, reading and studying on electronic devices has become more common. Although electronic devices have benefited mankind tremendously, they cause eyestrain and headaches and lead to poor reading comprehension. The link between visual environment and cognitive performance has been reported in basic research. The decline in comprehension when reading from an electric device might be due to poor concentration levels or different sensory processing circuits, which might be associated with physiological states, including brain and physiological activity levels. Even if the content of the text is the same, reading comprehension may be different depending on the visual context. Because vision has a dominant influence on other senses when it comes to sensory integration or cross-modality, visual input might also affect brain state and physiological condition. As such, brain activity and physiological changes likely exist as mediating variables in the relationship between the visual environment and cognitive performance.

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Reading on smartphone versus PC/laptop: 

You can read the text clearly without any strain on eyes at about one and half feet away from screen of PC (16 inch screen). Now you try to read the same text on your smartphone of screen size 6 inch. You will find only half of text on screen and you have to strain eyes to read it and you have to read it at half feet distance from your eyes. If you increase text size by using multi-touch capacitive screen by using two fingers spreading, you will find that you can read text as easily as on PC but number of words would be too few. So you have to keep moving book page to read the whole content. This is the greatest limitation of smartphone which cannot be overcome by today’s technology. Contents can be viewed and read with ease, and comprehensive content can be accessed from single screen appearance on PC. The same data can be read and viewed on smartphone but book page need to be moved constantly to gather comprehensive content and comprehensibility is achieved only through piece-meal data gathering. Not only your eyes but even your brain is stressed to assimilate data coming in piece-meal. The smartphones’ small screen size can make it difficult to view and properly display materials and as a result there is a high risk of reducing learning performance due to increased cognitive load.

Remember, human eyes and human brains are same no matter whether screen size is 16 inch or 6 inch. Smartphone screen of 6 inch is a technological innovation which makes us see the world through it. However, genetically and biologically, our eyes and brains are not tuned to see and understand the world through a small window of 6 inch. Enormous strain is put on eyes and brain when we try to assimilate information through 6 inch window. Trying to read entire book through 6 inch window is unnatural and counter-productive as information reaching brain in piece-meal will make it harder to understand. Smartphone can never match PC when you are trying to read a book on it.

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How to protect your eyes from your mobile screen:

The answer to the Computer Vision Syndrome cannot be stop using the mobile phone, because that is not practical or possible. So here are some tips on how to use your mobile phone better, so as to prevent damage to your eyes, despite watching movies on your mobiles.

-1. Take regular breaks: Remember the 20-20-20 rule for 20/20 vision. After every 20 minutes, look away from your phone and look at something at least 20 feet away for at least 20 seconds. Close your eyes for twenty seconds. This will help rest your eyes and prevent fatigue.

-2. Adjust brightness of your mobile phone or computer screen: Make sure that your mobile phone screen brightness is adjusted so as to minimize damage to the eyes. If you are watching a movie on your mobile phone, make sure the room is well lit room, so that you can adjust your screen to lower brightness. Chances are, your smartphone’s brightness setting is way higher than necessary. Reducing the glare from your screen will make phone use easier on your eyes and can also help you conserve battery life. Simply access your phone’s settings and adjust the brightness to a lower, more comfortable level. Screen brightness should match the brightness of your surroundings.

-3. Think and blink: Remember to blink your eyes frequently. This is the single most important factor for preventing dry eyes.

-4. Adjust Your Text Size: If you have to squint to read on your phone, try making the default font larger so that your on-screen text will be bigger and easier to see.

-5. Maintain Proper Screen Distance and Position: Most people hold their phone at a distance of about 8 inches from their face. However, holding your phone that close can be very damaging to the eyes. Maintain a distance of about 16 to 18 inches in order to protect your eyes from long-hours of smartphone use. The greater the distance between your phone and your eyes, the less eye strain it is likely to cause, provided the print size and images are large enough for comfortable viewing. If you rest your phone on your pillow as you lay in bed, your phone is too close! Instead, your screen should be an arm’s length away and positioned 20 degrees below your eye level.

-6. Use Adequate Lighting: A lot of people browse their phones when their surroundings are completely dark. This can be damaging to your eyes. Although it is best to avoid this, lower your brightness level as much as possible while using your phone in the dark. You can also use a bedside lamp. This will make a significant amount of difference to your eyes. Some phones have Dark Mode or Night Light features that are very helpful in this regard.

-7. Seek help: In case your vision is not returning to normal, or your problems are persisting despite precautions, please visit your doctor to discuss your problems, which could be due to reasons other than just watching a movie on a mobile phone.

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How to prevent eye fatigue when using mobile devices in your children:

As a parent, barring your child from using mobile devices may not be the best or most practical approach. After all, your child will be exposed to these devices sooner or later. Instead, you should consider setting limits for your child when it comes to the use of such devices. This can be done by:

-1. Encouraging your child to engage in outdoor activities    

-2. Moderating the use of mobile devices to about 30 minutes per session

-3. Ensuring that your child takes frequent periods of eye rest (every 30 to 40 minutes). Get your child to look out of the window at distant objects to relax the eyes

-4. Ensuring that near vision activities are performed at a sufficient distance (device to be held at least 30cm away; computer screens should be placed at least 50cm away)

-5. Making sure that there is sufficient lighting to illuminate the room without causing any glare

-6. Bringing your child for yearly eye examinations to detect any vision problems early. Corrective visual aids like glasses, when required, can help the eye to focus better 

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Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis, a 2020 study:

The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults. Authors conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. Authors used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I2 statistic was used to assess heterogeneity.

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Understanding smartphone overuse and its impact on the ocular system can help the growing population of users, especially children, manage their devices in a healthier way. A systematic review of 14 studies revealed a significant association between smartphone overuse and visual impairment. However, the cross-sectional studies showed negative, but not statistically significant, associations between smartphone overuse and myopia, blurred vision and poor vision. Still, the adverse effects were more apparent in children than young adults. The review examined 10 cross-sectional studies and four controlled trials, which included a total of 27,110 patients ranging in age from 9.5 to 26. From the cross-sectional studies, the pooled odds ratio of 1.05 suggested that smartphone overuse was not significantly associated with myopia, poor vision or blurred vision; however, these visual impairments were more apparent in children (1.06) than young adults (0.91).

The controlled studies revealed that patients who overused smartphones displayed worse visual function scores. The pooled effect size was 0.76, which was statistically significant.

The researchers noted that most of the studies included in their systematic review were from Asia, which had higher prevalence rates of visual impairment even before digital devices were introduced.

Nevertheless, these results suggest that regulating device usage and restricting prolonged smartphone use may prevent adverse ocular and visual symptoms, especially in younger patients.

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Conclusions:

Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. The researchers recommend further research on the patterns of use, with longer follow-up on the longitudinal associations, to better inform detailed guidelines and recommendations for smartphone use in children and young adults. 

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Counterview:

Screens themselves aren’t dangerous for eyesight:

A computer screen usually covers a large part of your visual field, because it’s big, but a phone is much smaller. When talking about myopia (short sightedness), it makes a big difference whether you’re looking at a big screen or a small one, like a cell phone. But it actually doesn’t matter whether you’re looking at a book or a screen. What’s critical is the viewing distance. For example, if you read a book from 20 cm (8 inches) away all day, you’ll probably develop myopia pretty soon. You have to look at the viewing distance of the subject to their screen. The problem is usually that they’re reading small text. And if they are at a close distance, their eyes have to work harder to accommodate. If you’re working on an Excel spreadsheet, for example, you’re concentrating on a small area on the screen for a long period of time. And your eye movements are much more limited than if you were walking around outside. It’d be the same if it was a textbook. The thing is, now that most people use computers for work, they’re spending a lot more time reading in general. The screen itself is not dangerous — it’s the fact that it draws your attention for many hours.

It’s important not to get locked to some fixed target for many hours. It’s a good idea to change your viewing distance occasionally — look outside the window for a few minutes, get up and walk around a bit.

In Taiwanese schools, for example, it’s an official rule now that the children are only allowed to read for 30 minutes at a time, with a 10-minute break in between. And they also have to go out for at least one and a half hours per day. Since these rules were applied in 2012, there’s already been quite a reduction in the development of myopia in children.

The amount of blue light you’re exposed to when you go outside is so much greater than anything you’ll get from a computer/cell phone screen. We do have certain cells in the eye — melanopsin ganglion cells — that respond to blue light, and they influence our sleeping patterns. So if you’re looking at a screen in the evening, say from 8 p.m. to 10 p.m., it could affect your sleep quality. The question is always how much blue light. Is it enough to stimulate this melanopsin system sufficiently to really affect your sleep quality? If yes then it is risky. 

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Section-12

Smartphone overuse and mental health: 

The research that addresses the relationship between excessive use of electronic devices and negative health outcomes is often understood through screen time research. Excessive screen time has been associated with poor self-esteem, depression, anxiety, suicidal thoughts in several studies. However, a systematic review has argued that there is insufficient evidence for associations between screen time and health issues such as anxiety, poor self-esteem, poor cognition, poor sleep outcomes, or suicidal ideation. In contrast, other evidence suggests that youth who engaged in screen time behaviours (e.g., playing games or internet use) involving academic activities had better mental wellbeing that youth who spent less time on those activities. Longitudinal research shows a consistent relationship between screen time and health behaviours among youth and their mental health. Gunnell and colleagues (2016) analysed the relationship between physical activity, screen time, anxiety, and depression over a period of 11 years among Canadian participants from age 10 to 21 years. The authors found that, over time, an increase in anxiety and depression were associated with an increase in screen time use.

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Evidence from a review paper reports that smartphone use is associated with adverse mental health outcomes. Additionally, a meta-analytic review specifically reported that smartphone use is associated with stress and anxiety. A systematic review also confirms associations between problematic smartphone use and depression severity. Another study confirms associations between problematic smartphone use and negative psychological wellbeing in general. Horwood and Anglim assessed whether there are differences in the association between problematic smartphone usage behaviours and wellbeing. They found that when smartphone use was for entertainment purposes (i.e., used to relax, escape, pass time) it was correlated with lower wellbeing while smartphone use for communication purposes (i.e., texting, calling) was unrelated or slightly positively associated with wellbeing. Further research also suggests that specific smartphone activities may have specific associations with health outcomes. David, Roberts, and Christenson (2018) collected objective sensory data in the United States for a one-week period via smartphones, while feelings of wellbeing were self-reported using surveys. They found that studying the overall time spent using a device did not fully explain the relationship between screen time uses and anxiety and depression; rather, specific uses on the smartphone were associated with health outcomes. For instance, time spent using apps for taking photos and videos was associated with higher levels of reported anxiety and depression. On the other hand, time spent using productivity apps was associated with fewer reported relationship conflicts, while book apps were associated with lower levels of anxiety and depression. These findings suggest that smartphone-based screen time usage is varied and potentially has different associations with mental health than that of other types of devices. The cognitive–behavioural model of pathological internet use can further contextualise the literature’s findings. It suggests that generalised pathological internet use is to be distinguished from specific pathological internet use; where the latter refers to specific internet use such as online gambling. Additionally, the Uses and Gratifications Theory also highlights that people consume media depending on their own personal needs that can differ due to psychological and/or demographic characteristics. Findings from the literature, the cognitive–behavioural model of pathological internet use, and the Uses and Gratification Theory support that smartphone use behaviours differ at an individual level.

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Smartphone guidelines are a delicate matter since digital technology enables social connection, which has been especially important since the coronavirus disease (COVID-19) pandemic began. During this global health crisis, access to digital tools has been invaluable to not only connect socially and maintain mental health while following physical distancing public health orders, but also to maintain productivity in many sectors. While higher volumes of digital device usage and screen time accumulation has become inevitable, it is critical to understand how smartphone screen time is associated with health, particularly in a world where digital engagement has become the primary form of communication due to varied motivations such as work, leisure, entertainment, gaming, and social connection. Such findings can not only support the development of prevention policies of harmful behaviours, but also enable the development of ethical digital health interventions.

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There are concerns that some mobile phone users incur considerable debt, and that mobile phones are being used to violate privacy and harass others. In particular, there is increasing evidence that mobile phones are being used as a tool by children to bully other children. There is a large amount of research on mobile phone use, and its positive and negative influence on the human’s psychological mind, mental health and social communication. Mobile phone users may encounter stress, sleep disturbances and symptoms of depression, especially young adults. Consistent phone use can cause a chain reaction, affecting one aspect of a user’s life and expanding to contaminate the rest. It usually starts with social disorders, which can lead to depression and stress and ultimately affect lifestyle habits such as sleeping right and eating right.

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According to research done by Professor of psychology at San Diego State University Jean M. Twenge, there is a correlation between mobile phone overuse and depression. In the wake of smartphone being evolved, Twenge and her colleagues stated that there was also an increase seen in depressive symptoms and even suicides among adolescents in 2010. The theory behind this research is that adolescents who are being raised as a generation of avid smartphone users are spending so much time on these devices that they forgo actual human interaction which is seen as essential to mental health, “The more time teens spend looking at screens, the more likely they are to report symptoms of depression.” While children used to spend their free time outdoors with others, with the advancement of technology, this free time is seemingly now being spent more on mobile devices.

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Psychologist Nancy Colier has argued that people have lost sight of what is truly important to them in life. She says that people have become “disconnected from what really matters, from what makes us feel nourished and grounded as human beings.” People’s addiction to technology has deterred neurological and relationship development because tech is being introduced to people at a very young age. People have become so addicted to their phones that they are almost dependent on them. Humans are not meant to be constantly staring at a screen as time is needed to relax their eyes and more importantly their minds. Colier states: “Without open spaces and downtime, the nervous system never shuts down—it’s in constant fight-or-flight mode. We’re wired and tired all the time. Even computers reboot, but we’re not doing it.”

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The amount of time spent on screens appears to have a correlation with happiness levels. A nationally representative study of American 12th graders funded by the National Institute on Drug Abuse titled Monitoring the Future Survey found that “teens who spent more time than average on screen activities are more likely to be unhappy, and those who spend more time than average on non-screen activities are more likely to be happy.” One of the most important findings of this study is how the amount of time spent on non screen activities versus on screen activities affects the happiness levels of teenagers.

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However, while it is easy to see a correlation between cell phone overuse and these symptoms of depression, anxiety, and isolation, it is much harder to prove that cell phones themselves cause these issues. Studies of correlations cannot prove causation because there are multiple other factors that increase depression in people today. According to psychologist Peter Etchells, although parents and other figures share these concerns other possible variables must be reviewed as well. Etchells proposes two possible alternative theories: depression could cause teens to use iPhones more or teens could be more open to discussing the topic of depression in this day and age. A survey done by a group of independent opticians revealed that 43% of people under the age of 25 experienced anxiety or even irritation when they were not able to access their phone whenever they wanted. This survey shows the psychological effect that cell phones have on people, specifically young people

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Smartphone addiction and suicide:

Four studies examined smartphone addiction and its relationship with suicidal ideation in adolescents (Arrivillaga, Rey, & Extremera, 2020; Sohn, Oh, Lee, & Potenza, 2018) and young adults (Kim, Min, Kim, & Min, 2019b; Wan Ismail et al., 2020). All four studies found positive associations between smartphone addiction and suicidal ideation; in one study, however, smartphone addiction was no longer a significant predictor of suicidal ideation after adjusting for covariates, including demographics, Internet addiction, and sleep duration (Wan Ismail et al., 2020). All four studies were cross-sectional and used validated (and translated and validated) measures of smartphone addiction. Three used validated (and translated and validated) measures of current suicidal ideation (Arrivillaga et al., 2020; Sohn et al., 2018; Wan Ismail et al., 2020), and one used a one-item measure, created by the researchers, of past-year suicidal ideation (Kim, Min, Kim, & Min, 2019b).

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Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time, a 2017 study:

In two nationally representative surveys of U.S. adolescents in grades 8 through 12 (N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, suicide related outcomes, and suicide rates increased between 2010 and 2015, especially among females. Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on nonscreen activities (in­person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely. Since 2010, iGen adolescents have spent more time on new media screen activities and less time on nonscreen activities, which may account for the increases in depression and suicide. In contrast, cyclical economic factors such as unemployment and the Dow Jones Index were not linked to depressive symptoms or suicide rates when matched by year. 

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Association between problematic use of smartphones and mental health in the Middle East and North Africa (MENA) region: a systematic review of 2022: 

Smartphones have become essential components of daily life, and research into the harmful effects of problematic smartphone use (PSU) on mental health is expanding globally. The studies enrolled 21696 people and had low to moderate methodological quality. The prevalence of PSU ranges from 4.3 percent to 97.8 percent. The time factor (average duration of use per day, frequency of use, consultation during the night), type of application used on the smartphone, and socio-demographic characteristics were the determinants of PSU (age, gender, marital status). Depression, anxiety, and stress were all strongly correlated with PSU, with a stronger relationship between PSU and depression (0.164 ≤ r ≤ 0.996) than between PSU and anxiety (0.12 ≤ r ≤ 0.562) or stress (0.14 ≤ r ≤ 0.508). PSU is a real public health issue because it is linked to mental illnesses and social dysfunctions that are a wearisome burden on society.

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Psychological Morbidities Associated With Excessive Usage of Smartphones Among Adolescents and Young Adults: A Review 2022:

The aim of this study is to summarize the present situation and the correlation between smartphones and mental health. Cognitive, emotional difficulties, poor cognitive function, impulsivity, shyness, social networking addiction, low self-esteem, and some medical issues like insomnia, anxiety, depression, and a lack of cognitive control have been linked to excessive smartphone use.

Smartphone addiction and its detrimental effects:

Stress:

Stress is any type of change that causes psychological, emotional, or physical strain. In one study, young German internet users were questioned, and it was discovered that communication load was associated with emotions of stress and indirectly influenced grief and anxiety. Another study reached similar conclusions, a questionnaire was distributed to 439 students aged 12-17 years, including parents and young adults from Central Switzerland, and it was discovered that smartphone usage during the night hours was common among adolescents and that being awake all night resulted in poor perceived health. There was no tangible link between memory performance and mobile phones. As a result, it was found that digital stress is a big stimulant and causes major psychological health effects.

Depression:

Depression is a psychological disorder that results in persistent emotions of sadness, loneliness, and lack of joy and is thought to be highly correlated with addiction to smartphone usage. The majority of studies on this issue revealed that there is a relationship between these two variables, that is, depression and smartphone usage. Brian, in 2013 conducted research titled “Two Days Without Phone,” and she conducted her research on her students, Kenny and Franchesca. She found that while Franchesca was comfortable not to have her phone nearby and easily handed over her phone, Kenny did not want to lose his. In 2012, researchers discovered a significant increase in smartphone usage among teens and symptoms of an increase in depression which ultimately lead to suicidal thoughts.

Anxiety and Sleep Loss Pattern:

Anxiety is a type of mental illness that causes fear, nervousness, worry, and apprehension. In 2017, Boumosleh and Jaalouk studied whether depression and anxiety led to smartphone habits. Their cross-sectional study showed that sadness and anxiety are good predictors of smartphone addiction. A descriptive study conducted by Fisoun et al. found that internet addiction is similar to drug addiction. If internet addiction persists, it will end in the same outcomes as alcohol addiction. Another observational research suggested that sleeplessness can lead to depression. The subjective experience of finding it difficult to fall asleep or stay asleep is known as insomnia or sleeplessness. Li et al. in 2016 conducted a prospective cohort study and hypothesized that sleep deprivation and the risk of depression are related. Gutiérrez et al. discovered that problematic smartphone usage was linked to sleep deprivation, despair, and anxiety. Another Japanese study involving 94,777 young adults found that using a smartphone to send messages and calls after lights out was connected with sleep disturbances such as poor sleep quality, short sleep duration, insomniac symptoms, and excessive daytime sleepiness.

Cyberbullying:

Cox Communications carried out a study on students aged 13-18 years, of which 15% of students had experienced cyberbullying online, 10% had experienced it on mobile phones, and 5% were engaged in cyberbullying against another person using a mobile phone according to a poll, cyberbullying cause teens to become depressed and resent going to school. Additionally, this research has shown that children who experience cyberbullying are more likely to experience psychosomatic issues, such as chronic headaches, sleep issues, anxiety, and despair. Cyberbullying is more challenging to spot because it goes unnoticed than physical bullying. Because the internet provides anonymity, criminals can remain undetected.

False Prestige:

Adolescents may now easily access any of the most recent advancements in mobile technology. Adolescents who are naive for their age may accept the majority of things available on social media, can become serious about such things, and can get influenced, even if they may not be accurate. They might create a false sense of status and start living in a dream world. Some people could turn to crime to live out their desires.

Obesity:

Adolescents’ obesity may result from constant mobile phone usage. Harvard T.H. Chan School found that adolescents who use their phones for many hours daily are more likely to gain weight. According to the study, adolescents who spend more than five hours a day in front of a device are 43% more likely to receive less sleep and are less tend to do exercise, which can lead to obesity.

Vision Problems:

As per recent reports, there are many cases of vision problems that are mainly associated with increased smartphone screen time. Symptoms are ocular muscle fatigue, redness, lacrimation, irritation, blurry vision, and dry eyes. In a research of 30 medical students, smartphone vision syndrome was discovered in 83% of the participants. Adolescents and young adults use smartphones excessively, which outweighs their value and leads to new issues. Even if it is not possible to stop adolescents from using a phone, however, specific limits can be set on how much time to spend on it.

Cognitive Behavior:

Cognition is the mental activity or process of learning and comprehending things through experience, the senses, and thought. Ellison in 2012 asked that “are smartphones making us dumber?” Morin in 2013 asked that “is your smartphone making you fat and lazy?” Greenfield in 2013 stated that reliance on smartphones and related technologies is not aiding mental functioning, but rather, is having a negative impact on our ability to think, remember, pay attention and regulate emotion. Some have even made the claim that modern connectedness is “rewiring our brains” to constantly crave instant gratification and that this threat to our society is “almost as important as climate change”. The authors interpreted this result as evidence that increased daily multitasking leads individuals to experience greater difficulty in recruiting cognitive control resources. Regular media multitaskers had less grey matter in their anterior cingulate cortex, according to research by Loh and Kanai in 2016. This suggests that this behavior may directly affect the structural characteristics of a critical brain region involved in attention regulation.

Loneliness, Self-Control, Worry, and Anger:

Mahapatra in 2019 showed that sticking to smartphone use leads to a lack of self-regulation and loneliness which ultimately damages family relations, and leads to interpersonal conflicts and poor academic performances. High measures of worry and anger are seen in students with problematic smartphone use. Excessive reassurance-seeking behavior mediated the association between rumination and problematic smartphone use.

Physical Fitness:

Addicts to smartphones were less likely to walk every day. In particular, smartphone addiction may have a severe impact on physical health by limiting the quantity of exercise, such as walking, leading to an increase in fat mass and a decrease in lean mass, both of which have negative health effects.

Migraine:

It has been observed that smartphone usage leads to increased headache duration and frequency in migraine patients. In addition, as smartphone usage rises, it results in decrement in sleep quality and our quality of life. This is especially true for migraine sufferers who use their phones excessively, which is linked to poor sleep and daytime drowsiness.

Fear of Missing Out:

Fear of missing out (FOMO) has been characterized as concern over missing good events. It is also seen as a motivation for remaining informed of what others are doing on social media. It is such a common occurrence that a scale has been developed to quantify it. A significant association was found between FOMO scale scores and problematic smartphone use in a study of Turkish adolescents. According to a regression study, there was up to 28% of variation in FOMO scale scores due to problematic smartphone use in research on 2663 Belgian teenagers. It was found that there was a problem with FOMO due to excessive use of private social media sites. It predicted phubbing behavior is directly and indirectly linked with problematic smartphone usage, for example, spending too much time on Facebook.

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Studies conducted all over the world about smartphone addiction among adolescents and young adults and its detrimental effects are mentioned in table below.

Authors	Year	Population	Finding
Kim et al.	2020	South Korea (350 children)	Reduced sleep quality as well as duration
Lemola et al.	2015	362 adolescents sleep	Sleep disruption mediated the association between electronic media usage in bed before sleep and depressive symptoms
Tamura et al.	2017	Japan (295 high school students aged 15-19 years)	Shorter sleep duration and insomnia
Liu et al.	2019	Technical college in China (4733 students aged: 14-24 years)	Anxiety, depression, sleep disturbances
Farooq et al.	2019	Pakistan (500 university students)	Poor sleep quality and disturbed sleep pattern
Dharmadhikari et al.	2019	India (195 medical students)	Higher perceived stress and poor sleep quality
Demir and Sumer	2019	123 migraine young adult patients smartphone	Smartphone use has increased the length and incidence of headaches. Its excessive usage was linked to poor sleep quality, daytime drowsiness, and a worse quality of life
Turgeman et al.	2020	140 university students	Overuse of smartphones has been linked to social anxiety, anxiety, and depression
Darcin et al.	2016	367 university students	Loneliness and social anxiety
Eichenberg et al.	2019	Spanish (845 adolescents)	Maladaptive cognitive-emotion regulation was significant in problematic smartphone users
Kim et al.	2019	4,512 middle- and high-school students excessive	Excessive smartphone use was predicted with ADHD
Kapkın et al., Domoff et al, Mahapatra	2020, 2020 and 2019	Turkey (443 high-school students ) 193 adolescents 350 students (age: 15-20 years)	Excessive smartphone use was linked to childhood emotional abuse, emotion management issues, uncontrolled eating, constrained eating, food addiction, a more significant percent body fat, and loneliness

Conclusions:

Anything beyond what we need is poison. The same applies to the growing addiction to smartphone usage among adolescents and adults. It has become a public health issue leading to some concerning issues like anxiety, insomnia, over-dependency, behavioral and psychological changes, etc. Smartphone unquestionably improves access to knowledge and connectivity, but at the same time, its addiction is quite alarming. If guardians intend to give adolescents a phone, ensure they strictly supervise their phone usage. Otherwise, they may spend the entire day staring at a screen. If not, it will have irreparable consequences for the person’s physical health, relationships, studies, friendships, and family bonds. They must also agree on smartphone usage guidelines. And thus, this paper tries to pinpoint prior research by examining the links between smartphones and mental health problems related to addiction and helping us justify whether or not it is making us antisocial and unhealthy.

