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Correspondence to:
Dr.Sanjeev Davey,
B197, 3rdFloor, Prashant Vihar, Sector
14 Rohini, NewDelhi110085, India.
Email:Sanjeevdavey333@gmail.com
Review Article
ABSTRACT
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 Smartphones, 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: Smartphones addiction and Indian
adolescents was done using websites of EMBASE, MEDLINE,
PubMed, Global Health, PsycINFO, BiomedCentral, Web of
Science, Cochrane Library, world libraryWorldCat, Indian
libraries such as National Medical Library of India from
1January, 1995 to March 31, 2014 first for systematicreview.
Finally, metaanalysis on only Indian studies was done using
MedCalc online software capable of doing metaanalysis
of proportions. A total of 45 articles were considered in
systematicreview from whole world; later on 6 studies out
of these 45 related to Smartphones addiction in India were
extracted to perform metaanalysis, 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.
Keywords: Metaanalysis, mobile phone abuse, mobile
phone addiction, smartphone addiction, smartphones abuse,
systematicreview
INTRODUCTION
Adolescents are defined as young people between the ages
of 10 and 19years as per WHO(2014) criteria.[1] Today, 20%
of people persons in the world are adolescents, constituting
1.2billion people worldwide. Nearly, 243 million adolescents
1500
1501
Inclusion criteria
METHODS
The assessment of emergence of smartphone
abuse in Indian adolescents was done by a
mixed method approach as per preferred
reporting items for systematicreview and
metaanalysis(PRISMA[2009]) guidelines for
systematicreview and metaanalysis done by
usingMed-Calc online meta-analysis software.
Systematicreview strategy
Inclusion criteria
Exclusion criteria
Usage in %
72
62
56
39
30
38
53
47
89
92
84
DISCUSSION
Theme 1: Global and Indian Smartphones
usage scenario
Smartphone love has swept the world.
Smartphones technology is advancing at a rapid
rate. However, the advancement of the technology
is not what is alarming, but rather peoples misuse
and excessive engagement with their devices, so
most of adolescents are exposed to the media
applications and instant mobile broadband access
involved with the evolution of Smartphone. Our
systematicreview from the current theme, which we
derived, found explosive growth of Smartphones
use in the world with its rapid penetration
among adolescents in India.[5-8,10-15] What would
1503
Country of
study
Study
methodology
study design,
sample size etc.
Internet based
studies on
Gogulf.com of
investment and
research firms
Key findings
Implications of
studies
Key themes
synthesized
from studies
The Smartphone
usage in world
is expanding
at a rapid rate.
Annual rate
of growth of
Smartphone
users in
India129%
Smartphones
usage scenario
in world
and India
Reviewstudy,
evaluation
based, (n=31)
Benefits of Smartphone
are many and
negativeimpacts
are minor
Smartphones
impact on
society
Severe Smartphone
overuse-a sign
of Smartphone
addiction. Smartphone
addictionassociated
with psychopathologies
Unprotected and
problematic adolescent
sexual activity-more
common in those with
Smartphones addiction
Association of mobile
phone radiation with
fatigue, headache,
dizziness, tension and
sleep disturbance
A strategy to
stop/avoid
the misuse of
Smartphones
is required
Social and health
aspects of users
lives affected.
Affecting sleep
cycles, sexual
activity etc.
UK and US,
Singapore
and UAE
Thesis, Internet
based online
analysis and
journal articles
Miller, Khan,
AlKhlaiwi and Meo,
LabergeNadeauce
etal., McCartt
etal., Merlo etal.,
Khosla and Sawnani,
Dixit etal.[2230]
US, UK,
Saudi Arabia,
India
Reviewstudy,
crosssectional
study,
evaluation
based
SouthKorea,
UK, US,
India
Reviewstudy,
cross sectional
study,
evaluation
based
Adverse effects
of excessive
mobile phone
use can cause
BlackBerry
thumb to carpal
tunnel syndrome,
and child health
problems
Motives of Smartphone
Community
use were positively
concerns of
as well as negatively
mobile phones
related to different
overuseclose
relations. All high
link between
school students suffering continued
from depression,
problematic
anxiety and stress
Internet use and
must be screened for
the phenomena
Smartphones addiction of PLEs
Smartphones
abuse to
addiction
impacting
global and
Indian
adolescent
health
The Smartphone
psychology and
PUMP scale
to measure
problematic use
of Smartphones
WHI due to
mobile phone
interference
SAMS for
objective
assessment and
intervention
Contd...