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Psychological impacts of “screen time” and “green time” for children and adolescents: A systematic scoping review of 2020: 

Technological developments in recent decades have increased young people’s engagement with screen-based technologies (screen time), and a reduction in young people’s contact with nature (green time) has been observed concurrently. This combination of high screen time and low green time may affect mental health and well-being. The aim of this systematic scoping review was to collate evidence assessing associations between screen time, green time, and psychological outcomes (including mental health, cognitive functioning, and academic achievement) for young children (<5 years), schoolchildren (5–11 years), early adolescents (12–14 years), and older adolescents (15–18 years). Original quantitative studies were identified in four databases (PubMed, PsycInfo, Scopus, Embase), resulting in 186 eligible studies. A third of included studies were undertaken in Europe and almost as many in the United States. The majority of studies were cross-sectional (62%). In general, high levels of screen time appeared to be associated with unfavourable psychological outcomes while green time appeared to be associated with favourable psychological outcomes. The ways screen time and green time were conceptualised and measured were highly heterogeneous, limiting the ability to synthesise the literature. The preponderance of cross-sectional studies with broadly similar findings, despite heterogeneous exposure measures, suggested results were not artefacts. However, additional high-quality longitudinal studies and randomised controlled trials are needed to make a compelling case for causal relationships. Different developmental stages appeared to shape which exposures and outcomes were salient. Young people from low socioeconomic backgrounds may be disproportionately affected by high screen time and low green time. Future research should distinguish between passive and interactive screen activities, and incidental versus purposive exposure to nature. Few studies considered screen time and green time together, and possible reciprocal psychological effects. However, there is preliminary evidence that green time could buffer consequences of high screen time, therefore nature may be an under-utilised public health resource for youth psychological well-being in a high-tech era.

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Counterview:

Smartphones is good for mental health:

When it comes to mental health, technologies such as smartphones and social media networks are almost always discussed in terms of the dangers they pose. Alongside concerns expressed in the media, some experts believe that technology has a role in the rising rates of mental health problems. However, there is also evidence to suggest your smartphone could actually be good for your mental health.

The brain is a sensitive organ that reacts and adapts to stimulation. Researchers have looked into smartphone usage and the effects on the day-to-day plasticity of the human brain. They found that the finger movements used to control smartphones are enough to alter brain activity. This ability of technology to change our brains has led to questions over whether screen-based activity is related to rising incidence of such conditions as attention deficit hyperactivity disorder (ADHD) or an increased risk of depression and insomnia. Technology has also been blamed for cyber-bullying, isolation, communication issues and reduced self-esteem, all of which can potentially lead to mental ill health.

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However, focusing only on the negative experiences of some people ignores technology’s potential as both a tool for treating mental health issues and for improving the quality of people’s lives and promoting emotional well-being. For example, there are programmes for depression and phobias, designed to help lift people’s moods, get them active and help them to overcome their difficulties. The programmes use guided self help-based cognitive behavioural principles and have proven to be very effective.

Computer games have been used to provide therapy for adolescents. Because computer games are fun and can be used anonymously, they offer an alternative to traditional therapy. For example, a fantasy-themed role-playing game called SPARX has been found to be as effective as face-to-face therapy in clinical trials.

Researcher David Haniff has created apps aimed at lifting the mood of people suffering from depression by showing them pleasing pictures, video and audio of, for example, their families. He has also developed a computer game that helps a person examine the triggers of their depression. Meanwhile, smartphone apps that play subliminal relaxing music in order to distract from the noise and worries of everyday living have been proven to be beneficial in reducing stress and anxiety.

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Technology can also provide greater access to mental health professionals through email, online chats or video calls. This enables individuals to work remotely and at their own pace, which can be particularly useful for those who are unable to regularly meet with a healthcare professional. Such an experience can be both empowering and enabling, encouraging the individual to take responsibility for their own mental well-being.

This kind of ‘telemedicine’ has already found a role in child and adolescent mental health services in the form of online chats in family therapy, which can help to ensure each person has a chance to have their turn in the session. It has been found that young people who struggle to communicate during face-to-face sessions can be encouraged to text their therapist as an alternative way of expressing themselves, without the pressure of sitting opposite someone and making eye contact. Conditions such as social anxiety can stop people seeking treatment in the first place. The use of telemedicine in this instance means people can begin combating their illness from the safety of their own home. It is also a good way to remind people about their appointments, thus improving attendance and reducing drop-out rates.

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The internet in general can provide a gateway to asking for help, particularly for those who feel that stigma is attached to mental illness. Accessing information and watching videos about people with mental health issues, including high-profile personalities, helps to normalise conditions that are not otherwise talked about. People can use technology to self-educate and improve access to low-intensity mental health services by providing chat rooms, blogs and information about mental health conditions. This can help to combat long waiting times by providing support earlier and improving the effectiveness of treatment. More generally, access to the internet and use of media devices can also be a lifeline to the outside world. They allow people to connect in ways that were not previously possible, encouraging communication. With improved social networks, people may be less likely to need professional help, thus reducing the burden on over stretched services.

Research into the potential dangers of technology and its effect on the brain is important for understanding the causes of modern mental health issues. But technology also creates an opportunity for innovative ways to promote engagement and well-being for those with mental health problems.

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Many studies on the negative effects of smartphones are of low quality:

Smartphones have become an essential part of daily life. On the other hand, there’s no shortage of research pointing towards supposed negative effects of smartphone use, with some even claiming that the more time you spend using your smartphone, the worse your mental health. However, many of the studies that suggest negative links to smartphone use are low quality, often failing to measure how people actually use their devices. So many academics are interested in this topic that more than 900 rating scales have been developed to try and better understand people’s relationship with their technology. However, this results in the “many voices” problem, where pressure to publish can lead to an abundance of low-quality work that is quick and easy to conduct and appears impactful.

The ultimate consequence of this has been the definition of new “technology use disorders”. For example, some are going as far to argue for a consensus on the existence of gaming disorder, despite the fact that the majority of scientists do not agree that the evidence is of high enough quality for this. Defining a disorder prematurely is unethical, as those diagnosed may undergo unnecessary stigma, treatments, lifestyle changes and an altered sense of self.

Other studies also continue to make grand claims about the impact of technology, and generally recommend limiting use, when time spent on technology has not actually been measured. What’s more, these studies often do not comply with open science practices, including the sharing of data and analysis procedures.

One such study concluded that over 80% of anxiety symptoms could be explained by someone’s gaming addiction scores. However, these claims have now been withdrawn due to analysis error following accusations of data fabrication.

These revelations are rarely reported by the mainstream media and further serve to divert attention away from genuine digital harms – including misinformation, cyberbullying, fraud, and unequal access to technology.

While we can now measure smartphone use at a general level, this still doesn’t tell the whole story. For example, talking to your best friend on the phone is very different to browsing Facebook or watching a YouTube video. This makes previous research look even more limited, as claiming general smartphone use as solely negative or positive oversimplifies the complexities of behaviour.

Research has largely favoured studying problematic use, and there is an inherent lack of basic work on describing technology use as a core part of everyday life. This will be essential before we are better able to understand or mitigate harm.

Claims suggesting that smartphones are ruining a generation are incorrect yet remain impactful. This leads people to believe that general smartphone use is linked to poor mental health, and these concerns are common in adolescents.

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Why spending a long time on your phone isn’t bad for mental health, a 2020 study:

General smartphone usage is a poor predictor of anxiety, depression or stress say researchers, who advise caution when it comes to digital detoxes. Researchers measured the time spent on smartphones by 199 iPhone users and 46 Android users for one week. Surprisingly, the amount of time spent on the smartphone was not related to poor mental health. Instead, the study found that mental health was associated with concerns and worries about their own smartphone usage.

Lead author Heather Shaw of Lancaster University’s Department of Psychology said: “A person’s daily smartphone pickups or screen time did not predict anxiety, depression, or stress symptoms. Additionally, those who exceeded clinical ‘cut off points’ for both general anxiety and major depressive disorder did not use their phone more than those who scored below this threshold.” Instead, the study found that mental health was associated with concerns and worries felt by participants about their own smartphone usage. This was measured through their scores on a problematic usage scale where they were asked to rate statements such as “Using my smartphone longer than I had intended,” and “Having tried time and again to shorten my smartphone use time but failing all the time.” Heather Shaw said: “It is important to consider actual device use separately from people’s concerns and worries about technology. This is because the former doesn’t show noteworthy relationships with mental health, whereby the latter does.”

Previous studies have focussed on the potentially detrimental impact of ‘screen time’, but this study shows that people’s attitudes or worries are likely to drive these findings.

Dr David Ellis, from the University of Bath’s School of Management, said: “Mobile technologies have become even more essential for work and day-to-day life during the COVID-19 pandemic. Our results add to a growing body of research that suggests reducing general screen time will not make people happier. Instead of pushing the benefits of digital detox, our research suggests people would benefit from measures to address the worries and fears that have grown up around time spent using phones.”

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Nighttime smartphone use and changes in mental health and wellbeing among young adults: a longitudinal study based on high-resolution tracking data, a 2022 study:

Frequent nighttime smartphone use can disturb healthy sleep patterns and may adversely affect mental health and wellbeing. This study aims at investigating whether nighttime smartphone use increases the risk of poor mental health, i.e. loneliness, depressive symptoms, perceived stress, and low life satisfaction among young adults. High-dimensional tracking data from the Copenhagen Network Study was used to objectively measure nighttime smartphone activity. Authors recorded more than 250,000 smartphone activities during self-reported sleep periods among 815 young adults (university students, mean age: 21.6 years, males: 77%) over 16 weekdays period. Mental health was measured at baseline using validated measures, and again at follow-up four months later. Associations between nighttime smartphone use and mental health were evaluated at baseline and at follow-up using multiple linear regression adjusting for potential confounding. Nighttime smartphone use was associated with a slightly higher level of perceived stress and depressive symptoms at baseline. For example, participants having 1–3 nights with smartphone use (out of 16 observed nights) had on average a 0.25 higher score (95%CI:0.08;0.41) on the Perceived stress scale ranging from 0 to 10. These differences were small and could not be replicated at follow-up. Contrary to the prevailing hypothesis, nighttime smartphone use is not strongly related to poor mental health, potentially because smartphone use is also a social phenomenon with associated benefits for mental health.

Conclusions:

Contrary to the prevailing hypothesis, nighttime smartphone use was not strongly associated with poor mental health, possibly because smartphone use is also a social phenomenon with beneficial effects on mental health. Further research is warranted in order to confirm these findings preferably designs distinguishing between nightly social and consumption-related smartphone use.

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Section-13

Smartphone overuse and sleep:

Adequate sleep plays a critical role in children’s health and development, particularly in the early years. Short sleep duration in preschool children is linked to obesity in later childhood. Furthermore, sleep problems beyond age two are associated with reduced grey matter volume at seven years, indicating a role of sleep in early brain development.

International guidelines recommend that infants (0–1 y) sleep for up to 17 h/d, while toddlers (1–3 y) and preschoolers (3–5 y) should sleep between 10 and 14 h/d. However, today’s children sleep less than they did a century ago and 20–30% of parents report that their child has difficulties falling or staying asleep. The causes for this apparent epidemic of sleep problems are likely multi-factorial but lifestyle changes in an increasingly digitized world are a cause for concern.

Australia, Canada, South Africa, New Zealand and WHO have issued 24-h movement guidelines for under 5s, recommending an ‘optimal day’ in terms of children’s sleep, physical activity and sedentary behaviors (including screen time). This ‘whole day matters’ approach places each behavior along a continuum, where declines in one behavior results in an increase in another. Studies in older children and adults have shown that daytime physical activity and screen time both influence sleep, but less is known about these relationships in children under 5 y of age. The early years are also a critical period in life for establishing healthy behaviors as screen time and physical activity appear to track from early into later childhood and adolescence and consequently may influence sleep later in life.

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Sleep is a basic requirement for human survival. It is very important for restoring tired bodies and minds and leading a normal life. Sleep deprivation can negatively impact physical, social, and psychological health. Memory processing, metabolite clearance, immune restoration are some of the important functions of sleep. Sufficient sleep plays an important role in maintaining the homeostasis of the central nervous system and human immune function. Insufficient sleep causes symptoms such as memory loss, decreased cognitive function, and fatigue. Despite the importance of sleep, most adolescents experience insufficient sleep qualitatively and quantitatively. According to previous reports, 69.7% of Korean adolescents answered that their sleep time was insufficient, while only 30.3% of adolescents were satisfied with their sleep time. Their average weekly sleep time was six hours and twelve minutes. This is less than 8 to 10 h a day, the recommended sleep standard time for adolescents presented by the American Academy of Sleep Medicine. Insufficient sleep negatively affects adolescent growth, emotion, and immunity. It shows a high association with childhood obesity. Adolescents who continuously experience sleep disorders show increases in cortisol secretion. This reduces memory and leads to a lack of concentration, which adversely affects their academic performance. Healthy sleep habits in adolescence are very important because insufficient sleep during adolescence is likely to have a negative effect on adulthood.

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With the widespread use of portable electronic devices and the normalization of screen media devices in the bedroom, insufficient sleep has become commonplace, affecting 30% of toddlers, preschoolers, and school-age children and the majority of adolescents. In a recent literature review of studies investigating the link between youth screen media use and sleep, 90% of included studies found an association between screen media use and delayed bedtime and/or decreased total sleep time. Proposed mechanisms include displacement of time that would have been spent sleeping, psychological stimulation and light exposure, and increased physiological alertness. This pervasive phenomenon of pediatric sleep loss has widespread implications due to the associations between insufficient sleep and increased risk of childhood obesity, disrupted psychological well-being and impaired cognitive/academic functioning.

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The use of light-emitting electronic devices before and during the sleep period is likely to stimulate cognitive arousal and delay the release of the sleep hormone melatonin affecting both sleep onset latency and sleep perceptions. Prolonged sleep disruptions are likely to interfere with mental restitution and mood, and several studies have shown that poor sleep plays an important etiological role in the development of poor mental health working through changed emotional regulation and neuro-biological interaction. Poor sleep quality has shown to either affect or exacerbate feelings of perceived stress, which may over a longer period develop into depressive symptoms. Further, sleep deprivation may also hamper daily functioning and the ability and energy to engage in meaningful activities, which are likely to affect overall life satisfaction and feelings of being socially connected. While it is less likely that sleep disruption from technology use plays a key role in the aetiology of severe mental disorders requiring prolonged clinical intervention, the general mental wellbeing such as stress perceptions, life satisfaction, depressive symptoms, and feelings of social isolation may be affected.

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Sleep is essential to proper cognitive functions. Lim and Dinges (2010) conducted a meta-analysis of over 70 studies and found that short term sleep deprivation (48 hours) had negative implications in speed processing and accuracy in cognitive tasks related to simple and complex attention, working memory, processing speed, and short-term memory. Sleep deprivation does not have to be as long as 48 hours to bestow negative effects on cognitive function. Pilcher and Walters (1997) compared students who were sleep deprived for 24-hours against those who had 8-hours sleep on a range of cognitive tasks. They found that the sleep deprived group performed worse on all cognitive tests, however they reported higher levels of attention and estimated performance on the cognitive tests when compared to the control group. Pilcher and Walters (1997) concluded that these findings indicate that college students are not aware of the severity of sleep deprivation on their own cognitive abilities and do not perceive themselves as greatly affected by a lack of sleep. This could affect the reliability of any self-reported sleep questionnaires when interviewing a student sample. Studies have repeatedly shown that students have high levels of night time phone use (Sharkey, Carskadon, Figueiro, Zhu, & Rea, 2011). A study showed that students are only achieving adequate sleep duration approximately 29% of the time (Lund, et al, 2010). With many studies showing the connection between light exposure and reduced sleep quality, a study conducted tested the effects off artificial light on sleep quality and duration, five light conditions were tested in relation to the level of salivary melatonin suppression. The five types of light participants were exposed were to Red light (660nm), Amber light (595nm), Green (525nm), Blue/Green (497nm) and Blue (470nm). Lower wavelength (high frequency-high energy) light resulted in greater melatonin suppression from 65% to 81 %. Lower wavelengths also showed a greater Dim Light Melatonin onset (DLMO) ranging from 27 to 36 minutes (Wright, & Lack, 2001).  This study shows the effects of blue light specifically. Blue light is also the most used light frequency on Smartphone devises. 

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Blue infused white light has been implemented in the workplace to increase alertness and productivity (Viola, James, Schlangen, & Dijk, 2008). The uses of devices that emit blue light at night have been recorded to interfere with the body’s biological clock. The process of releasing melatonin takes time with a gradual reduction of light perceived by the eyes, however in this technologically advanced age, 90% of people will expose themselves to blue light right up until they go to sleep (National Sleep Foundation, 2008), especially students. This interferes with the natural production of melatonin making it harder to fall asleep.  The brain of mammals follows certain circadian rhythms that are advantageous to the organism, (e.g. mice hunt at night). The process that keeps track of the daily fluctuations in light is known as the “Pacemakers”. Many of thousands of neural connections govern this process in the suprachiasmatic nuclei (SCN) located in the anterior hypothalamus.

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For many, media use has become intricately connected with our bedtime routine and sleep. Media use prior to bedtime (reported by 9 out of 10 Americans between the ages of 13 and 64, Gradisar et al., 2013) is associated with sleep loss, irregular sleep-wake patterns, poorer sleep quality and increased tiredness during the day (Bartel, Gradisar, & Williamson, 2014; Kubiszewski, Fontaine, Rusch, & Hazouard, 2013; Owens, 2014).

Three mechanisms have been put forward to explain how media use might affect sleep quality. 

-1. First, exposure to bright light, such as that emitted by a television, computer or mobile phone screen, suppresses the secretion of melatonin, delaying sleep onset and disrupting our sleep (Cajochen et al., 2011; Chellappa et al., 2013; Wood, Rea, Plitnick, & Figueiro, 2012).  Melatonin production is particularly sensitive to light at the short wavelength range or blue light, typically emitted by newer mediascreens equipped with light-emitting diodes or LED’s (Berson, Dunn, & Takao, 2002; Chellappa et al., 2013). 

-2. The second mechanism is called sleep displacement, which appears to be strongest among children and adolescents (Adam, Snell, & Pendry, 2007; Hysing, Stormark, Jakobsen, & Lundervold, 2015; Reynolds et al., 2015).  Media use is an unstructured leisure activity.  Unlike dance lessons or sports games, it has no predefined beginning or end points (Kubey, 1986), and is, therefore, more likely to bring about time displacement (Van den Bulck, 2000; 2004b) especially when it happens late or as part of a bedtime ritual (Kubiszewski et al., 2013; Westerik, Renckstorf, Wester, & Lammers, 2005). 

-3. Third, sleep can also be affected by media content. There is a lot of violent and sexual content in the media (Brown et al., 2006; Dill, Gentile, Richter, & Dill, 2005).  Exposure to such content can induce arousal, fright and stress reactions in children (Anderson et al., 2010; Harrison & Cantor, 1999; van der Molen & Bushman, 2008).  The increased excitement and stimulation resulting from this exposure may be associated with difficulties falling asleep or poor sleep quality.

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The advent of the mobile phone has been one of the most profound media revolutions of the past decades.  By 2013, the adoption of mobile phones in society had climbed to over 90%, and over half of the users now have the most advanced version, called a smartphone (Smith, 2013). These provide a multitude of functionalities, ranging from text messaging and calling, to Internet-surfing, e-mailing, watching videos, getting traffic directions or listening to music (Duggan, 2013).  Mobile phone usage has been associated with various health problems and is considered to be harmful to our sleep quality (Calamaro, Mason, & Ratcliffe, 2009; Nathan & Zeitzer, 2013; Söderqvist, Carlberg, & Hardell, 2008; Thomée, Härenstam, & Hagberg, 2011).  Using mobile phones around bedtime or even after lights out, has become a common practice: as early as 2007, one in five Flemish adolescents reported sending and/or receiving text messages at least once a week after lights out, and 15.2% of them sent and/or received more than 10 messages per night (Van den Bulck, 2007).  Van den Bulck’s study (2007) found that those who used mobile phones after lights out at least once a month were two times more likely to report feeling very tired one year later, at follow-up, compared to those who never used their mobile phone at night.  For those who used them after lights out about once a week or several times a week these odds were three and five times higher, respectively. In a large sample of Japanese adolescents (N = 95680), 18% indicated using their mobile phone daily after lights out and frequency of use was higher among senior compared to junior high school students. Mobile phone usage after lights out was associated with shorter sleep duration and poorer sleep quality, more daytime sleepiness and insomnia symptoms (Munezawa et al., 2011). Several studies found adverse effects of electromagnetic fields emitted by mobile phones on sleep electroencephalograms (Loughran et al., 2005; Lowden et al., 2011) and melatonin onset time (Wood; Loughran, Stough, 2006).  Nathan & Zeitzer (2013) investigated mobile phone usage and daytime sleepiness in a sample of California high-school students (N = 211).  Although they found no direct relationship, they reported that the need to feel accessible at all times and failed attempts to reduce mobile phone usage were predictive of daytime sleepiness.  Respondents scoring higher on these two predictors were also more likely to stay up later to use their mobile phone and to be awakened more often at night by their mobile phone.  Other studies have confirmed that psychological attributes of high mobile phone usage (such as the need to be accessible) are related to sleep disturbances (Thomée et al., 2011). 

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Most studies on this topic deal with children and adolescents. Studying the literature suggests, however, that different processes are at work among adults. For example, while media use is generally modeled as a predictor of sleep difficulties, a longitudinal study among emerging adults found media use to be an outcome and not a cause of sleep problems (Tavernier & Willoughby, 2014). The authors hypothesized that media may be used by adults as a way to cope with their sleep problems. Moreover, while media use often results in a shorter sleep duration among children and adolescents, also known as sleep displacement (King, Delfabbro, Zwaans, & Kaptsis, 2014; Zimmerman, 2008), studies among adults have found evidence of time shifting, a process whereby media use coincides with later bedtimes and rise times, resulting in no impact on total sleep duration (Custers & Van den Bulck, 2012; Exelmans & Van den Bulck, 2014).

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An array of sleep factors are known to build up in the brain during wakefulness and they are known to dissipate during sleep and these factors are known to be responsible for the homeostatic process. The suprachiasmatic nuclei (SCN) are the main organs responsible for the circadian rhythm. The classical photoreceptors rods and cones are responsible for image forming vision, but ipRGCs (intrinsically photosensitive retinal ganglion cells) that express melanopsin are most important for the non-image forming photoreception and they regulate circadian photic entrainment, pupillary light response, and other important biological functions. Synchronization of homeostatic and circadian regulation are important for the quality, quantity, and timing of sleep. Blue light of around 460 nm spectrum, suppresses melatonin, and affects human circadian clock. Source of this blue light can be, light from an artificial light source such as blue-enriched LED lamp, LED backlight for LCD, organic light emitting diodes, computer screens, and from the smartphones monitor.

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A recent study in America showed that 90% of young adults under 30 used some technological device in the hour before bed. A recent review of literature in which the association between youth screen media use and sleep was assessed, almost 90% studies reported delayed sleep time and also decreased total sleep duration among bedtime media users. People exposed to blue light at night can have increased incidence of obesity, diabetes, sleep, psychiatric, and cardiovascular disorders and cancers due to epigenetic changes.

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There are many different reasons for sleep disorders. Bedtime usage of smartphones has become one of the rising reasons for sleep disturbance. Research by the medical professionals has concluded that: 1) the adverse effects of bedtime smartphone usage on sleep health, and 2) the damaged sleep health could further have adverse health effects of obesity, diabetes, and insomnia (Shochat, 2012; Mortazavi & Mortazavi, 2018; Schweizer et. al., 2016; Hughes & Burke, 2018; Exelmans & Van Den Bulck, 2016; Polos et. al., 2015; and Levenson et. al., 2017).

Shochat (2012) stated that the usage of electronic media is one of the most important factors affecting sleep in young people and adults. Smartphones with Internet access allow people to browse media and watch videos/movies. Watching videos/movies with screen brightness of the phone makes people more active, which will slowly delay their sleep. Shochat (2012) has concluded that technological advancements have taken their toll on human health with damaging effects on sleep quality, quantity, and timing.  Figure below is the schematic model of environmental and behavioral factors interfering sleep quality, quantity, and timing, in which technology is regarded as one of the environmental factors (Shochat, 2012). 

Figure above shows environmental and behavioral factors interfering sleep quality, quantity, and timing 

(Source: Shochat, 2012)

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In contrast to Shochat (2012)’s environmental and behavioral concerns related to sleep disturbance, Mortazavi and Mortazavi (2018) explained why smartphone usage at the night-time causes adverse effects on human biologically (see figure blow). Usually smartphones emit a blue light that suppresses the secretion of melatonin, a sleep hormone. The reduced melatonin secretion disturbs human’s circadian rhythm (i.e., the internal body clock for sleep/wake cycle). Mortazavi and Mortazavi (2018) specifically recommended women with hereditary breast cancer predisposition avoid using of smart phones at the night-time. When women with hereditary breast cancer predisposition uses smartphones or tablets at the night-time, the blue light will amplify their risk of cancer. Hence, it is advised to avoid using smartphones at the night-time or to be used by wearing sunglasses or amber lenses that can reduce the exposure to blue light and hence the risk of disruption in circadian rhythm (Mortazavi and Mortazavi, 2018). One of the many cancer-preventing properties of melatonin is to limit estrogen production. Increased lifetime exposure to estrogen is a well-known cause of breast cancer.

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Figure above shows Impact of night-time smartphone usage on breast cancer (Source: Mortazavi & Mortazavi, 2018)

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Schweizer et. al. (2016) conducted a longitudinal study among adolescents and showed that ownership of smartphones tends to entail sleep disturbance. They surveyed 591 participants twice with two years apart. They also divided the participants into three groups as owners, non-owners, and new owners. They found all three groups decreased their sleeping time between time 0 and time 1. At time 0 (with average age around 14), owners of a smartphone were found to sleep significantly less than non-owners or new-owners especially on school days, and to report significantly more sleeping problems. At time 1, owners and new-owners showed no significant differences on sleep duration or sleeping problems.

Hughes and Burke (2018) measured the impact of refraining from overnight smartphone use on wellbeing. They asked the experimental group participants who abstained from smartphone use in the bedroom for one week to answer the four surveys pre- and post the experiment: Subjective Happiness Scale, Quality of Life Scale, Smartphone Addiction Scale, and Intensity & Time Affect Survey. In three out of these four measures, the hypothesis of increased wellbeing was upheld. 

Exelmans and Van Den Bulck (2016) studied the bedtime use of mobile phone and sleep. They concluded that 50% of the respondents owned a smartphone, and 60% took their mobile phones to the bedroom. Calling/texting after lights out have significantly predicted respondents’ scores on the Pittsburgh Sleep Quality Index (PSQI), particularly “longer sleep latency, worse sleep efficiency, more sleep disturbance, and more daytime dysfunction.” Using the Fatigue Assessment Scale (FAS) and the Bergen Insomnia Scale (BIS), they found that bedtime mobile phone use predicted respondents’ self-reported later rise time, higher insomnia score, and increased fatigue. 

Exelmans and Van Den Bulck (2016) also found that age significantly moderated the relationship between bedtime mobile phone use and fatigue, rise time, and sleep duration: increased bedtime mobile phone usage was associated with more fatigue and later rise times among younger respondents (≤ around 40 years old); but it was related to an earlier rise time (≥ 60.15 years old) and shorter sleep duration (≥ 66.4 years old) among older respondents.

Polos et al. (2015) examined the extent and impact of mobile device-based Sleep Time-Related Information and Communication Technology (STRICT) use among 3139 U.S. adolescents (average age of 13.3 years) and found that about 62% of them used STRICT after bedtime, 56.7% texted/tweeted/messaged in bed, and 20.8% awoke to texts. They also found that STRICT use was associated with insomnia, daytime sleepiness, eveningness, academic underperformance, later bedtimes, and shorter sleep duration.

Levenson, et al. (2017) conducted a large-scale study of 1763 young adults (19 – 32 years) in the U.S. and found that using social media within thirty minutes before bed had an odd ratio of 1.62 for increased sleep disturbance.  Importantly, the more frequently the young adults checked their social media before bed, the greater their sleep disturbances were likely to be.

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Here are some tips to help you get out of using any screen usage before bedtime:

-1. Night mode: While the blue spectrum of your screen time exposure keeps you awake, the yellow spectrum/tint of the night mode helps you sleep. This is because our brain associates sundown with sleep, and sustained use of a yellowish-orange tint in your devices are more likely to put you to sleep as it doesn’t activate your brain.

-2. Unwinding through non-screen habits: If you’re the kind of person who reads or watches movies before bedtime on your tablet or phone before sleeping, it is best to go offline. Reading books with a time limit and engaging in calming practices that do not involve a screen would be beneficial in helping you replace your smartphone’s adverse effects on your mind. You can look into journaling, reading, playing board games, talking to your partner, and anything that keeps you away from your smartphone and PC screen. These activities don’t stimulate or activate our brain in an addictive or harmful cycle like a smartphone or PC would induce.

-3. Switch on DND/Airplane mode: You can activate the Do Not Disturb mode of your phone to only ring/vibrate in case of exceptions. Additionally, using the airplane mode can help if you’re not expecting/able to take any calls.

-4. Time limit before bed: There is a time window when you should stop all forms of screen exposure. By avoiding any screen exposure one hour before bedtime, you’re setting yourself up for a night of high-quality sleep where blue light from your phone doesn’t disrupt your sleep.

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My view:

When you are super tired (due to lot of running around, lot of physical or mental work during day time) you fall asleep no matter what you did just before bed. The sleep pressure is so high there is really no effect of what happens before bedtime. So all the logic of smartphone use before bedtime disrupting sleep is valid provided you are not super tired.

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Section-14

Smartphone overuse and Neuroscience:   

All day long, we’re inundated by interruptions and alerts from our devices. Smartphones buzz to wake us up, emails stream into our inboxes, notifications from co-workers and far away friends bubble up on our screens, and “assistants” chime in with their own soulless voices. Such interruptions seem logical to our minds: we want technology to help with our busy lives, ensuring we don’t miss important appointments and communications.

But our bodies have a different view: These constant alerts jolt our stress hormones into action, igniting our flight or flight response; our heartbeats quicken, our breathing tightens, our sweat glands burst open, and our muscles contract. That response is intended to help us outrun danger, not answer a call or text from a colleague. We are simply not built to live like this. Our apps are taking advantage of our hard-wired needs for security and social interaction and researchers are starting to see how terrible this is for us. A full 89% of college students now report feeling “phantom” phone vibrations, imagining their phone is summoning them to attention when it hasn’t actually buzzed. Another 86% of Americans say they check their email and social media accounts “constantly,” and that it’s really stressing them out. Endocrinologist Robert Lustig says that notifications from our phones are training our brains to be in a nearly constant state of stress and fear by establishing a stress-fear memory pathway. And such a state means that the prefrontal cortex, the part of our brains that normally deals with some of our highest-order cognitive functioning, goes completely haywire, and basically shuts down. “You end up doing stupid things,” Lustig says. “And those stupid things tend to get you in trouble.” We can change this by drawing boundaries around socially acceptable smartphone use. If we can make a smartphone addiction taboo (like smoking inside buildings, for example), people will at least have to sanction their phone time off to delegated places and times, giving their brains a break.

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The effects of smartphone overuse on the brain:

Today’s youth could benefit from educational support, safety and security smartphones provide and protect themselves by using social media in a way that protects their mental health. Through smartphones, we can have immediate access to various databases and documents. Good habits can be encouraged and tracked, like using health applications. GPS monitoring will assist parents in keeping their children safe. Research suggests smartphones affect our brain in a variety of ways. Researches show that the brain in your pocket is draining energy from the brain in your head.

-1. Smartphone effects on IQ and productivity:

The takeaway finding from a new study from The University of Texas at Austin’s McCombs School of Business says that people who were the most reliant on their smartphones performed poorer than their less-reliant counterparts. Most people multitask in order to get something done in less time. It appears to be more effective, but it’s not. Scientists have known for years what people often won’t admit to themselves: humans can’t really multi-task. This is true for almost all of us: about 97.5% of the population. The other 2.5% have freakish abilities; scientists call them “super taskers,” because they can actually successfully do more than one thing at once. They can drive while talking on the phone, without compromising their ability to gab or shift gears. But since only about 1 in 50 people are super taskers, the rest of us mere mortals are really only focusing on just one thing at a time. That means every time we pause to answer a new notification or get an alert from a different app on our phone, we’re being interrupted, and with that interruption we pay a price: something called a “switch cost.” Sometimes the switch from one task to another costs us only a few tenths of a second, but in a day of flip-flopping between ideas, conversations, and transactions on a phone or computer, our switch costs can really add up, and make us more error-prone, too. Every time we switch tasks, we’re also shooting ourselves up with a dose of the stress hormone cortisol. The switching puts our thoughtful, reasoning prefrontal cortex to sleep, and kicks up dopamine, our brain’s addiction chemical. In other words, the stress that we build up by trying to do many things at once when we really can’t is making us sick, and causing us to crave even more interruptions, spiking dopamine, which perpetuates the cycle. Psychologists have discovered that even fleeting mental blocks caused by switching between tasks will cost up to 40% of the productive time. After a while, the brain begins consciously searching for ways to fill the gaps in tasks. The more you try to multitask, the harder it becomes. Other research has shown that multitasking can have a detrimental effect on your short-term memory and artificially lower your IQ by up to 10 points. According to research, context switching destroys efficiency by slowing us down and making us feel rushed, overworked, and prone to burnout. You must know that how your screen time impacts the rest of your career if you intend to do your best work. Over the past two decades, it is estimated that 76,000 people have suffered head and neck injuries due to mobile phone use.

-2. Cognitive Ability: 

Today, it is incredibly convenient to just Google the things we don’t know and get the answer in just a click. But this over-reliance on Google and on the internet to solve our problems and questions backfires on us.

Dr. Gordon Pennycook, a Ph.D. in Cognitive Psychology at the University of Waterloo, expresses that our over-reliance on the internet has diluted our mental intelligence and abilities to logically solve and determine correct answers on our own. This is because we are truly dependent on what the Internet is giving us. Rather than reading about things and making conclusions analytically, we assume that the answers we garner from the internet are simply correct. According to a report published recently in the Journal of the Association for Consumer Research, a smartphone can tax the user’s cognition simply by its presence with that person. It discovers that a smartphone will demand its user’s attention even when they aren’t using it or thinking about it.

-3. Laziness of the mind:

Our brains can only process so much information at a time, about 60 bits per second. The more tasks we have to do, the more we have to choose how we want to use our precious brain power. So it’s understandable that we might want to pass some of our extra workload to our phones or digital assistants. But there is some evidence that delegating thinking tasks to our devices could not only be making our brains sicker, but lazier too. Researchers have found smarter, more analytical thinkers are less active on their smartphone search engines than other people. That doesn’t mean that using your phone for searching causes you to be “dumber,” it could just be that these smarties are searching less because they know more. But the link between less analytical thinking and more smartphone scrolling is there. We also know that reading up on new information on your phone can be a terrible way to learn. Researchers have shown that people who take in complex information from a book, instead of on a screen, develop deeper comprehension, and engage in more conceptual thinking, too. Brand new research on dozens of smartphone users in Switzerland also suggests that staring at our screens could be making both our brains and our fingers more jittery.

In research published this month, psychologists and computer scientists have found an unusual and potentially troubling connection: the more tapping, clicking and social media posting and scrolling people do, the “noisier” their brain signals become. That finding took the researchers by surprise. Usually, when we do something more often, we get better, faster and more efficient at the task. But the researchers think there’s something different going on when we engage in social media: the combination of socializing and using our smartphones could be putting a huge tax on our brains. Social behavior, “may require more resources at the same time,” study author Arko Ghosh said, from our brains to our fingers.

-4. Digital Amnesia: Excessive use of mobile phone could lead to memory loss:

Smartphone addiction could impair our brain’s ability to retain new information and form new memories. Psychologists have maintained for long that stress can cause amnesia or affect the memory adversely. But that is not the only reason. Excessive use of mobile phones, apparently, can cause memory loss in humans.

When cyber security company Kaspersky Lab conducted a survey of 6,000 mobile phone users, it found that 71 per cent of them can’t remember the phone numbers of their children and 87 per cent can’t recollect the phone numbers of their children’s schools. According to some of the respondents, losing their Smartphone will cause them to forget what they’ve been up to.

Distraction is one of the key factors that make memories more difficult to form. When we are busy multitasking on our Smartphones and quickly looking for information in multiple apps and notifications, we are only half-focused on learning a new skill. Hence, the information is unlikely to get stored in our long-term memory.

Smartphone addiction can interrupt sleep. We need deep sleep to detoxify our brain. It is only when we are in deep sleep that the brain engages in synaptic pruning—making room for new information by pruning old information. When we have interrupted sleep, synaptic pruning cannot take place, thus, impairing our ability to retain new information and form new memories.

Not just sleep, increased screen time also reduces our IQ significantly, according to the Institute of Psychiatry at the University of London.

Increasing exposure to mobile devices negatively affects the figural memory of adolescents, revealed a recent study by the researchers at Swiss Tropical and Public Health Institute (Swiss TPH). Figural memory, which helps us make sense of images, patterns and shapes, is located in the right hemisphere of the brain. Hence, teenagers, who hold their phone next to their right ear, are the most affected. The researchers, who did this study on 700 teenagers, claim that a young developing brain is more susceptible to phone-wave-induced changes up to 15 years of age. They found that on an average, a teen is exposed to 858 mJ/kg of radiation per day when their average call time is 10.6 minutes.

-5. Smartphone usage and teenagers’ mental health:

There is a concerning link between the popularity of smartphones and the rise of mental health issues among teenagers and young adults. Young people are now constantly aware of social media’s damaging effect on their lives and are taking measures to reduce it. According to a new survey, 54% of teenagers believe they waste so much time on their phones.

-6. Smartphone overuse demotes our Social Interactions:

The use of smartphones effectively kills your mood and pace, especially if you’re in a group setting. It steals away your attention from the people around you as well as your surroundings. It diminishes your cognitive ability in connecting and socializing with other people. This often results in further withdrawing from society and increasing the likelihood of being a “shut-in.”

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Alterations in White Matter Integrity in Young Adults with Smartphone Dependence, a 2017 study:

Authors hypothesized that due to its similarities to other behavioral addictions, SPD may also be associated with impairments of white matter fibers (Wang et al., 2016). In this study, authors investigated white matter integrity in young adults with SPD using observer-independent tract-based spatial statistics (TBSS) analysis with DTI and linked the quantitative variables of brain structures to the behavioral measures of SPD.

Smartphone dependence (SPD) is increasingly regarded as a psychological problem, however, the underlying neural substrates of SPD is still not clear. High resolution magnetic resonance imaging provides a useful tool to help understand and manage the disorder. In this study, a tract-based spatial statistics (TBSS) analysis on diffusion tensor imaging (DTI) was used to measure white matter integrity in young adults with SPD. A total of 49 subjects were recruited and categorized into SPD and control group based on their clinical behavioral tests. To localize regions with abnormal white matter integrity in SPD, the voxel-wise analysis of fractional anisotropy (FA) and mean diffusivity (MD) on the whole brain was performed by TBSS. The correlation between the quantitative variables of brain structures and the behavior measures were performed. The result demonstrated that SPD had significantly lower white matter integrity than controls in superior longitudinal fasciculus (SLF), superior corona radiata (SCR), internal capsule, external capsule, sagittal stratum, fornix/stria terminalis and midbrain structures. Correlation analysis showed that the observed abnormalities in internal capsule and stria terminalis were correlated with the severity of dependence and behavioral assessments. The finding facilitated a primary understanding of white matter characteristics in SPD and indicated that the structural deficits might link to behavioral impairments.

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Brain Drain: The Mere Presence of One’s Own Smartphone Reduces Available Cognitive Capacity, a 2017 study:

Our smartphones enable—and encourage—constant connection to information, entertainment, and each other. They put the world at our fingertips, and rarely leave our sides. Although these devices have immense potential to improve welfare, their persistent presence may come at a cognitive cost. In this research, authors test the “brain drain” hypothesis that the mere presence of one’s own smartphone may occupy limited-capacity cognitive resources, thereby leaving fewer resources available for other tasks and undercutting cognitive performance. Results from two experiments indicate that even when people are successful at maintaining sustained attention—as when avoiding the temptation to check their phones—the mere presence of these devices reduces available cognitive capacity. Moreover, these cognitive costs are highest for those highest in smartphone dependence. Authors conclude by discussing the practical implications of this smartphone-induced brain drain for consumer decision-making and consumer welfare.

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Wired to be connected? Links between mobile technology engagement, intertemporal preference and frontostriatal white matter connectivity, a 2019 study: 

Youth around the world are increasingly dependent on social media and mobile smartphones. This phenomenon has generated considerable speculation regarding the impacts of extensive technology engagement on cognitive development and how these habits might be ‘rewiring’ the brains of those growing up in a heavily digital era. In an initial study conducted with healthy young adults, authors utilized behavioral and self-report measures to demonstrate associations between smartphone usage habits (assessed both subjectively and objectively) and individual differences in intertemporal preference and reward sensitivity. In a follow-up neuroimaging study, authors used probabilistic tractography of diffusion-weighted images to determine how these individual difference characteristics might relate to variation in white matter connectivity, focusing on two dissociable pathways—one connecting the ventral striatum (vSTR) with the ventromedial prefrontal cortex (vmPFC) and the other connecting the vSTR with the dorsolateral prefrontal cortex (dlPFC). Regression analyses revealed opposing patterns of association, with stronger vSTR–vmPFC connectivity corresponding to increased mobile technology engagement but stronger vSTR–dlPFC connectivity corresponding to decreased engagement. Taken together, the results of these two studies provide important foundational evidence for both neural and cognitive factors that can be linked to how individuals engage with mobile technology.

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Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children, a 2020 study:

For the study, published in JAMA Pediatrics, researchers at the Cincinnati Children’s Hospital Medical Center compared brain scans of 47 otherwise healthy children aged 3 to 5 with parental reports of their screen use. In this cross-sectional study of 47 healthy prekindergarten children, screen use greater than that recommended by the American Academy of Pediatrics guidelines was associated with (1) lower measures of microstructural organization and myelination of brain white matter tracts that support language and emergent literacy skills and (2) corresponding cognitive assessments. They found that that children who exceed the one-hour-per-day guideline for screen time set by the American Academy of Pediatrics (AAP) had lower structural integrity of white matter in parts of the brain that are associated with literacy skills such as imagery, mental control and self-regulation. The children who exceeded the AAP guidelines also performed worse on cognitive tests. For instance, they had lower expressive language and were slower to rapidly name objects in tests of processing speed. “This is important because the brain is developing the most rapidly in the first five years,” said lead author Dr. John Hutton, a pediatrician at Cincinnati Children’s Hospital. “That’s when brains are very plastic and soaking up everything, forming these strong connections that last for life.”

The researchers noted that in just one generation, portable electronics have rapidly changed childhood, as screen time has become a regular part of learning and playing that only increases from infancy onward.

The children in the study averaged around two hours of screen time per day, though the highest amount reported was 12 hours per day. Around 60 percent had their own portable electronic device and 41 percent had a screen in their bedroom.

Previous studies have also linked screen time to behavioral issues in children, prompting the World Health Organization to set guidelines promoting physical activity over screen time.

This study does not show causation and the screens themselves are probably not directly damaging children’s brains. However, increased screen use may take away from time children would otherwise spend interacting with their families, who may also be using screens instead of interacting, The quality of these experiences could play an important role in white matter development. White matter tracts are the pathways for communication between different parts of the brain’s gray matter, which houses cells that actually tell the body what to do. Underdeveloped white matter tracts slow communication between parts of the brain and lead to disorganized information processing.

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Effects of smartphone overuse on headache, sleep and quality of life in migraine patients, a 2019 study: Smartphone use has been observed to increase headache duration and frequency in migraine patients. Its overuse in migraine patients is related to poor sleep quality and daytime sleepiness; furthermore, as the smartphone use increases, sleep quality decreases, daytime sleepiness increases and quality of life decreases. In conclusion, this study showed that headache, sleep quality, daytime functions and quality of life are affected depending on the extent of smartphone use in migraine patients.

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Mobile phones: The effect of its presence on learning and memory, a 2020 study:

The aim was to examine the effect of a smartphone’s presence on learning and memory among undergraduates. A total of 119 undergraduates completed a memory task and the Smartphone Addiction Scale (SAS). As predicted, those without smartphones had higher recall accuracy compared to those with smartphones. Results showed a significant negative relationship between phone conscious thought, “how often did you think about your phone”, and memory recall but not for SAS and memory recall. Phone conscious thought significantly predicted memory accuracy. Authors found that the presence of a smartphone and high phone conscious thought affects one’s memory learning and recall, indicating the negative effect of a smartphone proximity to our learning and memory.

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Exploring the link between smartphone overuse and cognitive decline: a scoping review of 2022:

The technological innovation of smartphones and various software has made our lives more convenient. However, the negative effects of our excessive dependence on them cannot be overlooked. The purpose of this scoping review was to understand the relationship between the use of smartphones and our cognitive functions, as well as to present important research directions for the future.

Material and methods.

All relevant literature, published as of 1 March 2020, was searched using the following databases: CInAHL, embase, PubMed, PsycInFo. The framework proposed by Arksey and o’Malley, which has a review process of five stages, was used for the review.

Results.

Overuse of smartphones was found to be related to decrease concentration, working memory and cognitive suppression. In particular, the results of concentration and cognitive restraint function could be interpreted as a result of the impulsive behaviour pattern of an individual, and the results of working memory could be explained by the principle of overload due to the limitation of the user’s working memory capacity. The association between smartphone usage levels and cognitive functions was compared. The results of this scoping review highlight the need for future research to thoroughly assess the user’s impulse and associated cognitive functions for smartphone use.

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The impact of digital media on children’s intelligence while controlling for genetic differences in cognition and socioeconomic background, a 2022 study:

Digital media defines modern childhood, but its cognitive effects are unclear and hotly debated. Authors believe that studies with genetic data could clarify causal claims and correct for the typically unaccounted role of genetic predispositions. Here, authors estimated the impact of different types of screen time (watching, socializing, or gaming) on children’s intelligence while controlling for the confounding effects of genetic differences in cognition and socioeconomic status. Authors analyzed 9855 children from the USA who were part of the ABCD dataset with measures of intelligence at baseline (ages 9–10) and after two years. At baseline, time watching (r = − 0.12) and socializing (r = − 0.10) were negatively correlated with intelligence, while gaming did not correlate. After two years, gaming positively impacted intelligence (standardized β =  + 0.17), but socializing had no effect. This is consistent with cognitive benefits documented in experimental studies on video gaming. Unexpectedly, watching videos also benefited intelligence (standardized β =  + 0.12), contrary to prior research on the effect of watching TV. Although, in a post hoc analysis, this was not significant if parental education (instead of SES) was controlled for. Broadly, these results are in line with research on the malleability of cognitive abilities from environmental factors, such as cognitive training and the Flynn effect.

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Aberrant intrinsic neural network strength in individuals with “smartphone addiction”: An MRI data fusion study, 2022 study:

Excessive smartphone use, also referred to as “smartphone addiction” (SPA), has increasingly attracted neuroscientific interest due to its similarities with other behavioral addictions, particularly internet gaming disorder.

A growing number of studies in recent years emphasized negative physical and psychosocial effects of excessive use of smartphones, also known as “smartphone addiction”. Studies have shown that excessive smartphone use has many similarities to other addictive disorders. These include the failure to resist the use of the smartphone, withdrawal from social relations, continuation of use despite being aware of negative consequences and deception of others regarding the amount of time spent using it. Excessive smartphone use is very similar to the “internet gaming disorder (IGD)”, which is a recognized disorder included in the Diagnostic and Statistics Manual of Mental Disorders, the handbook health practitioners in the US use as a guide for diagnosing mental disorders.

Studies have shown that individuals with excessive smartphone use behaviors may exhibit structural and functional changes to their brains such as reduced gray matter volume or intrinsic neural activity in the region of the brain called anterior cingulate cortex, altered functional connectivity and changes in activity in various parts of the cortex during processing of emotions.

Structural and functional correlates of smartphone addiction, a 2020 study found that:

• Persons with SPA showed lower gray matter volume in insula and temporal cortex.
• Persons with SPA showed reduced resting-state activity of the anterior cingulate cortex.
• Anterior cingulate cortex volume and activity was associated with SPA-severity.
• The data suggest aberrant neural integrity of the salience network.

“Because of its similarities to internet gaming disorder (IGD), there is an ongoing debate on if excessive smartphone use (ESU) is a facet of IGD or a distinct form of addictive behavior,” said study authors Mike M. Schmitgen and Robert Christian Wolf of the Cognitive Neuropsychiatry working group at Heidelberg University. “In this paper, researchers wanted to expand the extant knowledge on putative neural mechanisms underlying ESU by using multivariate data fusion methods to capture joint information in brain structure and resting-state activity.”

To study whether people with excessive smartphone use behaviors differ from the general population in gray matter volume in certain areas of the brain and indicators of spontaneous brain activity (amplitude of low frequency fluctuations – ALFF), the researchers conducted a study using functional magnetic resonance imaging.