1504
Table2: Contd...
Name of author of
study with reference
citation
Country of
study
Bengt etal.,
Avvannavar etal.,
Kapdi etal., Khurana
etal., Subba etal., Jain
and Kakkar, Aggarwal
etal., MACRO and
Neha etal.[3544]
Pedrero Prez etal.[45]
UK, US,
India
US
Study
methodology
study design,
sample size etc.
Anthropological
review of
literature.
Crossimpact
analysis(n=15)
Review
Key findings
Implications of
studies
Key themes
synthesized
from studies
Directand
indirect impacts
Smart phone
health risks:
societal,
environmental
and economical
SAMS=Smartphone Addiction Management System, WHI=Work-home interference, PUMP=Problematic use of mobile phone,
PLEs=Psychoticlike experiences
Table3: Effect of mobile phones usage on individual psychosocial factors of medical college students
Names of authors Study of effect of mobile phone usage on other
Statistical values
Cohens 95% CI Cramers
with year of study variables
considered from study
d
V
LCI HCI
[40]
Subba etal.
n=336
Number of persons with whom students
0.51
0.28 0.73
0.01
n=335, 2=20.5
talked on phone most often
Ringxiety
n=113
Classroom usage
0.49
0.11 0.87
0.03
n=114, P=0.019
2
Studies hampered
1.08
0.48 1.6
0.09
=12.7, n=56,
P=0.0001
Students borrowed money from friends to pay
0.015 0.53 0.56
0.07
2=0.003, n=51
Stress due to network inaccessibility/
0.56
0.2 0.9
0.03
n=128, P=0.002
phone malfunction
Dixit etal.[30]
n=200
Presence of nomophobia/used mobile
0.68
0
1.3
0.12
n=37
phone during college hours
Keep their mobile phones with them even
0.32
0 0.65
0.02
n=146
when they go to sleep(for 24 h a day)
Lose their concentration and become stressed
0.65
0
1.3
0.11
n=40
when they do not have their mobile
Upgrade their mobile software at least once a year
0.57
0
1.1
0.08
n=50
Mobile phone is a necessary tool to help them
0.3
0 0.61
0.02
n=166
keep connected with their family members
Keep on checking their mobile
0.45
0
0.9
0.05
n=79
phones for messages and calls
Keep on checking their mobile
0.51
0
1
0.06
n=62
phones for messages and calls
Students used it when absolutely necessary
1
0
2
0.26
n=19
CI=Confidence interval, LCI=Lower limit of confidence interval, HCI=Higher limit of confidence interval
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Limitations of study
Too small sample size of six studies in
metaanalysis can be a limiting factor in
generalization of findings from study, as file drawer
effect may also occur due to noninclusion of all
unpublished data despite all efforts in searching
literature. Approach of first systematicreview of
global studies and later on metaanalysis of only
Indian studies may have methodological concerns
and can also be a debatable issue.
CONCLUSIONS
Increase in the use of smartphones in societies,
has raised concern about social and psychological
effects of excessive use of smartphones especially
among Indian adolescents. Smartphones have
made mobile connectivity so accessible that todays
Indian generations are abusing their Smartphone.
Smartphone abuse to addiction has become
more serious since adolescents can download
and run numerous applications with smartphone
even without Internet connection. Smartphone
addiction are is still not sufficiently addressed
within studies in literature, so what is suggested is
more indepth qualitative and quantitative studies
in the future with larger sample sizes, and the
development of policies to raise awareness about
this issue by Indian governments for better future
of Indian adolescents as a priority action.
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