After recruiting participants through ads, flyers and social media, they selected a group of 44 participants. These were divided into a smartphone addiction group (SPA, 20 persons, 14 females) and a group without smartphone addiction (n-SPA, 24 persons, 17 females) based on psychological assessments (short version of the Smartphone Addiction Scale). Wanting to differentiate between smartphone addiction and the internet gaming disorder, researchers excluded any persons showing this disorder from the sample.

All participants completed another, more comprehensive, smartphone addiction assessment (Smartphone addiction inventory – SPAI-I) and an assessment of depression (Beck Depression Inventory – BDI). Participants underwent functional magnetic resonance imaging (fMRI) four times, “a resting-state scan, three experimental paradigms and a structural scan.” This particular paper reported on results of the resting-state scan — a scan taken while participants were at rest and instructed to close their eyes.

Two resting-state fMRI components that differed between the two groups were found. “One of these networks mainly comprised areas of the frontal cortex, whereas the other one predominantly comprised parietal and cerebellar regions,” Schmitgen and Wolf said.

“Aberrant activity of both networks has been previously suggested in addictive disorders, including IGD. It is possible that in persons with ESU, the very same systems could drive addictive behavior, at least partly. In this regard, it is noteworthy that authors found associations between neural network strength and time spent with the device as well as for sleep difficulties.”

This study suggests distinct neural mechanisms underlying specific biological and behavioral dimensions of excessive smartphone use. This study using functional magnetic resonant imaging (fMRI) compared brain activities of persons suffering from smartphone addiction (excessive smartphone use) and those who use their smartphones in a less intrusive way. It reported systematic differences in brain activity during rest between the two groups. Additionally, two fMRI indicators of neural activity were found to be correlated with psychological assessments of excessive smartphone use. The study was published in Brain and Behavior.

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Smartphone overuse and Dopamine: 

Dr. David Greenfield calls smartphones the world’s smallest slot machine. Dr. Greenfield is a technology expert who has studied cell phone addiction. He says that every so often, the cell phone gives you a reward. These rewards in the form of emails, text messages or other updates. These rewards are surprises, and you don’t much about them before they arrive. They may be filled with great news, much like a slot machine will often deliver a jackpot. Someone who is addicted to their phone experiences a dopamine release when these rewards come through. Cell phone addicts crave these releases; so much so that they can’t think about anything else. They may use their phones frequently, without even thinking about it. They think about their phones first thing in the morning, and last thing at night. If their phones go missing, or they can’t check them for some reason, it causes a panic. Experts often refer to this type of dopamine release as a dopamine loop. It just continues for as long as the phone is in the person’s hand. It’s why checking a text message turns into social media scrolling, and then moves on to using Google. It is an addiction in every sense of the word.

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“I feel tremendous guilt,” admitted Chamath Palihapitiya, former Vice President of User Growth at Facebook, to an audience of Stanford students. He was responding to a question about his involvement in exploiting consumer behavior. “The short-term, dopamine-driven feedback loops that we have created are destroying how society works,” he explained. In Palihapitiya’s talk, he highlighted something most of us know but few really appreciate: smartphones and the social media platforms they support are turning us into bona fide addicts. While it’s easy to dismiss this claim as hyperbole, platforms like Facebook, Snapchat, and Instagram leverage the very same neural circuitry used by slot machines and cocaine to keep us using their products as much as possible.

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If you’ve ever misplaced your phone, you may have experienced a mild state of panic until it’s been found. About 73% of people claim to experience this unique flavor of anxiety, which makes sense when you consider that adults in the US spend an average of 2-4 hours per day tapping, typing, and swiping on their devices—that adds up to over 2,600 daily touches. Most of us have become so intimately entwined with our digital lives that we sometimes feel our phones vibrating in our pockets when they aren’t even there.

While there is nothing inherently addictive about smartphones themselves, the true drivers of our attachments to these devices are the hyper-social environments they provide. Thanks to the likes of Facebook, Snapchat, Instagram, and others, smartphones allow us to carry immense social environments in our pockets through every waking moment of our lives. Though humans have evolved to be social—a key feature to our success as a species—the social structures in which we thrive tend to contain about 150 individuals. This number is orders of magnitude smaller than the 2 billion potential connections we carry around in our pockets today. There is no doubt that smartphones provide immense benefit to society, but their cost is becoming more and more apparent. Studies are beginning to show links between smartphone usage and increased levels of anxiety and depression, poor sleep quality, and increased risk of car injury or death. Many of us wish we spent less time on our phones but find it incredibly difficult to disconnect.

Why are our smartphones so hard to ignore?

Dopamine and social reward:

Dopamine is a chemical produced by our brains that plays a starring role in motivating behavior. It gets released when we take a bite of delicious food, when we have sex, after we exercise, and, importantly, when we have successful social interactions. In an evolutionary context, it rewards us for beneficial behaviors and motivates us to repeat them.

The human brain contains four major dopamine “pathways,” or connections between different parts of the brain that act as highways for chemical messages called neurotransmitters. Each pathway has its own associated cognitive and motor (movement) processes. Three of these pathways—the mesocortical, mesolimbic, and nigrostriatal pathways—are considered our “reward pathways” and have been shown to be dysfunctional in most cases of addiction. They are responsible for the release of dopamine in various parts of the brain, which shapes the activity of those areas. The fourth, the tuberoinfundibular pathway, regulates the release of a hormone called prolactin that is required for milk production.

Figure above shows three dopamine pathways and their related cognitive processes.

Most of your dopamine is generated deep in the midbrain, and it is released in many different areas across the brain. These areas are largely responsible for behaviors associated with learning, habit formation, and addiction.

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While the reward pathways (figure above) are distinct in their anatomical organization, all three become active when anticipating or experiencing rewarding events. In particular, they reinforce the association between a particular stimulus or sequence of behaviors and the feel-good reward that follows. Every time a response to a stimulus result in a reward, these associations become stronger through a process called long-term potentiation. This process strengthens frequently used connections between brain cells called neurons by increasing the intensity at which they respond to particular stimuli.

Although not as intense as hit of cocaine, positive social stimuli will similarly result in a release of dopamine, reinforcing whatever behavior preceded it. Cognitive neuroscientists have shown that rewarding social stimuli—laughing faces, positive recognition by our peers, messages from loved ones—activate the same dopaminergic reward pathways. Smartphones have provided us with a virtually unlimited supply of social stimuli, both positive and negative. Every notification, whether it’s a text message, a “like” on Instagram, or a Facebook notification, has the potential to be a positive social stimulus and dopamine influx.

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Research in reward learning and addiction have recently focused on a feature of our dopamine neurons called reward prediction error (RPE) encoding. These prediction errors serve as dopamine-mediated feedback signals in our brains (figure below). This neurological feature is something casino owners have used to their advantage for years. If you’ve ever played slots, you’ll have experienced the intense anticipation while those wheels are turning—the moments between the lever pull and the outcome provide time for our dopamine neurons to increase their activity, creating a rewarding feeling just by playing the game. It would be no fun otherwise. But as negative outcomes accumulate, the loss of dopamine activity encourages us to disengage. Thus, a balance between positive and negative outcomes must be maintained in order to keep our brains engaged.

Figure above shows reward prediction and subsequent dopamine activity.

Unexpected rewards increase the activity of dopamine neurons, acting as positive feedback signals for the brain regions associated with the preceding behavior. As learning takes place, the timing of activity will shift until it occurs upon the cue alone, with the expected reward having no additional effect. And should the expected reward not be received, dopamine activity drops, sending a negative feedback signal to the relevant parts of the brain, weakening the positive association.

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Variable reward schedules:

How do social media apps take advantage of this dopamine-driven learning strategy? Similar to slot machines, many apps implement a reward pattern optimized to keep you engaged as much as possible. Variable reward schedules were introduced by psychologist B.F. Skinner in the 1930’s. In his experiments, he found that mice respond most frequently to reward-associated stimuli when the reward was administered after a varying number of responses, precluding the animal’s ability to predict when they would be rewarded. Humans are no different; if we perceive a reward to be delivered at random, and if checking for the reward comes at little cost, we end up checking habitually (e.g. gambling addiction). If you pay attention, you might find yourself checking your phone at the slightest feeling of boredom, purely out of habit. Programmers work very hard behind the screens to keep you doing exactly that.

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If you’ve been a Facebook user for more than a few years, you’ve probably noticed that the site has been expanding its criteria for notifications. When you first join Facebook, your notification center revolves around the initial set of connections you make, creating that crucial link between notification and social reward. But as you use Facebook more and begin interacting with various groups, events, and artists, that notification center will also become more active. After a while, you’ll be able to open the app at any time and reasonably expect to be rewarded. When paired with the low cost of checking your phone, you have a pretty strong incentive to check in whenever you can.

Other examples highlight a more deliberate effort to monopolize your time. Consider Instagram’s implementation of a variable-ratio reward schedule. Instagram’s notification algorithms will sometimes withhold “likes” on your photos to deliver them in larger bursts. So when you make your post, you may be disappointed to find less responses than you expected, only to receive them in a larger bunch later on. Your dopamine centers have been primed by those initial negative outcomes to respond robustly to the sudden influx of social appraisal. This use of a variable reward schedule takes advantage of our dopamine-driven desire for social validation, and it optimizes the balance of negative and positive feedback signals until we’ve become habitual users.

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Smartphones and social media apps aren’t going anywhere anytime soon, so it is up to us as the users to decide how much of our time we want to dedicate to them. Unless the advertisement-based profit model changes, companies like Facebook will continue to do everything they can to keep your eyes glued to the screen as often as possible. And by using algorithms to leverage our dopamine-driven reward circuitry, they stack the cards—and our brains—against us. But if you want to spend less time on your phone, there are variety of strategies to achieve success. Doing things like disabling your notifications for social media apps and keeping your display in black and white will reduce your phone’s ability to grab and hold your attention. Above all, mindful use of the technology is the best tool you have. So the next time you pick up your phone to check Facebook, you might ask yourself, “Is this really worth my time?”

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Difference between addictive pleasure and true happiness:

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Smartphone overuse and GABA:

Researchers have found an imbalance in the brain chemistry of young people addicted to smartphones and the internet, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA) in 2017.

Hyung Suk Seo, M.D., professor of neuroradiology at Korea University in Seoul, South Korea, and colleagues used magnetic resonance spectroscopy (MRS) to gain unique insight into the brains of smartphone- and internet-addicted teenagers. MRS is a type of MRI that measures the brain’s chemical composition.

The study involved 19 young people (mean age 15.5, 9 males) diagnosed with internet or smartphone addiction and 19 gender- and age-matched healthy controls. Twelve of the addicted youth received nine weeks of cognitive behavioral therapy, modified from a cognitive therapy program for gaming addiction, as part of the study.

Researchers used standardized internet and smartphone addiction tests to measure the severity of internet addiction. Questions focused on the extent to which internet and smartphone use affects daily routines, social life, productivity, sleeping patterns and feelings. “The higher the score, the more severe the addiction,” Dr. Seo said. Dr. Seo reported that the addicted teenagers had significantly higher scores in depression, anxiety, insomnia severity and impulsivity.

The researchers performed MRS exams on the addicted youth prior to and following behavioral therapy and a single MRS study on the control patients to measure levels of gamma aminobutyric acid, or GABA, a neurotransmitter in the brain that inhibits or slows down brain signals, and glutamate-glutamine (Glx), a neurotransmitter that causes neurons to become more electrically excited. Previous studies have found GABA to be involved in vision and motor control and the regulation of various brain functions, including anxiety.

The results of the MRS revealed that, compared to the healthy controls, the ratio of GABA to Glx was significantly increased in the anterior cingulate cortex of smartphone- and internet-addicted youth prior to therapy. Dr. Seo said the ratios of GABA to creatine and GABA to glutamate were significantly correlated to clinical scales of internet and smartphone addictions, depression and anxiety.

More study is needed to understand the clinical implications of the findings, but Dr. Seo believes that increased GABA in the anterior cingulate gyrus in internet and smartphone addiction may be related to the functional loss of integration and regulation of processing in the cognitive and emotional neural network. The good news is GABA to Glx ratios in the addicted youth significantly decreased or normalized after cognitive behavioral therapy. “The increased GABA levels and disrupted balance between GABA and glutamate in the anterior cingulate cortex may contribute to our understanding the pathophysiology of and treatment for addictions,” Dr. Seo said.

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Experts’ views about constant use of digital technologies affecting our brain health:

-1. Richard Davidson, neuroscientist at the University of Wisconsin Madison and founder and director of the Center for Healthy Minds:

I am most worried about the increase in distractability, the national attention deficit we all suffer from, and the consequences that arise from this.  Our attention is being captured by devices rather than being voluntarily regulated. We are like a sailor without a rudder on the ocean — pushed and pulled by the digital stimuli to which we are exposed rather than by the intentional direction of our own mind.  The ability to voluntarily regulate attention is more developed in humans than other species. As William James, the great psychologist, wrote in 1890, “The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will.” But we are becoming impaired in that capacity, globally. We’re all pawns in a grand experiment to be manipulated by digital stimuli to which no one has given explicit consent. This is happening insidiously under the radar. This, to me, underscores the urgency of training our minds with meditation so we don’t have to check our phone 80 times a day.

-2. Gary Small, author of the book iBrain and director of UCLA’s Memory and Aging Research Center at the Semel Institute for Neuroscience and Human Behavior:

My biggest concern is with young people, whose brains are still developing from birth through adolescence. There’s a process called pruning [the process of removing neurons that are damaged or degraded to improve the brain’s networking capacity]. This could be affected through all the time using tech. We don’t have data on that — but it certainly can raise a concern.  [The constant use of technology] does affect our brain health. It has an upside and a downside. The downside is that when people are using it all the time it interferes with their memory because they are not paying attention to what’s going on. They are distracted. As far as I know, there are not systematic studies looking at that. You can only look indirectly at this. So we have studied the frequency of memory complaints according to age. You find about 15 percent of young adults complain about their memory, which suggests there might be things going on such as distraction.  On the positive side, there are certain mental tasks, when using these technologies, that exercise our brains. Some studies have shown some video games and apps can improve working memory, fluid intelligence [problem-solving], and multitasking skills.

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Counterview:

Smartphone devices may not reduce cognition but may enhance it:

From Socrates to Spielberg, every generation has worried about the next generation being ruined by the next big thing, be it writing, telephone, radio, television, computers, Internet, or cell phones. Now it is smart devices and artificial intelligence. Dovetailing with this perennial cultural narrative, a popular trend of behavioural research has linked the use of digital technology to poorer memory, attention, or executive functioning. Meanwhile, digital technology is becoming ever smarter and more pervasive in our daily activities (e.g., predictive search, autonomous vehicles, social robotics). Do these observations imply that our cognitive abilities are worsening?

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Worsening cognition? 

Besides popular media’s claims, some scientific findings have been interpreted to suggest that digital technology can lead to poorer memory, attention or executive functioning. Upon scrutiny of these assertions, however, one notices two important argumentative assumptions. The first assumption is that the impact has a lasting effect on long-term cognitive abilities. The second assumption is that digital technology has a direct, unmoderated impact on cognition. Both assumptions, however, are not directly supported by empirical findings.

A critical examination of the evidence suggests that the demonstrated effects have been temporary, not long-term. For example, in a prominent study investigating people’s reliance on external forms of memory, participants were less likely to remember pieces of information when they were told this information would be saved on a computer and they would have access to it. On the other hand, they remembered the information better when they were told it would not be saved.  There is a temptation to conclude from these findings that using technology leads to poorer memory — a conclusion that the authors of the study did not draw. When technology was available, people relied on it, but when it was not available, people were still perfectly capable of remembering. As such it would be hasty to conclude that technology impairs our ability to remember.

Furthermore, the effect of digital technology on cognition could be due to how motivated someone is, rather than their cognitive processes. Indeed, cognitive processes operate in the context of goals for which our motivations may vary. Specifically, the more motivating a task is, the more engaged and focused we are. This perspective recasts experimental evidence showing that smartphones undermine performance on tasks of sustained attention, working memory or functional fluid intelligence.

Motivational factors are likely to play a role in research results, especially considering that research participants often find the tasks they are asked to do for the study inconsequential or boring. Importantly, this means that digital technology does not harm cognition; if a task is important or engaging, smartphones would not undermine people’s ability to perform it.

Beyond experimental findings, there is some evidence that the more people use digital technology in daily life, the worse their performance becomes on certain cognitive tasks (e.g., associations of media multitasking with task switching, episodic memory, and attention lapsing). These effects are correlational, not causal, and subject to third variables and alternative explanations. Indeed, cross-sectional negative effects of smartphone use during classroom activities disappear once stable student characteristics (e.g., impulsivity, socioeconomic status) and classroom characteristics (e.g., class size, course difficulty) are controlled for in a longitudinal design.

Altogether, convincing evidence remains lacking for the broad notion that technology has detrimental lasting effects on our cognitive abilities. It may, or it may not. The scientific jury is still out.

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Changing cognition:

To make use of digital technology, internal cognitive processes are less focused on information storage and computation. Instead, these processes convert information into formats that can be offloaded onto digital devices — like search phrases — and then re-loaded and interpreted. This kind of cognitive offloading is like how people take notes on paper instead of committing certain information to long-term memory, or when children use their hands to help with counting.

The main difference is that digital technology helps us offload complex sets of information more effectively and efficiently than analogue tools, and it does so without sacrificing accuracy. One significant benefit is that the internal cognitive capacity that gets freed up from having to perform specialized functions like remembering a calendar appointment is freed up for other tasks. This in turn means that we can accomplish more, cognitively speaking, than we ever could before.

As such, digital technology need not to be viewed as competing with our internal cognitive process. Instead, it complements cognition by extending our ability to get things done.

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Smartphone overuse and reaction time:

Reaction time (RT) is the time interval between the applying of a stimulation and the appearance of acceptable voluntary response by a subject i.e. it’s the activity of how long it takes for brain and nerves to react to a stimulation. It is typically expressed in milliseconds. Reaction time is incredibly necessary for our everyday lives and it needs an intact sensory system, cognitive processing unit, and motor performance. It reflects the speed of the flow of neuronal and physiological, cognitive, and information processes which are created by the action of stimulation on the person’s sensory system. The receipt of information (visual or auditory), its process, decision making, and giving the response or execution of the motor act are the processes that follow each other and build what we tend to call the time interval. The RT involves the subsequent three stages:

-a) process of the external stimulus b) Its higher cognitive processing and decision-making c) Formulating a response.

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‘Reaction Time’ is required in daily activities such as driving and while engaging in sports activities, in emergency situations, and in many day-to-day activities. Reaction time depends on nerve connectivity and signal pathways. Reaction time is important for individuals in all age group, any profession and also just to carry out activities of daily living. Impaired reaction time affects the individual’s ability to respond quickly to specific stimulus which will also affect our ability to function and perform various activities of daily livings. Reaction time is validated as a tool to measure cognitive function and quality of life in healthy individuals as well as patients.

Many factors are shown to have an effect on reaction time together with gender, age, physical fitness, level of fatigue, distraction, alcohol, personality type, limb used for test, biological rhythm, and health and whether or not a visual or an auditory stimulus is given to test the reaction time. Reaction time is not dependent on socialcultural influences. Prolonged reaction time denotes attenuated performance.

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The visual reaction time pathway is as follows:

Figure above shows visual reaction time pathway:  

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Correlation between smartphone screen time and reaction time in young adults of age 18-25 years, 2021 study: 

Due to ever increasing use of smartphones and increase dependency on it, it has been a topic of great interest among researchers to find out how mobile phones have an effect on human anatomy and human brains but there haven’t been several studies regarding the same. And reaction time is one amongst the tool to measure cognitive function in human beings. This study included males and females of age 18-25years within BMI 18.522.9kg/m2 and having two weekly average screen-time of more than 4 hours. These individuals were asked to perform Deary Liewald’s test for Simple and Choice reaction time. The included 54 participants (3 males and 51 females) and data collected did not pass normality, hence Spearman’s test was used to find the correlation. The correlation coefficient (r value) and p value for the correlation between smartphone screen time and Simple reaction time is 0.070 and 0.61 and for Choice reaction time is -0.048 and 0.729 respectively. The study shows no significant correlation between the parameters screen time and reaction time (simple and choice reaction time) since p>0.05. The study aims to find correlation between screen time and reaction time. The study shows no significant correlation between the parameters screen time and reaction time (simple and choice reaction time).

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Section-15

Smartphone use while driving or walking: 

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Distracted driving due to smartphone use:

In January 2004, at 4:00 p.m., in Grand Rapids, Michigan, a 20-year old woman ran a red light while talking on a cell phone. The driver’s vehicle slammed into another vehicle crossing with the green light directly in front of her. The vehicle she hit was not the first car through the intersection, it was the third or fourth. The police investigation determined the driver never touched her brakes and was traveling 48 mph when she hit the other vehicle. The crash cost the life of a 12-year-old boy. Witnesses told investigators that the driver was not looking down, not dialling the phone, or texting. She was observed looking straight out the windshield talking on her cell phone as she sped past four cars and a school bus stopped in the other south bound lane of traffic. Researchers have called this crash a classic case of inattention blindness caused by the cognitive distraction of a cell phone conversation.

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It is widely recognised that road trauma remains a burden for global health. In 2015, the World Health Organization estimated that 1.2 million people die as a result of road crashes worldwide annually. The premise that human factors are the root cause of most road safety safe-critical events and therefore should be the target of safety and prevention efforts is widely recognised. Mobile phone interactions while driving involve a multitude of cognitive and physical resources, with such behaviour consistently linked with inferior driving performance and reduced safety margins. Conservative estimates have shown that the crash risk is higher among distracted drivers than non-distracted drivers. In the USA alone, mobile phone distraction is likely to explain a quarter of crashes. This is confirmed in the largest naturalistic study worldwide, Second Strategic Highway Research Program Naturalistic Driving Study (SHRP 2 NDS), which has reported data showing that hand-based mobile phone interactions increase crash risk, with odds ratios indicating that texting increases crash risk by ∼6.1.

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At first glance, a combination of a definitive mobile phone ban while driving and strong enforcement should be the most effective approach to address this problem. However, research worldwide (e.g. Farmer, Klauer) showing a large prevalence of mobile phone distracted driving has confirmed that legislation and enforcement is not necessarily preventing mobile phone usage while driving. Pioneers and advanced road safety systems with strong laws on distracted driving such as Australia and the USA have been unsuccessful in stopping these behaviours. Recent naturalistic driving estimates in the USA have confirmed that drivers are distracted in some way around half of the time, with mobile phone use making up about a quarter of the distracted time. Observational on-road studies have found that nearly 18.7% in the USA and 5% in Australia use a mobile phone while driving.

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Some groups of the population seem more susceptible to mobile phone distraction than others. Alarmingly, distracted driving, particularly the use of mobile phones while driving, is more prevalent among young drivers aged 18–24 years. In Australia, Young, Rudin-Brown confirmed through an observational study that young drivers (<30 years) more frequently use handheld mobiles than middle-aged and older drivers (30 years and more) while driving. This is in accordance with international studies, where at least one in two young drivers in U.S. and Canada have been found to use a mobile phone while driving. Consistently, multi-national studies have confirmed that mobile usage while driving, particularly handheld interactions, is associated with crash risk among young drivers. There may be gender differences within young drivers: recently in Victoria (Australia), males were observed to have a larger engagement in mobile phone distracted activities than females. A greater understanding of usage patterns and predictors among vulnerable groups will support the development of targeted countermeasures.

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A text can take one’s eyes off the road for an average of five seconds. Although brief, one driving at 55 mph can travel the length of a football field in that time. Approximately three percent of drivers are talking on the phone when stopped at an intersection. Furthermore, five percent of drivers are on the phone at any given time. The Insurance Institute of Highway Safety (IIHS) reported those who used cell phones more often tended to brake harder, drive faster, and change lanes more frequently, predisposing them to crashes and near-crashes. They are also two to six times more likely to get into an accident. Research indicates driver performance is adversely affected by concurrent cell phone use, delaying reaction time and increasing lane deviations and length of time with eyes off the road. It can also cause “inattention blindness,” in which drivers see but do not register what is in front of them.

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Teen drivers are especially at risk. About 1.2 million and 341,000 crashes in 2013 involved talking and texting, respectively. Distractions such as music, games, GPS, social media, etc., are potentially deadly when combined with inexperience. The dangers of driving and multitasking continue to rise as more technology is integrated into cars. Teens who texted more frequently were less likely to wear a seat belt and more likely to drive intoxicated or ride with a drunk driver. Cell phone use can reduce brain activity as much as 37%, affecting young drivers’ abilities to control their vehicles, pay attention to the roadway, and respond promptly to traffic events.

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Vision is the most important sense for safe driving. Yet, drivers using hands-free phones (and those using handheld phones) have a tendency to “look at” but not “see” objects. Estimates indicate that drivers using cell phones look but fail to see up to 50 percent of the information in their driving environment. Distracted drivers experience what researchers call inattention blindness, similar to that of tunnel vision. Drivers are looking out the windshield, but they do not process everything in the roadway environment that they must know to effectively monitor their surroundings, seek and identify potential hazards, and respond to unexpected situations.

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The National Highway Traffic Safety Administration estimates that nine percent of all drivers at any given time are using cell phones, and the National Safety Council estimates about one in four motor vehicle crashes involve cell phone use at the time of the crash. Cell phone distracted driving has become a serious public health threat. A few states have passed legislation making it illegal to use a handheld cell phone while driving. These laws give the false impression that using a hands-free phone is safe.

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Multitasking impairs performance:

Multitasking and inattention:

Multitasking is valued in today’s culture, and our drive for increased productivity makes it tempting to use cell phones while behind the wheel. People often think they are effectively accomplishing two tasks at the same time. And yes, they may complete a phone conversation while they drive and arrive at their destination without incident, thus accomplishing two tasks during the same time frame. However, there are two truths to this common belief.

(1. People actually did not “multitask.”

(2. People did not accomplish both tasks with optimal focus and effectiveness.

Multitasking is a myth. Human brains do not perform two tasks at the same time. Instead, the brain handles tasks sequentially, switching between one task and another. Brains can juggle tasks very rapidly, which leads us to erroneously believe we are doing two tasks at the same time. In reality, the brain is switching attention between tasks – performing only one task at a time & information it receives:

-1. Select the information the brain will attend to

-2. Process the information

-3. Encode, a stage that creates memory

-4. Store the information.

Depending on the type of information, different neural pathways and different areas of the brain are engaged. Therefore, the brain must communicate across its pathways.

Furthermore, the brain must go through two more cognitive functions before it can act on saved information. It must:

-5. Retrieve stored information

-6. Execute or act on the information.

When the brain is overloaded, all of these steps are affected. But people may not realize this challenge within their brains (see paragraph below).

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Figure above shows inattention while driving that misses a signal. 

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Why do drivers miss important driving cues?

Everything people see, hear, feel taste or think – all sensory information – must be committed to short-term memory before it can be acted on. Short-term memory can hold basic information for a few seconds. However, to get even very basic information into short-term memory, the brain goes through three stages to prioritize and process information. The first stage is called “encoding.”

Encoding is the step in which the brain selects what to pay attention to. Encoding is negatively affected by distractions and divided attention. During this first stage, the brain will “screen out” information as a way to deal with distraction overload (Figure above).

All human brains have limited capacity for attention. When there is too much information, the brain must decide what information is selected for encoding. Some decision processes are conscious and within a person’s “control,” while other decisions are unconscious so we’re not aware of them. Therefore, people do not have control over what information the brain processes and what information it filters out.

For example, a person who is talking on a cell phone while driving has a brain that’s dealing with divided attention. The brain is overloaded by all the information coming in. To handle this overload, the driver’s brain will not encode and store all of the information.

Some information is prioritized for attention and possible action, while some is filtered out. The driver may not be consciously aware of which critical roadway information is being filtered out.

Performance is impaired when filtered information is not encoded into working short-term memory. The brain doesn’t process critical information and alert the driver to potentially hazardous situations. This is why people miss critical warnings of navigation and safety hazards when engaged in cell phone conversations while driving.

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What are primary and secondary tasks? What happens when people switch attention between them?

When people perform two tasks at the same time, one is a primary task and the other a secondary task. One task gets full focus (primary) and the other moves to a back burner (secondary). People can move back and forth between primary and secondary tasks. Secondary, or back-burner status, doesn’t mean people are ignoring the task. When a person stands before a stovetop full of pots, all pots and burners can be monitored at the same time. But one pot is getting primary attention, such as a front pot being stirred. While stirring the right front pot, the person sees the covered left back burner pot begin to boil and bubble over. Quickly, the person must remove the hot lid, remembering to grab a potholder first. The person also must keep his or her hand away from steam as the lid is lifted. It is difficult to continue evenly stirring the right front pot while switching attention and attending to the back burner pot. A person may or may not be aware that the stirring pattern has changed in the front pot, which was supposed to be the primary task getting full attention. Or a person may have even put the spoon down, knowing he or she can’t do two potentially harmful tasks at one time and stay safe. Certainly, driving a vehicle is a more cognitively complex activity than cooking. The human brain does the same switching between primary and secondary tasks when a person is driving a vehicle (primary task) while talking on a handheld or hands-free cell phone (secondary task). Should driving a vehicle ever be a “back burner” task?

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Slower Response Time and Reaction Time:

Response time includes both reaction time and movement time. Reaction time involves attentional resources and information processing, while movement time is a function of muscle activation.

Cell phone use has been documented to affect reaction time. Due to the “attention switching” costs discussed earlier, it makes sense that driver reactions may be slower when using cell phones. For every information input, the brain must make many decisions: whether to act on information processed, how to act, execute the action and stop the action. While this process may take only a fraction of a second, all of these steps do take time. When driving, fractions of seconds can be the time between a crash or no crash, injury or no injury, life or death. Numerous studies show delayed response and reaction times when drivers are talking on hands-free and handheld cell phones. Reaction time has shown impairment in a variety of scenarios:

• A University of Utah driving simulator study found drivers using cell phones had slower reaction times than drivers impaired by alcohol at a 0.08 blood alcohol concentration, the legal intoxication limit. Braking time also was delayed for drivers talking on hands-free and handheld phones.
• Drivers talking on hands-free phones in simulated work zones took longer to reduce their speed when following a slowing vehicle before them and were more likely to brake hard than drivers not on the phone. Many braking scenarios included clues that traffic was going to stop. Side-swipe crashes also were more common. Work zones are challenging environments for all drivers, and rear-end collisions are a leading type of work zone crash, putting workers and vehicle occupants at risk. Driver distraction is a significant contributing factor to work zone crashes.
• Hands-free phone use led to an increase in reaction time to braking vehicles in front of drivers, and reaction time increased more and crashes were more likely as the traffic density increased.
• Testing of rear-end collision warning systems showed significantly longer reaction time during complex hands-free phone conversations. Drivers in reaction time studies tended to show compensation behaviors by increasing following distance. However, drivers in three studies who attempted to compensate for their reduced attention this way found increased headway often was not adequate to avoid crashing.

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Problems Staying in Lane:

“Lane keeping” or “tracking” is the driver’s ability to maintain the vehicle within a lane. While most cell phone driver performance problems involve significant reaction time impairment, there are minor, less significant costs with lane keeping. It is suggested that lane keeping may depend on different visual resources than responding to hazards by reacting. In addition, avoiding hazards requires drivers to watch for unexpected events, choose an appropriate response and act. This requires information processing and decision-making that is more cognitively demanding than lane keeping tasks, which is more automatic. Still, when we are driving at roadway and freeway speeds with vehicles spaced less than a few feet from each other in parallel lanes, the margin of error for decision-making and response time to avoid a crash is very small. Perhaps drivers who create a hazard by straying from their lanes must depend on other drivers around them to drive defensively and respond appropriately, and it may be those reacting drivers whose cell phone use should be of concern.

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Handsfree device:

Driving while using a handsfree cellular device is not safer than using a hand held cell phone, as concluded by case-crossover studies, epidemiological, simulation, and meta-analysis. The increased cognitive workload involved in holding a conversation, not the use of hands, causes the increased risk. For example, a Carnegie Mellon University study found that merely listening to somebody speak on a phone caused a 37% drop in activity in the parietal lobe, where spatial tasks are managed. Driving while talking on cell phones – handheld and hands-free – increases risk of injury and property damage crashes fourfold.

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The brain is behind all tasks (visual, auditory, manual and cognitive) needed for driving:

Recent developments in functional magnetic resonance imaging (fMRI) now allow researchers to see the brain’s reactions to specific challenges and tasks. A Carnegie Mellon University study produced fMRI pictures of the brain while study participants drove on a simulator and listened to spoken sentences they were asked to judge as true or false. The pictures below show that listening to sentences on cell phones decreased activity by 37 percent in the brain’s parietal lobe (Figure below), an area associated with driving. In other words, listening and language comprehension drew cognitive resources away from driving. This area of the brain is important for navigation and the type of spatial processing associated with driving. Because this study involved listening and thinking of an answer and not actual cell phone conversation, the researchers concluded the results may underestimate the distractive impact of cell phone conversation.

The same study also found decreased activity in the area of the brain that processes visual information, the occipital lobe. While listening to sentences on cell phones, drivers had more problems, such as weaving out of their lane and hitting guardrails. This task did not require holding or dialling the phone, and yet driving performance deteriorated. The scientists concluded this study demonstrates there is only so much the brain can do at one time, no matter how different the two tasks are, even if the tasks draw on different areas and neural networks of the brain. The brain has a capacity limit. These fMRI images provide a biological basis of the risks faced by drivers.

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How do cell phones differ from talking to passengers or listening to music while driving?

Here we discuss the distraction of cell phone conversation, many people understandably wonder how this risk compares to talking with passengers or listening to a radio. Drivers talking on cell phones make more driving errors than drivers talking with passengers. Drivers are more likely to drift out of lanes and miss exits than drivers talking with passengers. Why? Adult passengers often actively help drivers by monitoring and discussing traffic. Passengers tend to suppress conversation when driving conditions are demanding. Although some studies found that passengers did not reduce conversation distraction, so research evidence is mixed. Talking on cell phones has a different social expectation because not responding on a cell phone can be considered rude. In addition, callers cannot see when a driving environment is challenging and cannot suppress conversation in response. Passengers can see the roadway and may moderate the conversation.

Listening to music does not result in lower response time, according to simulator studies. But when the same drivers talk on cell phones, they do have a slower response time. Researchers have concluded that voice communication influenced the allocation of visual attention, while low and moderate volume music did not. This discussion does not mean that listening to music or talking with passengers is never distracting. Loud music can prevent drivers from hearing emergency sirens, and cognitive processing can lead to a decrement in vehicle control. Some conversations with passengers can be distracting to drivers. Any task that distracts a driver should be avoided.

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Driving while distracted can result in a wide range of errors, some of which may be fatal. These include:

-1. A lack of awareness of surrounding road users and potential hazards;

-2. Failing to see road signs and warnings;

-3. Struggling to maintain the recommended safe speed;

-4. Failing to keep a safe distance from the vehicle in front; and

-5. Poor Lane discipline and switching lanes without indicating.

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Safe Driving Tips:

-Turn off your phone before starting your journey;

-Take regular breaks and use the time to check messages or make calls;

-Avoid using your mobile phone even with hands-free technology;

-If you need to urgently make a call, find a safe place to park first;

-Don’t call or text someone you know is driving;

-If you call someone and they are driving, ask them to call back after their journey, when the car is parked in a safe place; and

-Remember the only appropriate time to use a mobile phone is in an emergency, to dial the emergency services.

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Measures to reduce the risks:

-1. Smartphone mount:

A good smartphone mount can securely hold a phone where it’s easy to see and interact with, so it’s more like using an in-dash display or a car GPS device as seen in the figure above.

Mount the phone near eye level:

For navigation and other essential tasks while driving, a great step any driver can take is to add a smartphone mount in their vehicle. It offers the best combination of safety, convenience, and stability for your phone. Smartphone mount can reduce the risk of using a phone while driving in several ways:

• A good mount holds the phone near a driver’s normal line of sight through the windshield, which eliminates the need to look down and minimizes the time your eyes are off the road.
• By eliminating the need to hold the phone, you can keep both hands on the wheel, so you’ll have optimal control if you need to quickly swerve to avoid an obstacle.
• Having your phone mounted nearby and closer to your face than, say, if it were sitting in a cup holder or a console bin encourages the use of voice commands to dial numbers, enter destinations, choose music, and send short messages. If your car doesn’t have built-in Bluetooth, you can also use a Bluetooth kit to route the phone’s audio through your car’s audio system. This makes it easier to hear directions, music, and phone calls, which could lessen the need to reach for the phone to adjust the volume.
• If you do have to touch the phone, placing it in a convenient, nearby spot at the dash level makes it easier to reach and more like adjusting a car stereo, which, according to a 2013 report by the NHTSA (PDF), has “little effect on driving performance … or crash risk.”

-2. Use a phone-friendly in-dash system:

Using a system that has Apple CarPlay and Android Auto can make phone use less dangerous and improve your overall driving experience. These features mirror the phone functions that you’re already used to, and they place them on a car’s large infotainment display. Instead of having to work with a small phone screen, using these features simplifies the interface with larger buttons, which are easier to see and interact with. This basically makes using your phone similar to operating a car’s audio or built-in navigation system. Android Auto is a mobile app developed by Google to mirror features of an Android device, such as a smartphone, on a car’s dashboard information and entertainment head unit. Once an Android device is paired with the car’s head unit, the system can mirror some apps on the vehicle’s display.

Apple CarPlay (shown above) and Android Auto, available in many new cars and add-on stereos, provide a more driver-friendly interface for navigating, streaming audio, and conducting hands-free calls through your phone. These two systems allow drivers to connect their phones to use the vehicle’s built-in microphone and speakers and view a simplified phone interface that is projected on the infotainment screen. Strayer et al. (2018) found lower distraction levels when completing secondary tasks with Android Auto and Google CarPlay compared with the native systems designed by five different automakers.

-3. Try a “do not disturb while driving” mode:

Minimizing the number of incoming messages and calls can also reduce the distraction of having a phone in the car. Many phones let you do this through a “do not disturb while driving” feature. You can set the one for iPhones (iOS 11 and later) to automatically activate when the phone senses motion or connects to a car via Bluetooth. Depending on your settings, it can limit incoming messages and calls to ones you want to come through, and if a message is urgent, you can have Siri read it aloud. You can also set up an automatic reply with a custom message that goes to people trying to message you. While the phone’s screen normally stays dark in this mode, the app still lets you use Maps to navigate.

Google built a similar feature into its Android OS, but it’s available only in its Pixel 2 and 3 phones. For other Android phones, you can use third-party apps, such as Driving Detective and Drivemode, to get similar functionality. An alternative for Android phone owners is the Android Auto app, which limits your phone’s usage mainly to navigating, listening to audio, conducting hands-free calls, and sending and receiving messages by voice. As with the “do not disturb while driving” apps, you can set this one up to turn on automatically when it detects you’re in a car. The Android Auto app works well, but better use it with a good smartphone mount.

-4. Focus on the road:

Safety advocates say that phone use should be kept to a minimum. Good tools can help you stay safe, but the most important aid in reducing your risk is your own common sense. Make the road your number one priority. Even if you’re using your phone only through voice commands or by pressing the occasional button or two, don’t try to do this when there are other things to focus on. If you’re approaching an intersection, passing a car, merging, or manoeuvring through a crowded street, wait a minute. And if you need to do something that you can’t accomplish with a voice command or a quick button press—looking up an address, setting up a playlist or an audiobook, sending an extended message—do it before you begin driving or after you find a safe place to pull off the road. Smartphone can be a valuable aid in the car—like stereos and navigation systems can be—so making it easy to access and being careful about how you use it can prevent it from becoming a deadly distraction. 

-5. Crash avoidance technology:

Crash avoidance technology may be the most promising avenue for reducing crash risks related to distractions of any type. Warnings can redirect a distracted, inattentive or sleepy driver’s attention back to the roadway if the potential for a collision is detected. Some systems attempt to avoid the collision altogether if a driver does not respond fast enough or does not respond at all.

-6. Cellphone laws:

Bans on hand-held phone conversations while driving are widespread in many countries. Mobile phone use while driving is common but it is considered dangerous due to its potential for causing distracted driving and subsequent crashes. Due to the number of crashes that are related to conducting calls on a phone and texting while driving, many jurisdictions have made the use of calling on a phone while driving illegal in an attempt to curb the practice, with varying levels of efficacy. Many jurisdictions have enacted laws making handheld mobile phone use illegal. Many jurisdictions allow use of a hands-free device. Driving while using a hands-free device has been found by some studies to provide little to no benefit versus holding the device itself and carrying on a conversation. In some cases restrictions are directed only at minors, those who are newly qualified license holders (particularly those of a younger age), or to drivers in school zones. In addition to voice calling, activities such as texting while driving, web browsing, playing video games, or phone use in general may also increase the risk of a crash.

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Smartphone use while walking:

Smartphone zombie:

A smartphone zombie is a pedestrian who walks slowly and without attention to their surroundings because they are focused upon their smartphone. Safety hazards have been noted due to such distracted pedestrians. Cities such as Chongqing and Antwerp have introduced special lanes for smartphone users to help direct and manage them. In Chongqing, China, the government constructed a dedicated smartphone-sidewalk, separating the phone users and the non-phone users. In Hong Kong, they are called dai tau juk (the head-down tribe). Texting pedestrians may trip over curbs, walk out in front of cars and bump into other walkers. The field of vision of a smartphone user is estimated to be just 5% of a normal pedestrian’s. An app which uses the phone’s camera to make it seem transparent can be used to provide some warning of hazards. In Augsburg, Bodegraven and Cologne, ground-level traffic lights embedded in the pavement have been introduced so that they are more visible to preoccupied pedestrians, while traffic signals at an intersection in Zagreb cast the red light downwards, causing glare on smartphone screens. In Seoul, warning signs have been placed on the pavement at dangerous intersections following over a thousand road accidents caused by smartphones in South Korea in 2014. In October 2017, the City of Honolulu, Hawaii introduced a measure to fine pedestrians looking at smartphones while crossing the road. In 2019, China introduced penalties for “activities affecting other vehicles or pedestrians” and a woman was fined 10 yuan in Wenzhou.

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Pedestrian smartphone overuse and inattentional blindness: An observational study in Taipei, Taiwan 2018:

This study investigated the influence of various smartphone tasks (calling, music listening, texting, playing games, and web surfing) on the smartphone overuse and inattentional blindness of pedestrians in Taipei, Taiwan. Pedestrian smartphone overuse was observed and recorded via Wi-Fi cameras to determine whether pedestrians were using their smartphones when crossing a street with a signal. After crossing the street, pedestrians were interviewed to obtain additional information regarding demographics, smartphone tasks, data plan, and screen size. Pedestrians were classified into the case (distracted) and control (undistracted) groups. By determining whether pedestrians saw something unusual – a clown walking the opposite direction – and heard the national anthem played by the clown, inattentional blindness and deafness were examined. Pedestrians’ situational awareness was assessed by ascertaining whether they remembered how many seconds remained before the crossing signal upon arriving at the curb.

Results:

In total, 2556 pedestrians crossed the street and underwent the interview. Smartphone overuse and inattentional deafness were the commonest among music listeners. Playing Pokémon Go gaming was the task most associated with inattentional blindness. Logistic regression models revealed that contributing factors to smartphone overuse and inattentional blindness were a large smartphone screen (≥5 in), unlimited mobile Internet data, and being a student. The interactions of gaming with being a student and with unlimited data were significantly associated with smartphone overuse, inattentional blindness and deafness, and situational awareness.

Conclusions:

Listening to music was the smartphone task most associated with pedestrian smartphone overuse and inattentional deafness. Pokémon Go was the most associated task with inattentional blindness and reduced situational awareness.

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Section-16

Measures to control smartphone overuse:

Smartphone overuse is becoming a public health concern. In contrast to tobacco control, the aim of public health interventions is not to prohibit smartphone use, but to promote safe, healthful and mindful use. Smartphone overuse is an emergent public health issue that demands public health solutions. At an infancy stage, the field requires stronger empirical evidence for the health consequences of smartphone overuse and the efficacy and effectiveness of potential interventions. Furthermore, if we had successful experiences, it could be adopted in other digital devices, because digital overuse would be more and more popular in the coming years.

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For most people, ditching technology altogether isn’t going to happen. Cutting down seems like a more realistic approach. To do this, make a plan. Pinpoint your unhealthy habits and then decide which ones you want to change. It is really helpful to get a clear picture of your tech use and review the time spent on your phone. How that time is divided up with different applications is a great place to start, and then you can identify which areas to begin to limit. And remember, what constitutes healthy technology use varies from person to person. There’s no magic amount of screen time that is good or bad. You have to find out what works for you and your family. Here are some strategies to help you manage your smartphone overuse.

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-1. Behavioral:

Many studies have found relationships between psychological or mental health issues and smartphone addiction. Hence, behavioral interventions such as individual or family psychotherapy for these issues may help. In fact, studies have found that psychotherapeutic approaches such as cognitive behavioral therapy and motivational interviewing are able to successfully treat internet addiction and may be useful for mobile phone overuse. Further, support groups and family therapy may also help prevent and treat internet and smartphone addiction.

Complete abstinence from mobile phone use or abstinence from certain apps can also help treat mobile phone overuse. Other behavioral interventions include practicing the opposite (e.g. disrupt their normal routine and re-adapt to new time patterns of use), goal-setting, reminder cards (e.g. listing 5 problems resulting from mobile phone overuse and 5 benefits of limiting overuse), and creating a personal inventory of alternative activities (e.g. exercise, music, art).

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If you’re trying to eat healthier, a common piece of advice you might hear from a nutritionist is to avoid having junk food in the house. The idea is that unhealthy eating, a choice you might otherwise make without thinking, should require effort. The same idea applies to the phone. Silo off parts of your home where your phone is not physically proximate, such as the dinner table and the bedroom. Some people take this even further. The digital-technology scholar Cal Newport advocates the “phone foyer” method, wherein he leaves his phone by the front door when he walks into his house, and doesn’t put it in his pocket until he leaves again. If he needs to look at it, he does so only in the foyer. Addiction is a hateful thing, stripping us of freedom. As the Greek Stoic philosopher Epictetus taught in his Discourses, “No man is free who is not master of himself.” Addiction is doubly hateful when its ill effects make a profit for others, whether they be tobacco companies, social-media advertisers, or smartphone makers.

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Document your usage:

In 2008, a study funded by the National Institute of Health, recruited nearly 1,700 people to help them lose weight — by keeping a food diary (a written or digital list of everything they ate). The results were astounding: The more food records people kept, the more weight they lost. Knowing their food choices would be recorded, rather than eaten and forgotten, was a powerful motivator to make better choices. Furthermore, participants began noticing patterns in their diet, which could only be understood and appreciated after they wrote it down. When you document your smartphone usage, you will know you are spending hours on phone. Applications such as iOS Screen Time, Android Digital Well-Being, Moment, Forest, Quality Time, Detox, Space, or OffTime can help document your smartphone usage.

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Stop using smartphone for entertainment:

Latest electronic devices such as smartphones have drastically replaced the conventional TVs and computers for entertainment because these devices are easily accessible and they are quick to load. With a smartphone, you can watch a movie, play games, listen to your favorite songs and chit chatting through messenger. Conversely, you can only use a conventional TV to watch movies or drama, it is less convenient. It is true that the smart devices are convenient and easy to use, but if you want to break the habit of cell phone addiction, stop using your smartphone to play games or watch YouTube. Instead, stick to the traditional way, watch a TV and use a computer to play games. Why is that so? The answer is simple, you want to make less convenient to have fun with your smartphone so that you can break the bad habit of using your phone all the time.

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Don’t use your phone for all tasks: 

There is seemingly an app for everything these days. But using our phones for all the tasks they’re capable of can result in us relying on them too much. Plus, picking up a smartphone to use a timer or calculator can encourage us to use them for other things at the same time. How many times have you picked up your phone and become distracted by a notification, forgetting what you were going to use it for in the first place?

Think about how you could go back to basics to negate the need for some applications. For instance, you could use a traditional calendar, calculator, or stopwatch instead of your phone. One thing that many people are reverting back to is a traditional alarm clock. This is an especially good idea as it alleviates the need to have your phone beside your bed. Consider only allowing yourself to use a computer for certain applications such as social media. This can drastically cut your usage and prevent you from checking Facebook when you’re on a date or out with friends.

Use a Smart Watch:

Sometimes you use your smartphone to look at the time and other aspects. To reduce your smartphone usage, if you have some extra cash lying around, you could probably buy a smartwatch. This is not a bad thing to do and, this is a sort of delegation. By buying a smartwatch, you can use it to track your time, check the notifications of your phone and, if you splurged on a premium model, even make calls. This includes the regular smartwatch features of detecting steps, heart rate and more.

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Focus on other activities:

Clearly, there are times when you should be doing something other than using your phone, for example, completing work tasks or schoolwork. But you might also be wasting valuable leisure time on your phone. If this is the case, it’s worth thinking about other things you could channel your energy into. The key here is to identify times during the day when you find yourself using your phone too much. Then replace the phone activity with something else. For example, if you’re taking a planned break from work or schoolwork, consider doing something other than turning to your phone, such as meditating, going for a walk, or making a soothing cup of tea. Do you find yourself reading low-quality content on your phone? Consider reading physical books or magazines instead. Studies have shown that you actually retain more information this way. Do you spend hours on your phone in the evening and on weekends? Think about a hobby you’ve been wanting to try and take that up instead.

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Purchase a Feature Phone/Dumb phone:

If you have some extra cash and can afford a feature phone, it is the best way to de-addict yourself from smartphones. A feature phone lacks social media applications, and has support for a few games, which are not appealing to the millennial crowd and, the basic use case of a feature phone is to make calls. This will greatly help combat your overuse since you will not be able to do most of the tasks that you do with your regular smartphone.  For someone who doesn’t want to bother with optimizing settings for dozens of apps, getting a “dumb phone” could be an attractive option. Dumb phones, like early cellphones, generally are either not internet-connected or aren’t optimized for heavy app usage. You can use this instead of or in parallel with your smartphone so you’re a little less obsessed with it. Palm and candy-bar Nokia phones are popular options. But there’s something counterintuitive about buying an extra phone to stop you from using your existing phone. And since you can now essentially convert your iPhone into a “dumb phone” through the Screen Time setting called “Downtime,” which blocks all apps except the ones you choose and still lets you call and text, there’s no unique utility for feature phone.

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Human beings are motivated by reasons and purposes. We do things because we have a reason to do it. In the professional world, successful people are able to produce extraordinary results because they give themselves stronger reasons to work on their dreams. On the other hand, unsuccessful people do not have strong reasons. This is why they live in mediocrity and often find excuses or blame others for everything that happened in their lives. Similarly, if you want to overcome smartphone overuse, you have to give yourself a strong and emotional reason to stop. Therefore, ask yourself, “Why do I want to stop spending so much time on my phone?” When your reasons are strong and emotional, you will be more committed and do whatever it takes to stop spending so much time on your phone. You will follow through the decision you have made and change your habit. For example, an alcoholic who tries to stop his bad drinking habit will never succeed in his attempt to quit drinking unless he has an empowering reason to do so. If the alcoholic has been diagnosed with liver cirrhosis and the doctor advises him to stop drinking immediate to save his life, do you think he will do whatever it takes to stop drinking? Of course, he will do whatever it takes to stop drinking. And the reason is that he has finally found a strong and emotional reason to quit his habit. When you know exactly why you want to do something, you have a crystal clear purpose and empowering reasons behind to support you, you will be committed to doing it. The same goes in overcoming smartphone overuse.

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-2. Phone setting:

Make Changes to your Notifications:

Notifications are one of the most annoying distractions that might cause addiction. You finish your work and wish to keep your phone away, but, the notification pings start coming in. This leads to doom scrolling, endless tweets, and more. If you can control your notifications, your smartphone overuse can be minimized to an extent. The best way to do so is to shut off or mute notifications for all distracting apps, such as youtube, social media applications and even messaging apps. Keep just the most important apps for notifications, so that you do not miss out on important stuff.  Disable the sounds and banners that flash across your screen, notifying you that you have a new Facebook message, email, or TikTok video to watch. Instead, batch them so they all come at once, either hourly or less often. Research indicates that doing so can reduce stress. It makes it less likely you’ll pick up your phone and then get caught in that vortex, mindlessly scrolling without realizing half an hour has passed.

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Remove Unnecessary Applications (apps):

Whenever somebody sets up a new smartphone, they download their favourite apps. In doing so, sometimes one downloads separate apps, some of them being addicting. These applications might not be of your need, but, you wish to keep opening them. This is a problem that can be addressed and, if one feels like it, they can delete the unnecessary application.  This will greatly help combat screen usage and, will also lead to clearing up of space in your smartphone. This usually works best on games that one does not feel like playing but ends up playing regardless. In doing so one will be able to de-addict themselves from using their smartphone as often as they would if the app would be present on their device.

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Use Applications (apps) for help:

Sometimes, you need a little bit of enforcement to reduce your smartphone usage. To do this, there are applications available that can help you limit your smartphone usage. There are many apps available in Google Play Store that lock the applications that might be distracting and you will be able to use these apps after a certain amount of time. Some of these apps are ActionDash, StayFree – Screen Time Tracker, YourHour – Phone Addiction Tracker, etc. All these apps track your smartphone usage habits and keep a track of the apps that you use the most. You can set a predefined time for each individual app or a category of apps, which when exceeded will lock the app for the day and you won’t be able to access the app. These apps help in maintaining your ideal smartphone usage balance and can help curb smartphone addiction.

In case you use a smartphone that has stock Android then your device would have come with Digital Wellbeing functionality, which is a feature included on most new stock Android smartphones. These help one target and combat their smartphone addiction including checking the number of hours they have used a particular app and, limiting usage of these particular apps. It also shows you the number of hours you have spent on your phone and keeps a log of the total usage over the last few weeks and months. This is a helpful feature in knowing how much you use your smartphone and tracking your usage pattern.

If you have an iPhone, the Screen Time feature, which is built into Apple’s iOS, is the easiest option. You can limit how much time you spend on each app. After a five-minute warning, you’ll be stopped from using the app. There’s an option to override your restriction with a passcode. iOS’s Screen Time and Android’s Digital Wellbeing are great for finding out how much time you spend on various applications on your phone. They will even tell you how many times a day you pick up your phone.

Figure above shows iOS Screen Time app.

Once you have an idea about where the real problems lie, you’ll be better equipped to face them head on. Enter Apple’s Screen Time feature for iPhone, iPad and Mac. It’s built in, tracks and monitors how much time you spend on your devices — and can lock you or the kids out of apps after you’ve reached a set amount of time. You can even block access to your kid’s Apple device at a specific time each night, preventing them from staying up past their bedtime playing their favorite games under the covers.  Screen Time will monitor and help you track or limit your usage on iPhone, iPad and Mac. You’ll need to set up the service on each device you use. For a complete picture of total usage, make sure to turn on Screen Time and the Share Across Devices option. That will ensure that time spent on your iPhone, iPad and Mac is calculated together.

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Apps limit:

Facebook and Instagram have their own time-well-spent features that monitor how long you’re using the apps, allow you to set limits, and block notifications for certain time for periods. Snap and even some dating apps like Bumble have similar options. You can also set Instagram and Facebook apps to only use Wi-Fi rather than data. This way, you can only use the apps when you are at home.

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Turning Off your Phone while going to bed:

This might seem familiar. You wish to go to sleep, you get into bed and, ten minutes later you are on your phone. This is not an uncommon sight and, it is one that is worrying. To combat this, one can take a very easy step of turning off your smartphone before going to bed.

This will be very helpful to you in the long run in more ways than one. First, turning off your smartphone leads to better sleep, which will have many health benefits for you in the long run. Second, if you do not use the smartphone while trying to sleep, it will be a help to your eyesight as well.

Usually, when one goes to bed, they are not wearing their glasses. Using a phone without your glasses might result an increase in the power of your glasses, which is something that no one likes. By eliminating the use of a smartphone whilst in bed, you can avoid getting glasses or increasing the power of your spectacles.

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Turning your phone to greyscale:

Both iOS and Android offer the option to set your phone to greyscale, something that can help those who are colourblind as well as let developers more easily work with an awareness of what their visually impaired users are seeing. For people with full colour vision, though, it just makes your phone drab. Perfect! But does it work to hinder tech companies’ attempts to capture your attention? The idea is that if your phone is less pretty to look at, you’ll look at it less. Some effects are immediately notable. The bright red notification badges on iOS become much less shouty when they’re a mute grey. It’s the best of both worlds: they’re still easily legible, performing their function as notifications, but because they’re not screamingly bright, the desire to go through your apps consistently clearing the notifications is diminished.

Figure above shows Colourless iPhone.

Many smartphone addiction activists recommend turning one’s phone screen to grayscale mode, which helps reduce time spent on mobile phones by making them boring to look at.

Other phone settings alterations for mobile phone non-use included turning on airplane mode, turn on do not disturb, set a longer passcode, turning off cellular data and/or Wi-Fi, turning off the phone, removing specific apps, and factory resetting.

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Hide social media apps:

Drag all of your social and email apps into one folder that’s not displayed on your home screen, so it takes some work to open them. Even better, delete them from your phone and access them only via your laptop, which can dramatically cut down the amount of time you spend on them.

Make your phone harder to unlock:

Instead of taking advantage of convenient features like Face ID, use a passcode that you have to manually enter. Researchers have found that having such a delay before accessing your phone can reduce usage.

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Put a hairband around your phone:

Brad Soroka recommends placing a hairband around your cell phone. When placed in the middle of the phone, the hairband allows users to answer phone calls easily, but makes other uses of the phone more difficult (including simple texting). In his words, “Every time you want to use your phone, this brings about a mindfulness exercise and makes you ask ‘what is my intention?’ If you really want to use the phone, set your intention for why, and remove the hair band.” The hairband trick is not about making your phone impossible to use. The practice is about bringing greater mindfulness to each specific use of it… as opposed to mindlessly unlocking your phone every 3 minutes.

When used as a collection of tools to improve your work, health, parenting, and life, cell phones are wonderful and bring countless benefits. But when used mindlessly and unintentionally, they become a distraction from the things in life that matter most—in addition to the negative effects.

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-3. Yondr pouch:

Yondr pouches are small, gray pouches that swallow phones and lock them away from the fingers and eyes of their addicted owners. Since it started in 2014, hundreds of thousands of the neoprene pouches have been used across North America, Europe and Australia. People entering a school, courtroom, concert, medical facility, wedding or other event are asked to slip their phones into the pouches when they enter. Once locked, the phones stay with their owners until they are ready to leave the premises, and then the devices are released from their tiny prisons at an “unlocking base.” The pouches can be rented for a single event or on extended leases. They are now used in more than 600 U.S. schools. The effects are immediate: At first, people seem agitated and unsure of what to do with their hands. But then they adjust. At San Lorenzo High School in California, which began requiring students to Yondr (yes, it’s a verb) their phones from the beginning of first period until the end of the last, the difference has been stark. Grades have gone up, and discipline problems have plummeted. Referrals for defiance and disrespect are down 82 percent. There’s also another effect: The campus is really loud now. Students are interacting, talking to each other, reading, kicking a ball, socializing because they’re not standing in a circle texting each other.

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Smartphone cage:

In some schools, a mobile phone cage is used to prevent students from using smartphones in the classroom during lessons.

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-4. Digital Detox:

A digital detox is a time without digital devices, such as smartphones. A digital detox is a period of time during which a person refrains from using electronic devices such as smartphones or computers, regarded as an opportunity to reduce stress or focus on social interaction in the physical world. A digital detox is simply removing all digital and smartphone devices for your life for a while. It enables you to spend time focusing on what might actually make you happy and will help you get some rest. 

Motivations to start a digital detox include:

• Concern about developing addictive behavior that some identify as an Internet addiction disorder
• Aiming to reduce stress and anxiety caused by the over-use of technology
• Re-focusing offline social interactions and actions
• Re-connecting with nature
• Increasing mindfulness
• Improving one’s learning ability by decreasing distractions and eliminating multi-tasking

It’s easy to feel addicted to our smartphones. Consider doing a digital detox to reduce stress, focus on social interaction and connect with nature. “People are always amazed by how different they feel after not being on their phones and that motivates them to want to keep going,” says Tanya Goodin, author of OFF. Your Digital Detox for a Better Life. Goodin devised a 7-day digital detox that will allow you to unplug and recharge.

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Counterview:

Digital detox is unnecessary:

A small reduction in Smartphone Use can make a Big Difference for Mental Health:

A new study, published in Journal of Experimental Psychology: Applied, found that it only takes a minor tweak in smartphone usage to make a noticeable difference in your mental health. As per the study, conscious and controlled changes of daily time spent on smartphone use can contribute to subjective well-being—fewer depressive and anxiety symptoms, less problematic use tendencies, more life satisfaction—and to a healthier lifestyle, [including] more physical activity, [and] less smoking behavior, in the longer term.

Key Takeaways:

• This study found reducing your smartphone usage by just an hour a day for a week can improve your mental health.
• Monitoring your smartphone usage and how it impacts you can help you to make positive changes.
• Completely stopping smartphone usage was not found to be as beneficial for mental health.

Try reducing smartphone use every day to stay happy and healthy. Digital detoxes are unnecessary according to this study. People who were assigned to spend an hour less each day on their smartphones turned out to be happier and healthier than those who abstained. The respondents learned to regulate their attention and set boundaries. Reducing your smartphone use is better for your well-being than stopping cold turkey.

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Digital detox: An effective solution in the smartphone era? A systematic literature review of 2021:

Smartphone use, e.g., on social network sites or instant messaging, can impair well-being and is related to clinical phenomena, like depression. Digital detox interventions have been suggested as a solution to reduce negative impacts from smartphone use on outcomes like well-being or social relationships. Digital detox is defined as timeouts from using electronic devices (e.g., smartphones), either completely or for specific subsets of smartphone use. However, until now, it has been unclear whether digital detox interventions are effective at promoting a healthy way of life in the digital era. This systematic literature review aimed to answer the question of whether digital detox interventions are effective at improving outcomes like health and well-being, social relationships, self-control or performance. Systematic searches of seven databases were carried out according to PRISMA guidelines, and intervention studies were extracted that examined timeouts from smartphone use and/or smartphone-related use of social network sites and instant messaging. The review yielded k = 21 extracted studies (total N = 3,625 participants). The studies included interventions in the field, from which 12 were identified as randomized controlled trials. This systematic review provides a synthesis of existing evidence of associations between digital detox and different outcomes, e.g., time of use, performance, self-control, health and well-being, and social relationships. Generally, this review shows that the results across the studies and the different outcomes are quite diverse. Even though a few more studies revealed positive, rather than negative, consequences from digital detox interventions, most of the studies showed either no effects or mixed findings regarding digital detox efficacy. It can be concluded that across the included studies, digital detox interventions exert some promising effects on usage itself and on depression symptoms. However, the inconsistent findings regarding other outcomes across all presented studies prevent making a recommendation as to whether to promote or discard digital detox interventions, as positive and counterproductive consequences need to be examined more clearly. 

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Section-17

Treatment of smartphone addiction: 

While the research around the effects of cellphone use is still developing because it’s a relatively new topic, there’s a general scientific consensus that cellphone addiction is a real problem. Even tech bosses like Tim Cook, Jack Dorsey, and Mark Zuckerberg have publicly acknowledged the powers of their tools to damage your mental wellbeing — and some have built features into their technologies that try to gently ease people out of overuse. Some have criticized this approach, saying that if tech execs really wanted to help people with smartphone dependence, they would change their products to be inherently less addictive. But that would require tech companies to radically change their business models.

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Dr. Lembke noted that an addiction is partially defined by the three C’s:

Control: Using a substance or performing a behavior (like gambling) in ways that would be considered out of control, or more so than intended.

Compulsion: Being intensely mentally preoccupied with and using a substance (or performing a behavior) automatically, without actively deciding to do so.

Consequences: Continued use in spite of negative social, physical and mental consequences.

Many of us can recognize some of these behaviors in our own phone use.

Dr. Alter, on the other hand, doesn’t consider smartphone or screen overuse as a true addiction, and both he and Dr. Lembke noted that there is disagreement within the health community about this. “I don’t think it rises to the level of a medical addiction,” Dr. Alter said. “To me it’s more of a cultural malady than anything.”

Regardless of how you define it, both experts say there are ways to reduce your phone use.

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Take a ‘screen fast.’

One approach Dr. Lembke has found to be highly effective in her clinical practice is to completely avoid using all screens, not just phones, for anywhere from a day to a month. This strategy hasn’t been formally studied in screen overuse patients in particular, she said, but the evidence for its use with other types of addictions, like alcoholism, suggests it can be effective. How long you decide to fast will depend on your level of use, Dr. Lembke said. The average person might start with a 24-hour fast, for example, while someone with a more severe case of screen overuse may want to avoid screens for longer. Of course, a true fast may not be practical for many people, whether because of work or personal reasons, but the goal is to get as close to full avoidance as possible. Dr. Lembke warned that many people — even those with milder screen overuse — may notice withdrawal symptoms initially, like irritability or insomnia, but that over time they’ll start feeling better. In her 25 years of seeing patients, Dr. Lembke has noticed that by the end of a one-month fast, the majority of her patients usually “report less anxiety, less depression, sleeping better, more energy, getting more done, as well as being able to look back and see in a more cleareyed way exactly how their screen use was affecting their lives,” she said. Those who fast for less than a month will still see benefits, she said, though they likely won’t be as dramatic. After abstaining from screens for a period, she recommended reflecting on how you want your relationship with your devices to look like going forward. She believes such phone vacations might “reset” the reward pathway, letting our brains recover from technology’s easy and regular dopamine hits, at least for a time.

But reports of effectiveness are entirely anecdotal. Rosen has been studying various strategies with his students, such as disabling notifications for social media and hiding addictive apps. But the gains are modest, he says, and evaporate when the students resume normal use.

To Lembke, the greatest danger of smartphones isn’t impaired attention or behavioral addiction but how the devices keep us from “being fully present for the people around you, whether it’s at a meal or a meeting or with your children,” Lembke says. “I think there’s a slow erosion of human connection.”

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Some countries, especially in East Asia, treat digital addiction as seriously as gambling or substance abuse. China and South Korea, for example, view internet obsession as a public health threat and have opened hundreds of treatment centers. In China, an estimated 24 million people ages 6 to 29 are thought to be addicted to the internet. The country’s treatment centers are known as “boot camps” because patients—who are cut off from the internet—must wear camouflage uniforms and perform military-style drills. Some much less extreme treatment facilities have popped up in the U.S. One such center is reSTART in Fall City, Washington. Patients there spend time away from technology while working with counsellors to discover the issues behind their digital dependencies. The canter’s founder, Cosette Rae, says many of her teen patients have dropped out of school because they’re so hooked on video games or the internet. Some of them are even malnourished because they can’t pull themselves away from their screens long enough to eat healthy foods.  “The past couple years, we’re getting more and more kids that want to come in,” says Rae. “They’re saying, ‘Hey, I’ve tried to quit . . . and I can’t.’”

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Evidence-based clinical strategies for prevention and treatment of smartphone addiction: 

As problematic smartphone use shares many similarities with Internet addiction, the treatment for Internet addiction could be adopted as a strategy to ameliorate problematic smartphone use (Kim, 2013). Most treatments for problematic smartphone are psychosocial in nature According to Chun (2017), effective interventions usually have five components:  involuntary restriction, self-awareness and self-control, school factors, peer support, and professional services. He concluded that the most effective intervention is self-awareness and control, in which it is also itself a protective factor (Gokcearslan et al., 2016; Van Deursen et al., 2015). Another study recommended cognitive behavioral therapy to enhance self-awareness in managing Internet addiction (Chun, Shim, & Kim, 2017). There are also various practical management strategies available to limit smartphone usage such as keeping the smartphone away, removing apps, and limiting service (e.g., monitoring usage, setting notification, and blocking apps) (Löchtefeld, Böhmer, & Ganev, 2013). Several smartphone overuse intervention apps had been designed based on the prior mentioned strategies (Ko et al., 2015). Löchtefeld et al. (2013) developed AppDetox, which enables the users voluntarily to set rules to “detox” from particular mobile apps. This app was designed in such a way that the user could have options on the restriction of certain apps. For instance, the user could only use the app at specific time of the day (with count down timer), or would be restricted on the usage at certain time or at all times. A total of 11,278 different rules were created, and the users broke these rules up to 78,927 times. Another example, NUGU (No Use is Good Use), is a group based intervention app that was developed to improve self-regulation in smartphone use by taking advantage of available social supports. This app involves self-monitoring, goal setting, social learning, and competition (Ko et al., 2015).

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There are more comprehensive ICT systems designed to provide objective assessment and interventions. For example, the Smartphone Addiction Management System (SAMS) includes monitoring, transmission, archiving, analysis, and feedback procedures. Despite the accuracy of the assessed data and efficacy of this ICT based system, the information is not enough to conclude a medical diagnosis (Lee, Ahn, Choi, & Choi, 2014). Another system, the Smartphone Overdependence Management System (SOMS), was later developed in order to scientifically analyze behavioral patterns leading to smartphone overuse, prevent and monitor smartphone overdependence, and provide the clients with integrated treatment information (Lee, Rho, et al., 2016). However, there has been no study yet undertaken to test its effectiveness in managing problematic smartphone use.

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Traditionally, studies focus on parental interventions in order to protect children from excessive smartphone use. Some of the more promising results emerge from studies of the use of authoritative parenting styles. Such parents are able to perceive the severity of the threat (problematic smartphone use), and thus more readily engaged in a parental mediation role (Hwang et al., 2017). The parents emphasize involuntary restrictions, i.e., boundaries, and have sensible expectations such as setting rules to limit amount of time spent and type of content viewed (Chun, 2017). Another important aspect of parenting influence are that parents in general should behave as a role model by reducing the use of smartphone and spending more time with adolescents (Cheever, Moreno, & Rosen, 2018; Terras & Ramsay, 2016). For example, parents can engage the adolescents with healthy activities to direct them away from using smartphone excessively. In support of this view, Lee and Ogbolu (2018) proposed four core strategies—instructive strategies, rule setting, usage checking, and content filtering—for parents in managing children and adolescent’s problematic smartphone used.

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School also can play its role by establishing policies to monitor or ban the use of smartphones at school. This may be an essential step as school environment can greatly influence young people (Chun, 2017). School authorities and teachers can work together to raise the awareness of the harmful consequences of problematic smartphone use among the students and educate them on healthier activities and how to be disciplined on smartphone use. The awareness should not overemphasize the harmful consequences but guide the students to be a smart user to optimize its functions, bringing good learning outcomes in daily life.

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Cognitive-behavioral therapy (CBT) provides step-by-step ways to stop compulsive behaviors and change your perceptions about your smartphone. Therapy can also help you learn healthier ways of coping with uncomfortable emotions, such as stress, anxiety, or depression. Recent evidence shows that the Cognitive Behavioral Model, exercise therapy, and art therapy are effective in reducing anxiety, depression, impulsiveness, and withdrawal symptoms for smartphone and internet addiction. Chun et al. (2017) demonstrated the effectiveness of integrative therapy including art-cognitive behavior therapy, integrative arts therapy, motivational interviewing, and cognitive behavioral therapy in managing Internet addiction. They also reported that groups of 9–12 participants in the intervention tend to have the best outcomes. Such groups, they argued, are more likely to form a type of “therapeutic community” that encourages greater connection and acceptance and, therefore, more long-lasting behavioral change. Other researchers, including Lee, Seo, and Choi (2016) have applied more conventional psychological approaches such as cognitive behavioral therapy in their intervention, home-based daily journal of smartphone use (HDJ-S). This program helped the participants to visualize the pattern of smartphone use and reflect through self-evaluation and discussion with parents. The study included 335 adolescent subjects. It showed significant reduction in problematic smartphone use and raising the parents’ concerns of their children’s smartphone activities.

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In addition, Kim (2013) recommended exercise rehabilitation as an evidence-based intervention to address the physical and psychological issues in excessive smartphone use. This rehabilitation helps individuals to recover from musculoskeletal conditions like carpal tunnel syndrome, stick neck, backache, poor posture, chronic pain or fatigue, and neurological or metabolic conditions. Exercise rehabilitation was also proven to enhance mental resilience by feeling of confidence and happiness, which aids in recovery of anxiety and depression.

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Mindfulness-based cognitive behavioral intervention:

Mindfulness is a form of meditation that involves engaging full, directed, and active awareness of an internal experience (Shonin, Van Gordon, & Griffiths, 2014). A number of researchers have applied mindfulness in treating behavioral addictions, such as pathological gambling, workaholism, and Internet addiction (De Lisle, Dowling, & Allen, 2012; Son, 2011; Van Gordon et al., 2017). Van Gordon et al. (2017) proposed that the mindfulness approach may be suitable for behavioral addictions for several reasons: (a) substitution of addictive behaviors with meditation can reduce relapse and withdrawal symptoms; (b) cultivation of compassion helps with addiction-related negative emotions; (c) shift of focus to the intrinsic value of life and life priorities from the instant reward from addictive activities; (d) reduce salience; and (e) improve on patience. Lan et al. (2018) conducted their pilot study using the group mindfulness-based cognitive behavioral intervention (GMCI) developed based on the theoretical framework of CBT. This is a weekly stepwise intervention program with a total of eight sessions, aiming at cognitive reconstruction, integrated with mindfulness meditation in dealing with relapse, finding substitution for smartphone use, and setting life goals. Cognitive reconstruction helped the participants to identify the root cause of smartphone overuse and objectify the behavior and its consequence. In combination with mindfulness practice, the participants were able to dissociate the affection connected to the smartphone. It also significantly ameliorated the symptoms of the problematic smartphone use, such as decreased uncontrolled response, and coped with the uneasiness in the absence of smartphone as well as to deal with relapse effectively.

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Yoga:

Yoga is proven to be a viable tool to address physiological, psychosocial, and addictive behaviors by promoting self-regulation and self-control. Yoga is a holistic process of bringing body, mind, and spirit into communion. It has a lineage of more than 5000 years. It has shown a positive effect on perceived stress and quality of life with regular practice among young adults by cultivating subjective well-being. Empirical evidence reports that regular practice of yoga in a school has a positive influence on dysphoric moods, emotion regulation, and self-esteem. Yoga appears to be a promising treatment for addiction and other psychiatric disorders. Its ability to connect with life aids in the detoxification of our minds and bodies, as well as the regulation of emotions, thereby improving our well-being. This is an important aspect of addressing addiction’s craving, compulsive behavior, tolerance, and relapse conditions. As a result, incorporating yoga and meditation into daily life will aid in the regulation of the symptoms of maladaptive behavior associated with smartphone addiction.

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Section-18

Smartphone Overuse and Future Human with abnormalities: 

Humans may have abnormalities in the future due to Excessive Use of Smartphones. According to a study commissioned by TollFreeForwarding, excessive use of technology can lead to abnormalities as seen in the figure below.

Researchers worked with a 3D designer to produce images of a “future human” with physical problems brought on by regular technological use. Scientists gave the 3D model the moniker “Mindy.” As reported first by Interesting Engineering, the team examined scientific studies and professional viewpoints on the subject, focusing on the detrimental impacts technology can have on the human body, particularly over an extended length of time. The image’s design was inspired by the frequent use of laptops, smartphones, and other technological devices.

Bent Back:

According to the researchers, Mindy would eventually develop a bent back. This resulted from people using modern technology devices excessively, which changed the way they stood and sat. They claim that looking down at a smartphone or up at a computer screen all the time could cause tension on various body components, causing an arched back and spinal misalignment. Spending hours looking down at your phone strains your neck and throws your spine off balance. Consequently, the muscles in your neck have to expend extra effort to support your head. Additionally long periods spent in front of a computer can cause the torso to pull away from the hips rather than remain vertically straight.

Claw hand:

The cubital tunnel syndrome is ulnar nerve compression in the elbow that causes numbness in the fingers, is another feature of the 3D image that can be seen as a result of prolonged usage of a smartphone. This new term was developed to describe how using a smartphone all the time causes the hand to permanently adopt a claw-like structure. The excessive use of technology in the future may also result in humans having elbows that are 90 degrees.

Stronger Skull, Second Eyelids: 

The study further claimed that future humans would have stronger skulls to shield their brains from radiation from smartphones and second eyelids to protect their eyes from strain and an excess of blue light from screen exposure.  Humans may develop a larger inner eyelid to prevent exposure to excessive light, or the lens of the eye may be evolutionarily developed such that it blocks incoming blue light but not other wavelength lights like green, yellow or red. 

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Moral of the story:   

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-1. We are living in a world where digital engagement has become the primary form of communication due to varied motivations such as work, leisure, shopping, finance, education, entertainment, gaming, and social connection. About 70% of all digital media engagement in the US happens from a smartphone. So, TV, games, laptops, gaming consoles, theatres, etc. are all squeezed into the tiny remainder of 30%.

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-2. A smartphone is a cellphone with advanced features such as the ability to download and use apps and access to the internet, so the two terms aren’t interchangeable, even if people sometimes use them that way. Smartphone is a mobile phone that offers more advanced computing ability and connectivity than a contemporary basic ‘feature phone.’ Smartphone technology is an innovative invention in that it combines the functions of conventional phone and computer in a single smaller device. The popularity of smartphones is ascribable to the affordances they provide. Smartphones make it possible to perform a variety of daily tasks in one device, including, but not limited to, calling and texting people, checking and sending email messages, scheduling appointments, surfing the Internet, shopping, social networking, searching for information on the Internet, gaming, entertainment, etc. Smartphones have more connectivity possibilities and advances than any other form of screen time electronic devices. For example, individuals can engage in activities such as watching television, gaming, and communications such as texting all on the same device. Smartphones have long overtaken laptop and desktops as the most preferred medium for browsing the web.

Because smartphones are ubiquitous and provide numerous capabilities, smartphones go beyond serving communication, information and entertainment purposes. Smartphones enable people to fulfill needs such as learning, individual capability, safety, and human relationships, which is attributed to the mobility of smartphones. Smartphones have significantly transformed our lives and have become indispensable part of our lives. 

Owing to the convenience and multiple functions of smartphones, users tend to become over-attached and preoccupied with their devices.

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-3. The use of smartphones is now a necessity, not a choice. Worldwide smartphone mobile subscriptions surpassed 6.5 billion in 2022 and are expected to reach 7.7 billion in 2027. According to the findings from the Pew Research Center (2019), among young adults ages 18-29, 99% own a cellphone, with 96% owning a smartphone. The multiple features of smartphones, such as communications, multimedia, photography, navigation, and internet access, have made our social, cultural, and economic relations much more efficient. Smartphones have quickly become integrated into every aspect of our lives by connecting us with friends, family, teachers, banks, transportation, food, entertainment, resources and essentially the world. Used wisely and responsibly, smartphones enhance our lives. We can share our ideas with people from all over the world. Smartphones provide us endless learning opportunities. However, with the dramatic increase in smartphone uses and users, problems related to smartphone overuse are also becoming more and more serious.  

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-4. The smartphone, through its small size, ease of use, proliferation of free or cheap apps, and constant connectivity, changes our relationship with computers in a way that goes well beyond what we experienced with laptops. That’s because people keep their smartphones near them from the moment they wake up until the moment they go to bed, and throughout that time the devices provide an almost continuous stream of messages and alerts as well as easy access to a myriad of compelling information sources. Human beings have a deep, primitive desire to know everything that’s going on around them. That instinct probably helped us survive when we were cavemen and cavewomen. One of the main reasons people tend to be so compulsive in their use of smartphones is that they can’t stand the idea that there may be a new bit of information out there that they haven’t seen. The smartphone, more than any other gadget, steals from us the opportunity to maintain our attention, to engage in contemplation and reflection, or even to be alone with our thoughts. By design it’s an environment of almost constant interruptions and distractions. 

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-5. Females tend to see technologies like cell-phones and Internet as tools of communication – as a means to maintaining and nurturing relationships. Men, on the other hand, tend to see the Internet and related technologies as sources of entertainment and/or as sources of information. Female cell-phone use is typically related to sociability and interpersonal relationships, while for males, a more diversified type of usage is observed. Several studies have found that females have higher levels of dependence and problematic smartphone use than males.

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-6. I classify smartphone use as normal (social) use, overuse (problematic) and addiction. You may argue that use of smartphone while driving is not necessarily overuse but tell me who would use smartphone while driving but otherwise normally. People who use smartphone dangerously or inappropriately almost always use smartphone excessively otherwise also. It is their tendency to use phone excessively anywhere that results in dangerous or inappropriate use. Of course, you can overuse smartphone without dangerous or inappropriate use. Let us call it unnecessary use (wasting time). But these heavy users also suffer from negative health consequences and therefore they become problematic users. Smartphone overuse is twice as prevalent among teenagers as among adults. Smartphones are being used for various purposes such as gaming, Social Network Services (SNSs) and watching video clips (YouTube). Therefore, excessive use of smartphones may have difference characteristics according to the type of smartphone use. 

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-7. Smartphone overuse refers to people spending too much time on their smartphones to an extent that it negatively affects their life. Studies have shown that smartphone overuse is associated with procrastination, depression & anxiety disorders, and sleep disorders. In addition to psychological health, it has also been associated with physical health problems. For instance, due to small screen size, touch panel, and handholding, long time using smartphone increases the risk of ocular diseases, dysfunction of fingers, neck pain, and other musculoskeletal problems. Moreover, smartphone overuse also leads to dysfunctions in daily life, as it distracts people, distorts perception of time, and negatively affects productivity, academic performance and interpersonal relationships. Moreover, smartphone overuse also sucks up time that could have been spent in a more constructive way, and is associated with other lifestyle risk behaviors such as physical inactivity. Important adverse effect of smartphone overuse is accidents and injuries. Smartphone use leads to slowed reaction time and increased distraction, both of which are associated with accidents. Smartphone overuse has been observed to increase headache duration and frequency in migraine patients due to poor sleep quality and daytime sleepiness. Moreover, internet use through smartphones has been considered to cause problematic behaviors such as violence influenced by game-playing and cyber-bulling through social network services (SNSs); furthermore, internet is also considered an easily accessible source of pornography for adolescents. Because of its extensive impact on daily life, some new terms are invented in popular culture to describe problematic smartphone use, such as phubbing, ringxiety, nomophobia, and smartphone zombie.

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-8. There are three groups of factors which arguably contribute to the increasing use of the smartphone: namely, personal factors; smartphone factors; and social factors. Availability of extended free time, low self-confidence, and irresponsibility/escaping certain social gatherings/passing the time, are identified as the main personal factors. Loneliness and shyness predispose individuals to develop a dependence on smartphones. In addition, people with low self-esteem and high anxiety are more prone to develop mobile phone addiction to cope with negative emotions. The availability of competitively priced smartphones and attractive applications of smartphones are also mentioned in relation to increases in the overuse of smartphones. Finally, a range of social factors are linked with the overuse of smartphones including peer pressure, and fear of losing connection. Overuse to addiction is due to the addictive nature of the devices and its services like internet, SNSs, apps and games. Largely by design, the features that make smartphones convenient and fun also let them hijack the brain’s reward and attention systems. Enjoyable activities, from watching videos to playing games to seeing Facebook likes, switch on the brain’s “reward pathway,” flooding the brain with the feel-good chemical messenger dopamine. Smartphones offer a variable reward schedule that takes advantage of our dopamine-driven desire for social validation. Any dopamine-producing activity can lead to “behavioral addiction,” when a person feels compelled to engage in a behavior to the point that it hurts their health, work, or relationships. Also, phones have become part of an extended self. It is not uncommon for you to feel a sudden onset of anxiety should you drop phone or unable to find it.   

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-9. In general, the data show that the total time spent on cell phones decreases with age, with the highest times reported for people less than 20 years old, principally adolescents. Adolescents have a high tendency to engage in risk-taking, high exploration, seeking novelty and sensation, social interaction, and play behaviors that enable them to acquire certain skills for maturation and independence, especially in response to life stresses or changes in brain structures. This need for change, diversity, and intensity of stimulation can easily be fulfilled with smartphone use and this may make them more susceptible to problematic smartphone use. Family dysfunction in terms of domestic violence and parental addiction was significantly associated with adolescent smartphone addiction. The age of possession of one’s first cell phone is also relevant: the younger age at which this occurs, the greater the probability of problematic use in the future.

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-10. We are spending far too much of our time doing things that don’t really matter to us. The near-universal access to smartphone, starting at ever younger ages, is transforming modern society in ways that can have negative effects on physical and mental health, neurological development and personal relationships, not to mention safety on our roads and sidewalks. On average, a person spends 4 hours on smartphone devices daily. More time is spent on smartphone than eating, exercising, and socializing with friends. Screen time survey reveals consumers spend 50 to 60 days a year on smartphones. A study claims that about 20% of smartphone users (roughly one in five) use their phones eight hours a day or more. If you use it for a half an hour or an hour a day, fine. No problem. Then you’re using it for what it’s good for. Remember, it should be a tool that you use; not a tool that uses you.  

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-11. The biggest threat facing those who engage regularly with a smartphone is that these interactions take up time, which might have been traditionally spent elsewhere. Most students and teenagers are affected by it. Students want to play games, watching movies, listening songs, and other kinds of entertainment that waste their precious time. If people are spending a lot of time on their phones, that displaces time for other important activities, like exercise, studying and socialization. For example, a lack of physical activity is of a far greater demonstrable risk to young people with research highlighting clear links between media exposure and childhood obesity. On the other hand, data suggests that reducing the amount of time spent on digital devices will not automatically increase the time spent on physical activities. Promoting physical activity independently may be a more useful strategy.

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-12. Screen time is the amount of time spent using a device with a screen such as a smartphone, computer, television, or video game console. Solely auditory activities, such as talking on a phone and listening to music, are not included in screen time. The positive or negative health effects of screen time are influenced by levels and content of exposure. In a 2011 nationally representative survey of American parents of children from birth to age 8, TV accounted for 51% of children’s total daily screen time, while mobile devices only accounted for 4%. However, in 2017, TV dropped down to 42% of children’s total daily screen time, and mobile media devices jumped up to 35%. Researchers calls screens “electronic cocaine” and in China researchers tag them “digital heroin.” It may change the reward circuitry in a child’s brain and make them more dependent on screen media. When screen time does occur, the content should be high-quality, educational, slower-paced, and free of violence for children. Screen time shouldn’t interfere with learning, relationships with peers and family, physical activity, sleep, or mental health for children. There is evidence that higher levels of screen time is associated with a variety of health harms for children and young people (CYP), with evidence strongest for obesity, unhealthy diet, depressive symptoms and quality of life. To prevent harmful exposure of screen time, some governments have placed regulations on its usage.  

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-13. Nomophobia, or no mobile phone phobia, is “the fear of being out of mobile phone contact”.  Nomophobia is the modern fear of being unable to communicate through a smartphone. Anxiety is provoked by several factors, such as the loss of a mobile phone, loss of signals, and a dead mobile phone battery. Nomophobia has also been shown to increase the likelihood of problematic mobile phone use such as dependent use (i.e., never turning the device off), prohibited use (i.e., use in any environment where it is forbidden to do so), and dangerous use (i.e., use while driving or crossing a road). Nomophobia may also lead to physical issues such as sore elbows, hands, and necks due to repetitive use.

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-14. Nomophobia and smartphone addiction differ mainly in the way a smartphone user behaves with their smartphones. A smartphone user experiences nomophobia when fear or anxiety over not using a smartphone occurs. On the other hand, a smartphone user suffers from smartphone addiction when he or she excessively uses a smartphone regardless of harmful consequences. There is a strong positive association between nomophobia and smartphone addiction.

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-15. Although the concept of addiction has multiple definitions, traditionally it has been described as the repeated use of a substance despite the negative consequences suffered by the addicted individual. More recently, the notion of addiction has been generalized to include behaviors like gambling, sex, exercise, eating, Internet, and cell-phone use. Similar to substance addiction, behavioral addiction is best understood as a habitual drive or compulsion to continue to repeat a behavior despite its negative impact on one’s well-being. Behavioral addiction refers to a continuous repetition of certain behaviors that cause physiological and psychological difficulties. Any often-repeated behavior that triggers specific reward effects through biochemical processes in the body do have an addictive potential and the same neural circuitry experienced with substance addiction is activated with behavioral form of addiction. Loss of control over the behavior is an essential element of any addiction. Smartphone use can be dependency-forming, habitual, and addictive.

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-16. Smartphone addiction:

Smartphone addiction is defined as a form of behavior characterized by the compulsive use of the device that results in various forms of physical, psychological, or social harm. In recent studies, smartphone addiction is regarded as behavioral addiction and one of the problematic behaviors of adolescents. Four typical symptoms of smartphone addiction are, namely, withdrawal (e.g., experiencing negative feelings when having no access to smartphones), salience (e.g., constant checking and thinking about smartphones), conflict (e.g., smartphone use interferes with family and work life), and phantom phone signals (e.g., illusory perception of a phone vibrating or ringing).

Smartphone addiction has mainly focused on addiction at the device level. But understanding the smartphone overuse problem by focusing more specifically on internet use, SNSs use, and mobile apps is necessary to obtain deeper insights of the problematic smartphone use. We cannot separate smartphone overuse as a device overuse from smartphone overuse to access internet, SNSs, and using apps, therefore Smartphone addiction, Internet addiction, SNSs addiction, and Mobile app addictions are all overlapping although use of smartphone is central to all these addictions. You have to understand that a phone is not addictive by itself without the presence of internet, social media, games, etc. Your phone only becomes addictive when these other functions are available at your fingertips. The size and convenience of smartphones available anywhere, anytime, constantly connected with ease of accessibility and portability makes is distinct from other devices like laptop and tablets which can also be used to accomplish internet &SNSs addictions.

Although there is overlapping of smartphone addiction and internet addiction; smartphone addiction shows a distinct user profile that differentiates it from internet addiction, and smartphone addiction and internet addiction also differ in terms of addiction-risk factors.

Studies found that longer use was significantly associated with smartphone addiction as increased exposure is linked with increased dependency. Furthermore, later time of use was also significantly associated with smartphone addiction, with use after 1 a.m. conferring a 3-fold increased risk. The duration of smartphone usage has a positive effect on smartphone addiction, but not all persons who overuse smartphones become addicts. About 90% of cell phone owners overuse their phones, but only 10-12% are truly addicted. On the other hand, measuring duration of smartphone use is an inexact proxy for addiction, as some people may experience the features of addiction with lower duration of use while others may use their phone in an adaptive way for long periods of time (for example, answering work emails during a long commute) but be able to put the phone down without distress and attend to appropriate activities such as communicating with family members, or going to bed on time. Length of screen time should not be used as a proxy for smartphone addiction and a validated addiction instrument should be used to capture this phenomenon. Remember, prolonged screen time is not synonymous with addiction.    

In order to be classified as smartphone addict, you need to experience some deleterious impact on a major life sphere, whether it’s an impact on your work, your academic performance, your home life, primary relationship, parenting, legal status, your finances etc. Compulsive web surfing, watching videos, playing games, searching Google, or checking news feeds can lead to lower productivity at work or school and isolate you for hours at a time. All this compulsive use of smartphone can cause you to neglect other aspects of your life, from real-world relationships to hobbies and social pursuits. The study of smartphone addiction has also brought some novelties like its effects on potential increases of security vulnerabilities and potential exposure to future cyber victimizations (for instance, phishing).  Additionally, there is a coexistence relationship between substance use and behavioral addiction. There is a significant relationship between cell-phone abuse, school failure, depressive symptomatology, smoking and consuming cannabis, and other drugs.   

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-17. It is not yet clear whether smartphone use leads to depression or whether depressive symptoms cause people to seek out smartphone more (which could feed a vicious cycle). The question always is: chicken or egg? Were they depressed and anxious and, as a result, spending more time with their devices, or is it that spending time on smartphones made them depressed and anxious?  What is unequivocal from the studies, however, is that the more time children and adolescents spend on digital devices, the higher levels of depression are reported.

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-18. Teens who spent more time than average on screen activities are more likely to be unhappy, and those who spend more time than average on non-screen activities are more likely to be happy. The more extensively teenagers use their cell phones, the greater their risk of exposure to both experiencing and engaging within inappropriate mobile activity. Teens who are heavy cell phone users are more likely than ‘average’ users to be cell phone mis-users, become cyberbullies or experience harassment themselves. There are concerns that some mobile phone users incur considerable debt, and that mobile phones are being used to violate privacy and harass others.

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-19. Causes of obesity in children and teens due to smartphone overuse include:

(1. Lack of physical activity

(2. Children are exposed to the marketing of unhealthy foods that induce obesity.

(3. Inadequate sleep due to smartphone overuse disrupts hormone levels that regulate appetite and food intake resulting in overeating and obesity.

(4. Children and teens can binge eat even in the absence of hunger when they’re distracted in front of phones and screens, leading to weight gain. On the other hand, some of them are even malnourished because they can’t pull themselves away from their screens long enough to eat healthy foods.

(5. Smartphone used during meals distract children from satiety cues.

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-20. Blue light, also known as high-energy visible (HEV) light, is a color in the visible light spectrum that can be seen by human eyes. Blue light has short wavelength, high energy waves. In fact, they’re only slightly longer and less powerful than UV waves. The sun emits blue light. So do fluorescent and incandescent light bulbs. Human beings are exposed to more blue light than ever because of the widespread use of devices that rely on light-emitting diode (LED) technology. Computer and laptop screens, flat-screen televisions, smartphones, and tablets all use LED technologies with high amounts of blue light. Most of the blue light from the LEDs has wavelengths between 400 and 490 nanometers. Blue light from sun has wavelengths between about 450 and 495 nanometers. Many LED screens peak in the 435-440 nm. Some research shows a link between macular degeneration in retina and short-wavelength blue light with wavelengths between 415 and 455 nanometers.

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-21. There is a growing body of evidence that suggests that by multiple mechanisms, both daytime and bedtime smartphone use negatively affects sleep. Proposed mechanisms include displacement of time that would have been spent sleeping, psychological stimulation and light exposure, and increased physiological alertness. Smartphones overuse during daytime could cause something akin to a “hangover,” because we can’t detach from them in the time resulting in disturbed sleep. Using mobile phones around bedtime or even after lights out, has become a common practice. A recent review of literature in which the association between youth screen media use and sleep was assessed, almost 90% studies reported delayed sleep time and also decreased total sleep duration among bedtime media users. Smartphone usage after lights out is associated with shorter sleep duration and poorer sleep quality, more daytime sleepiness and insomnia symptoms; and the damaged sleep health could further have adverse health effects of obesity and diabetes. It is only when we are in deep sleep that the brain engages in synaptic pruning—making room for new information by pruning old information. When we have interrupted sleep, synaptic pruning cannot take place, thus, impairing our ability to retain new information and form new memories. Sleep experts have found that blue light from smartphones suppresses melatonin, making it hard to fall asleep and affecting a person’s biological rhythms of sleep. Violent and sexual content in the media may also be contributing factors for sleep disturbance. And having notifications, rings, or sounds throughout the night can definitely disturb your sleep. The radiofrequency electromagnetic field emitted by mobile devices can increase brain activity at night and interrupt non-REM sleep.   

It is recommended avoiding exposure to screens for 1 hour before going to bed. At bed time you can activate the Do Not Disturb mode of your phone to only ring/vibrate in case of exceptions. Additionally, using the airplane mode can help if you’re not expecting/able to take any calls.

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-22. Rat studies have found the relationship between blue light exposure and reduced melatonin levels, elevated levels of several reproductive hormones, and physical alterations in ovaries resulting in early puberty. Several studies in recent years have reported an increase in the beginning of early puberty in girls, particularly during the Covid-19 pandemic due to increased screen time and increased blue light exposure. Another reason for early puberty could be their average increase in weight. Researchers have advised limiting the usage of blue light emitting devices like smartphones in pre-pubertal children, especially at night when exposure may have the most hormone-altering effects.

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-23. About 2 out of every 3 persons will experience eye strain caused by excessive phone use. Ocular and visual effects of smartphone overuse include dry eyes, eye fatigue, loss of focus flexibility, macular degeneration and myopia. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms.

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-24. Overuse of mobile devices by young children can cause myopia (short-sightedness). Myopia occurs due to prolonged period of near work. You have to look at the viewing distance of the children to their screen. The problem is that they’re reading small text regularly, so they are at a close viewing distance, and their eyes have to work hard to accommodate. Furthermore, the earlier a child develops short-sightedness, the higher the risk of severe myopia in later life. Covid pandemic worsened the myopia crisis due to creations of artificial settings in which children were at home and in front of screens for long durations. 

Prevention of myopia:

-If you have to squint to read on your phone, try making the default font larger so that your on-screen text will be bigger and easier to see.

-Make sure that your mobile phone screen brightness is adjusted so as to minimize damage to the eyes.

-Maintain a viewing distance of about 16 to 18 inches in order to protect your eyes from long-hours of smartphone use. The greater the distance between your phone and your eyes, the less eye strain it is likely to cause, provided the print size and images are large enough for comfortable viewing.

-It’s important not to get locked to some fixed target for many hours. It’s a good idea to change your viewing distance occasionally — look outside the window for a few minutes, get up and walk around a bit.

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-25. Reading books on smartphone is not only bad for eyes as it can damage your eyes to some extent (vide supra) but also lead to poor reading comprehension. The smartphones’ small screen size makes it difficult to view and properly display materials and as a result there is high risk of reduced learning performance due to increased cognitive load. Additionally, distraction caused by incoming calls, messages and notifications, and eye strain itself lead to poor reading comprehension.  

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-26. The vast majority of children in the UK own a smartphone by the age of 11. Even though adults also use smartphones to a great extent, concerns tend to centre on children’s use because of the many social, biological, cognitive, and psychological changes that characterize this life period. Parents give their kids a smartphone for different reasons. While some feel a smartphone is a necessity to stay in contact with the kids, others see it as a way to keep kids entertained. Besides, some parents want to help kids stay in touch with their buddies. Interestingly, 40% of parents in the U.S. give their children smartphones to enjoy peace and quiet. The right age to give a child a smartphone is when they attain the age of 14 years but parents can wait until the child is 16 years depending on parental perception. The longer you wait to give your children a smartphone the better it is because smartphones can be addictive distractions that detract from schoolwork while exposing children to issues like online bullies, child predators or sexting.  

Dangers of letting a kid use smartphone too early include:

-Alters brain development.

-Impairs social skills & empathy development.

-Access inappropriate or harmful content

-Addiction and problematic use

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-27. There is emphasis on differentiating between different technology devices and their related activities: watching TV, playing games on PC, surfing internet on smart phones or any other screen exposure. While adults distinguish between these various activities, the young brain of the child cannot. Many of the effects occur whether the child is sitting in front of a smartphone or a TV and occur irrespective of what they are watching. It is recommended that children under the age of two watch no screen content at all because it can negatively affect early brain development. 

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-28. Clearly, digital technology offers many potential benefits to children, allowing them to connect with peers or access educational resources or entertainment. At the same time, there are legitimate concerns around who children interact with online, whether they experience cyber-bullying or access age-appropriate content, or whether screen-based communication may jeopardize their social development or well-being.

Parents underestimate the likelihood that their child might engage in online conversation using smartphone with people they do not know. This developing online relationship may lead to sexting or to convincing the child to meet the perpetrator in person. Children may be deceived, tricked, or coerced into engaging in sexual acts for the production of child sexual abuse materials (child pornography), which then can circulate online for years to come.

Studies have shown that excessive smartphone use in children can lead to attention issues, behavioral problems, learning difficulties, sleep disorders, and obesity. Too much time online may even inhibit a child’s ability to recognize emotions. The interviews and data from the NIH study have revealed that kids who spend more than two hours a day on screens got lower scores on thinking and language tests.   

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-29. Smartphones distract parents from supervising their children, which increases the risk of injury. Face-to-face interactions are important for cognitive, language and emotional development of children; and modern parents are so engrossed in their face-to-face interaction with smartphones that they ignore and neglect, face-to-face interaction with their children jeopardizing cognitive, language and emotional development of their children.

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-30. Children who have experienced traumatic upbringings involving parental neglect, could eventually become addicted to smartphones to cope with existing strains of family dysfunction. On the other hand, studies have also revealed that overprotective parental behaviors may increase addictive behaviors in children.

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-31. If parents are obsessed with smartphones, demonstrated by behavior such as frequent habitual checking of smartphones and becoming anxious without smartphones, it can lead to problematic behavior in young children as parents’ smartphone addiction significantly affects that of their children. If parents use smartphones obsessively, it is highly likely that children will have easy access to smartphones and imitate their parents by also using smartphones obsessively.

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-32. Teachers increasingly use smartphone devices to arrange, collect and check homework and the most common reason for using smartphones among children is to do homework.  

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-33. Smartphones afford students ample opportunities to obtain useful information anytime, anywhere. Students use this device to access teaching content and collaborate with both teachers and peers. However, it has been also observed that instead of attending lectures, students continue texting throughout and are unable to recall the lecture content. It seems that the negative impacts of smartphone use among students are tremendous and positive impacts are minor. Although smartphones offer students with several conveniences in their life (provide various learning resources) but it also affects students negatively by distracting their learning process, lower their academic performance, developing psychologically problems and social problems. Students are easily distracted from their studies because of mobiles, as the device contains applications that attract users to enjoy their software. The greater the use of a smartphone while studying, the greater the negative impact on learning and academic achievement. More studies were carried out to investigate the causes behind a negative relationship between smartphone use and academic performance; multitasking has emerged as a possible explanation. Obviously, as smartphone use is not only limited to texting and calling but Internet use, email, and social-networking sites such as Facebook, it can potentially increase multitasking and task switching during academic activities. This ultimately leads to decrease in academic performance. Teens have dropped out of school because they’re hooked on smartphone playing video games or the internet. The presence and usage of cell phone in the classroom—while not necessarily detrimental in all contexts—should be carefully monitored, intentionally structured, and even restricted in some cases. Student performance in high stakes exams significantly increases with a ban on mobile phones. 

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-34. A 11-year-old today is performing at the level of 8- or 9-year-old was performing thirty years ago.  A 14-year-old today exhibit higher level thinking skills of 12 year-old thirty years ago. It’s all about reacting quickly but at a shallow level … text messages and computer games are about speed and instant hits, rather than more profound or detailed ways of handling information. 

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-35. Yondr pouches are small, gray pouches that swallow phones and lock them away from the fingers and eyes of their owners. They are now used in more than 600 U.S. schools. The effects are fantastic. Grades have gone up, and discipline problems have plummeted. All schools all over world must use such small pouches to improve academic performance and discipline among students by locking away their smartphones.

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-36. Over the last thirty years social interaction (eye-to-eye contact) has gone down while eye-to-screen-contact has gone up. No matter how time online is measured and no matter which type of social activity is considered, time spent on the Internet/smartphone reduces time spent in face-to-face relationships. An hour on the Internet reduces face-to-face time with family by close to twenty-four minutes. Face-to-face time is traded off for huge amounts of time chatting online and these interactions are shallow and do not lead to any real human connection. Over time, this can result in loneliness, depression and social isolation. What was meant to be a way to facilitate communications has pushed people closer to their machines and further away from each other. Overuse of smartphone devices leads to atrophy of social mind.

There is direct relationship between the level of activity in the children’s mirror neuron systems and two distinct indicators of social functioning in typically developing children: empathy and social skills. Mirror neurons, by the way, work best in real life, when people are face to face; virtual reality and video talks via smartphones are pale substitutes. Communication via smartphones may come at the cost of the social and emotional skills central to civilised behaviour. College kids today are about 40 per cent lower in empathy than their counterparts of twenty or thirty years ago, as measured by standard tests of this personality trait. Many people see the current generation of university students – ‘Generation Me’ – as ‘one of the most self-centred, narcissistic, competitive, confident and individualistic in recent history … It’s not surprising that this growing emphasis on the self is accompanied by a corresponding devaluation of others.’  The sheer increase in child and adolescent exposure to media during this time could be one very important factor. One study found that lower levels of empathy concern are reported when communication occurred in presence of mobile devices while higher level of empathy is seen in individuals who communicate in absence of mobile devices.

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-37. Social support is the physical and emotional comfort given to you by your family, friends, co-workers and others. Decreased social support predicts later addiction to the smartphone and that smartphone addiction decreases social support over time. The greater the addiction, the less social support in the future, which in turn is associated with an increase in addiction again.

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-38. The term “phubbing” represents the act of snubbing someone in a social setting by concentrating on one’s phone instead of talking to the person directly. Not only is this behavior rude, but it can damage the quality of that relationship. Phubbing makes us feel bad, but even worse, it leads to unhappiness and depression.  

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-39. Smartphones can have negative consequences in the workplace such as lowering productivity, separating people from their realities, bringing stress from personal issues to work, and creating bad manners. Employees waste, on average, more than two hours per day using their phones. Cell phones are driving many of us to distraction—and taking a toll on productivity in the workplace. Clearly, much of the time spent on smartphone is not actually needed but is wasted. This poses particular problems when you need to concentrate on complicated processes at work. A state of deep concentration characterized by positive emotions accompanying flow cannot be reached when we are constantly getting distracted. Smartphones notifications can impair our concentration, even being short in duration they cause enough of a distraction to affect your ability to focus on a given task, decreasing your performance by prompting task-irrelevant thoughts and mind-wandering. It takes an average of 23 minutes and 15 seconds to get back to the deep focus you had on a task once you have been distracted. In fact, simply the presence of a cell phone is said to be distracting. When our attention is diverted due to repeated distractions, we use up valuable cognitive resources reorienting ourselves, leaving less mental energy for completing our work. So even brief interruptions increase our chances of making mistakes. 

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-40. Smartphone ban at workplace will not work for two reasons:

First, bans on using private smartphones are not easily enforceable. For an employer, it is difficult to ensure that employees adhere to the ban. This differs from the more common form of cyberloafing when employees use their desktop computers for browsing the internet. In this case, there are ways to monitor, sanction and even technically rule out employee misbehaviour.

Second, there is another reason why smartphone bans might not be effective in improving workplace performance. Employees might perceive a ban as a signal of distrust, even if the ban is not accompanied by measures to monitor or sanction violations. If employees have the impression that their employer does not trust them, they might be less motivated and exert less effort. Unless there are safety concerns, creating a “no cell phone use at work” policy can be perceived as punitive. In fact, posting a “mobile phones not allowed in workplace” notice will likely lead to morale problems. It’s better to accept cell phones as a part of modern-day work life and establish policies for their use.

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-41. Smartphone overuse in office workers significantly increases the chance of neck pain by 6 times. Both smartphone users with and without neck pain should try to keep their neck flexion angle between 0° and 15° when using their smartphone. This would reduce neck muscle activity and the risk of developing neck disorders associated with smartphone use.

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-42. Smartphone interactions while driving involve a multitude of cognitive and physical resources, with such behaviour consistently linked with inferior driving performance and reduced safety margins. People who use smartphone while driving are also likely to practice other unsafe behaviours like not wearing seat belt, drunk driving, fast driving, braking hard and changing lanes more frequently. Statistics show that 23% of road accidents result from smartphones distracting the driver, which accounts for more than a quarter of a million deaths worldwide every year. The National Highway Traffic Safety Administration estimates that nine percent of all drivers at any given time are using cell phones. A self-reported survey in Shanghai showed that more than 80% drivers had ever used mobile phone while driving. Cell phone distracted driving has become a serious public health threat. Many nations have passed legislation making it illegal to use a handheld cell phone while driving. These laws give the false impression that using a hands-free phone is safe. Even hands-free phone use leads to inattention blindness caused by the cognitive distraction of a cell phone conversation. Mere listening to sentences on cell phones decreased activity by 37 percent in the brain’s parietal lobe, an area associated with driving. In other words, listening and language comprehension drew cognitive resources away from driving. Texting on mobile phone increases crash risk by ∼6.1.

Smartphone use while driving increases crash risk by following mechanisms:

-Inattention blindness due to distraction in which drivers see but do not register what is in front of them

-Slow reaction time

-Problems staying in lane

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-43. You should switch off smartphone while driving except when you are using smartphone as a navigation device on roads. If you can’t switch off smartphone, then measures to reduce accident risk are smartphone mount, Apple CarPlay or android auto systems, use of DND mode on phone and crash avoidance technology.   

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-44. The two chief contributors to unnatural deaths are road accidents and suicide, and the increasing number of road accidents and suicide cases are now attributed to smartphones and social media use.

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-45. Most people multitask in order to get something done in less time. It appears to be more effective, but it’s not. Most of us can really only focusing on just one thing at a time. That means every time we pause to answer a new notification or get an alert from a different app on our phone, we’re being interrupted, and with that interruption we pay a price: something called a “switch cost.” Sometimes the switch from one task to other costs us only a few tenths of a second, but in a day of flip-flopping between ideas, conversations, and transactions on a phone, our switch costs can really add up, and make us more error-prone. Fleeting mental blocks caused by switching between tasks will cost up to 40% of the productive time.

Excessive use of mobile phone could lead to memory loss. Distraction is one of the key factors that make memories more difficult to form. When we are busy multitasking on our smartphones and quickly looking for information in multiple apps and notifications, we are only half-focused on learning a new skill. Hence, the information is unlikely to get stored in our long-term memory. In fact, mere presence of a smartphone and high phone conscious thought affects one’s memory learning and recall, indicating the negative effect of a smartphone proximity to our learning and memory.

Our over-reliance on the smartphone-internet has diluted our mental intelligence and abilities to logically solve and determine correct answers on our own. The ready availability of search engines on smartphones is changing the way we seek and store information. It’s good to know where to find the information you need—but skills like critical thinking and problem-solving can be developed only in the context of factual knowledge. In other words, you’ve got to have knowledge stored in your head, not just in your smartphone.

In a nutshell, overuse of smartphones can cause decrease in concentration, memory and cognition.     

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-46. A smartphone can tax the user’s cognition simply by its presence with that person. A smartphone will demand its user’s attention even when they aren’t using it or thinking about it. The mere presence of one’s own smartphone may occupy limited-capacity cognitive resources, thereby leaving fewer resources available for other tasks and undercutting cognitive performance.

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-47. Smartphone devices and services are designed to be as addictive as possible. They’ve been described to be exactly like poker/slot machines. You’re not losing money from using these services so you don’t feel like it’s a problem but we do get micro dopamine hits from likes, notifications and inbox messages. In an evolutionary context, dopamine pathways reward us for beneficial behaviors and motivates us to repeat them. Dopamine pathways are largely responsible for behaviors associated with learning, habit formation, and addiction. Rewarding social stimuli—laughing faces, positive recognition by our peers, messages from loved ones—activate the same dopaminergic reward pathways. Every notification, whether it’s a text message, a “like” on Instagram, or a Facebook notification, has the potential to be a positive social stimulus and dopamine influx.  

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-48. Neurobiological evidence of smartphone addiction:  

Numerous studies have shown that excessive amounts of screen-time damages brain structure by causing grey matter atrophy, reducing cortical thickness, compromising white matter integrity, impairing cognitive function and debilitating dopamine function. There are distinct neural mechanisms underlying specific biological and behavioral dimensions of excessive smartphone use.

(1. Smartphone addiction had significantly lower white matter integrity than controls in superior longitudinal fasciculus (SLF), superior corona radiata (SCR), internal capsule, external capsule, sagittal stratum, fornix/stria terminalis and midbrain structures. Correlation analysis showed that the observed abnormalities in internal capsule and stria terminalis were correlated with the severity of dependence and behavioral assessments. Smartphone addiction was associated with lower measures of microstructural organization and myelination of brain white matter tracts that are associated with literacy skills such as imagery, mental control and self-regulation. Underdeveloped white matter tracts slow communication between parts of the brain and lead to disorganized information processing.

(2. Smartphone addiction showed lower gray matter volume in insula, temporal cortex and anterior cingulate cortex. Anterior cingulate cortex volume and activity was associated with severity of addiction.

(3. There were aberrant activity of frontal cortex, parietal cortex and cerebellar regions.

(4. The ratio of GABA to Glutamate was significantly increased in the anterior cingulate cortex of smartphone- and internet-addicted youth, and it significantly correlated to clinical scales of internet and smartphone addictions, depression and anxiety.

(5. The MRI’s found significant differences in the brains of some kids who use smartphones, tablets, and video games more than seven hours a day. There is premature thinning of the cortex which processes information from the five senses. 

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-49. Smartphones are contaminated with bacteria. The use of smartphones inside hospitals especially in clinically sensitive areas is a subject of controversy because it may improve the quality of healthcare but also can transmit health care associated infections. Smartphone ought to be disinfected with disinfecting wipes or alcohol soaked cloth. Clinically sensitive areas of hospital ought to have UV smartphone cleaners that use 360-degree UV-C bulbs to kill all bacteria and viruses (99.9%).

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-50. Currently no scientific evidence establishes direct causal link between radiation from smartphones and cancer. However, when women with hereditary breast cancer predisposition uses smartphones at the night-time, the blue light will supress melatonin and amplify their risk of cancer. One of the many cancer-preventing properties of melatonin is to limit estrogen production. Increased lifetime exposure to estrogen is a well-known cause of breast cancer.    

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-51. About 88 per cent of married couples in India feel overuse of mobiles has hurt their relationships.

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-52. Studies found positive associations between smartphone addiction and suicidal ideation & suicide related outcomes. Suicide rates increased between 2010 and 2015 in U.S. Adolescents, especially among females due to smartphone overuse.  According to WHO, suicide rates among teens aged 15-19 rose by 47% between 2000 and 2017 due to smartphone and social media overuse.

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-53. Don’t use your smartphone for all tasks. There is seemingly an app for everything these days. But using our phones for all the tasks they’re capable of can result in us relying on them too much. Plus, picking up a smartphone to use a timer or calculator can encourage us to use them for other things at the same time. How many times have you picked up your phone and become distracted by a notification, forgetting what you were going to use it for in the first place?  

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-54. Most people spend much more time on their phones than they think. Most of that time was spent on social media, web browsing, and online shopping. You must document your smartphone usage, otherwise you will never know how many hours you wasted on smartphone. Applications such as iOS Screen Time, Android Digital Well-Being, Moment, Forest, Quality Time, Detox, Space, or OffTime can help document your smartphone usage. I was unaware of Digital Wellbeing on my smartphone till I started writing this article. Now I document my smartphone usage which in turn motivated me to reduce smartphone use. The best way to curb wrongdoing is to document it.   

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-55. Reducing your smartphone use is better for your well-being than completely stopping smartphone usage. Phone settings alterations for reducing smartphone use include turning on airplane mode, turn on do not disturb, set a longer passcode, turning off cellular data and/or Wi-Fi, turning off the phone, turn on greyscale, disabling your notifications for social media apps, removing specific apps, using Digital Wellbeing on android or Screen Time on iPhone and factory resetting. Above all, mindful use of the technology is the best tool you have. Cognitive Behavioral Therapy (CBT), exercise therapy, and art therapy are effective in reducing anxiety, depression, impulsiveness, and withdrawal symptoms of smartphone addiction. 

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-56. Smartphone overuse is becoming a public health concern. In contrast to tobacco control, the aim of public health interventions is not to prohibit smartphone use, but to promote safe, healthful and mindful use. Some countries have enacted laws for parents to monitor their children’s screen time as excess screen time is now considered to be the equivalent of vices like tobacco use, drinking alcohol, using drugs, and chewing betel nuts.   

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Counterview:  

Over the past decade, numerous studies have suggested that excessive smartphone use may be harmful as narrated in the paragraphs above but there is other side of the coin. This website does not take sides and narrates counter-views and counter-studies.

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-1. Many studies showing negative effects of smartphones are of low quality: often failing to measure how people actually use their devices. So many academics are interested in this topic that more than 900 rating scales have been developed to try and better understand people’s relationship with their technology. However, this results in the “many voices” problem, where pressure to publish can lead to an abundance of low-quality work that is quick and easy to conduct and appears impactful.  

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-2. A new meta-analysis of 47 studies finds discrepancies between self-reported guesstimates of screen time and actual time spent on digital devices. The findings suggest that 95% of screen time studies inaccurately estimate usage. The inaccurate self-report measures used for these studies may have resulted in over-inflated concerns about the harms of digital media use. These highly flawed studies are over-inflating the relationships between digital media use and typically negative outcomes, such as mental health symptoms and cognitive impairments, which of course explains the pervading view that smartphones, among other technologies, are bad for us. Media and technology use takes the blame for everything from increases in teenage depression and suicide to a higher incidence of Attention Deficit Hyperactivity Disorder (ADHD) and violence.   

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-3. A study found no evidence that adolescents’ digital technology engagement since the 1990s is linked to more mental health problems. Current digital technology engagement is no more harmful to the mental health of today’s adolescents than watching TV was for young people during the 1990s. Another study found the amount of time spent on the smartphone was not related to poor mental health. Instead, the study found that mental health was associated with concerns and worries about their own smartphone usage.

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-4. The effect of digital technology on cognition could be due to how motivated someone is, rather than their cognitive processes. This means that digital technology does not harm cognition; if a task is important or engaging, smartphones would not undermine people’s ability to perform it. It should be kept in mind that a general smartphone use may also have beneficial effects on certain processes of attention, inhibition, and working memory. Some studies have shown some video games and apps can improve working memory, fluid intelligence [problem-solving], and multitasking skills. Digital technology need not to be viewed as competing with our internal cognitive process. Instead, it complements cognition by extending our ability to get things done.

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-5. When you are super tired (due to lot of running around, lot of physical or mental work during day time) you fall asleep no matter what you did just before bed. The sleep pressure is so high there is really no effect of what happens before bedtime. So all the logic of smartphone use before bedtime disrupting sleep is valid if you are not super tired. In other words, people who do hard work throughout day will get good sleep no matter smartphone use at bedtime. Studies among adults have found evidence of time shifting, a process whereby media use coincides with later bedtimes and rise times, resulting in no impact on total sleep duration. Also, smartphone may be used by adults as a way to cope with their sleep problems.

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-6. Excessive smartphone use might also serve as a coping mechanism to relieve stress or to reduce emotional tension when an individual experiences family dysfunction, domestic violence, or parental addiction.

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-7. Smartphones’ ability to symbolically tie a person to others and/or allow actual connection with others outside of the immediate surrounding may have at least one specific benefit: reducing the negative psychological and physiological consequences of social exclusion.

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-8. Approaches within psychology have almost exclusively focused on correlational research that involves asking people to consider their personal experience with a technology rather than measuring their actual behavior and smartphones can record human-computer interactions directly, for example, behavioral interactions can be measured ‘in situ’ with applications. However, this is not an avenue explored by the majority of psychological research, despite having spent over a decade attempting to define ‘problematic’ or ‘addictive’ smartphone behaviors.  Conclusions surrounding use have therefore been largely negative and smartphones have repeatedly been associated with depression (Elhai, Dvorak, Levine, & Hall, 2017), anxiety (Richardson, Hussain, & Griffiths, 2018), disrupted sleep (Rosen, Carrier, Miller, Rokkum, & Ruiz, 2016), cognitive impairment (Clayton, Leshner, & Almond, 2015), and poor academic performance (Lepp, Barkley, & Karpinski, 2015).  While a smartphone can be used to engage with addictive behaviors such as gambling, its use can also support and maintain a healthy lifestyle. Smartphones are primarily used to facilitate social interactions and psychology has spent many years convincingly arguing that social support and integration has many positive health benefits. New technology also offers a host of new possibilities to improve physical and mental health (Ellis & Piwek, 2018). Engaging in positive conversation online can bring many health benefits. Conclusions from psychological science are therefore completely at odds with what might be expected in the general population and a new wave of research is starting to challenge previous findings. These revelations are rarely reported by the mainstream media and further serve to divert attention away from genuine digital harms – including misinformation, cyberbullying, fraud, and unequal access to technology.

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-9. A review by Nutt et al., (2015), accounting for evidence from 40 years of research on the dopamine theory of addiction, concludes that dopamine release is not responsible for the euphoric effect of all abused substances (p. 307) and that the relationship between dopamine and addiction is likely to be more complex than the dopamine theory of addiction suggests. This effectively debunks the claim that dopamine release and feelings of reward resulting from use of digital technology alone could cause addiction. Dopamine might even have a role in resilience against becoming dependent on some substances, turning the dopamine theory of addiction on its head. Release of dopamine is not problematic in itself, but a natural function that serves many important roles in normal brain functioning, such as influencing attention, working memory, motivational salience and fluent motor function. From a logical standpoint, if using digital technology could hijack the brain (or the dopamine system) and cause addiction, simply by being pleasurable, it stands to reason that most people would be addicted to it. This is clearly not the case, suggesting that dopamine release and feelings of reward alone do not cause addiction.

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-10. When smartphone use was for entertainment purposes (i.e., used to relax, escape, pass time) it was correlated with lower wellbeing while smartphone use for communication purposes (i.e., texting, calling) was unrelated or slightly positively associated with wellbeing. Further research also suggests that specific smartphone activities may have specific associations with health outcomes. Researchers found that studying the overall time spent using a device did not fully explain the relationship between screen time uses and anxiety & depression; rather, specific uses on the smartphone were associated with health outcomes.

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-11. People’s urge to engineer unique meaning and creativity for themselves has consequently extended the locus of mobile learning to settings outside the classroom: museums (Sharples, Taylor & Vavoula, 2007; Yatani, Onuma, Sugimoto & Kusunoki, 2004), field trips (Chen, Kao, Yu & Sheu, 2004; Stanton, O’Malley, Ng, Fraser & Benford, 2003), and use of educational games in a combination of settings. So, smartphones promote learning outside classrooms.

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-12. Some authors claim that new technology can ‘re-wire’ children’s brains and make them addicted (e.g. Ferranti, 2016). However, while some behaviours may certainly change brain structure and its function, this cannot, in itself, be taken as evidence for the development of addiction, nor can it even be considered a harmful outcome per se. Brain changes are part of a normal development process, in particular during adolescence (Blakemore and Mills, 2014). Changes in brain structure, as measured by magnetic resonance imaging (MRI) studies, seem to be subject to strong genetic control between late childhood and adolescence and are thus unlikely to be affected in any major way by subtle environmental influences such as technology (Mills, 2014). As Mills (2014) concludes in a review of the neuroscience literature on the effects of internet use on the adolescent brain, “Major brain changes, akin to what is suggested by the phrase ‘rewiring the brain’ are unlikely” (p. 385).

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-13. Smartphones lead to higher work efficiency. Using Smartphones in the workplace can be valuable in three ways: promoting autonomy, strengthening relationships with peers as well as superiors, and improving knowledge-sharing. Moreover, these three main factors can increase employee job satisfaction, which leads to better efficiency in the workplace.

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-14. Smartphones are good for mental health. Researcher David Haniff has created apps aimed at lifting the mood of people suffering from depression by showing them pleasing pictures, video and audio of, for example, their families. He has also developed a computer game that helps a person examine the triggers of their depression. Meanwhile, smartphone apps that play subliminal relaxing music in order to distract from the noise and worries of everyday living have been proven to be beneficial in reducing stress and anxiety. Technology can also provide greater access to mental health professionals through email, online chats or video calls. This enables individuals to work remotely and at their own pace, which can be particularly useful for those who are unable to regularly meet with a healthcare professional.

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-15. Digital detoxes are unnecessary. People who were assigned to spend an hour less each day on their smartphones turned out to be happier and healthier than those who abstained.

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-16. It is impossible to eliminate technology like Smartphones, but it is possible to control the negative usages and promote the positive usages to promote health, wealth and social relations.

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-17. Reaction time is incredibly necessary for our everyday lives and it needs an intact sensory system, cognitive processing unit, and motor performance. Prolonged reaction time denotes attenuated performance. A study found that smartphone overuse is not correlated with prolonged reaction time.

Note:

Although a study found that smartphone overuse is not correlated with prolonged reaction time; there is strong evidence to show that prolonged reaction time due to smartphone use while driving cause crashes. So, apply your mind while interpreting study results.  

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-18. People’s attitudes toward mobile phones tend to be largely positive. In most of the countries, a large majority say mobile phones have been good for them personally, and many also say mobile phones positively impact education and economy. Mobile phone users also overwhelmingly agree that their phones help them to stay in touch with faraway friends and family and keep them informed of the latest news and information. However, people in all countries are concerned about the risk that mobile phones might expose children to immoral or harmful content. 

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-19. Today’s youth could benefit from educational support, safety and security smartphones provide and protect themselves by using social media in a way that protects their mental health. Through smartphones, we can have immediate access to various databases and documents. Good habits can be encouraged and tracked, like using health applications. GPS monitoring will assist parents in keeping their children safe.

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Dr. Rajiv Desai. MD.

January 2, 2023

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Postscript:

Smartphone is the only handy and pocketable mobile computer that performs variety of tasks in a single device, and that connects us to everything in the world constantly from anywhere, at any time, resulting in numerous consequences for our daily lives. No wonder it is indispensable. If you don’t use smartphone, you may miss learning opportunity or social connection. If you use it excessively, you may entail all harms of overuse. We have to find a middle ground. Moderation is the key in smartphone use.     

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