Introduction

Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSAR) is a tertiary health care institution situated in complex of Sri Guru Ram Das University of Health Sciences, SriAmritsar, for teaching the undergraduate and postgraduate students in medical sciences and con­ducting the research. It has a 900-bedded hospital. Mobile phone addiction or internet addiction is defined as excessive behaviour in using technology tools such as smart phones, android applications or its entertainments [1]. Mobile phone usage characterized by addiction-like behaviour represents a specific form of technological addiction [2]. In a study conducted in 2019, the utilization of mobile phone internet facility for accessing social networking and engaging in group communication was reported by most of students. Mobile phone addiction was observed in nearly 40% of the subjects from the medical undergraduate (MBBS) students from medical college in Delhi [3]. Telephone and internet constitutes major elements of the society in this communication age. The extensive use of cell phones by different individual in societies necessitates close examination of its impacts on people’s health. Using cell phones late at night after lights are out is particularly popular among adolescents and young adults for talking and sending text messages [4].

Mobile phone provides a medium of communication that has found enthusiastic and nearly universal adoption globally in both developed and developing nations. India has the second highest mobile connections in the world after China, with more than 90 connections per 100 people [5]. Mobile phones, in the last decade, have evolved from a primary tool of interpersonal communication to that facilitating group communication [6]. This transformation has been enabled by the integration of mobile Internet facilities and exponential increase in the computing power of mobile phones, converting them into smartphones. A multitude of leisure activities drive smartphones usage, which include mobile gaming, streaming music and photo; and video sharing on social networks like Facebook, Twitter, WhatsApp, Instagram, etc. The number of smartphone users in developing countries like India is showing, a rapidly increasing trend especially in young, urban populations, with nearly one in three mobile phone users expected to be smartphone users by 2021 [7]. A Hands holding smartphone with Mobile Phone Addiction displayed on the screen is shown in figure 1.

Technological addiction is a form of non-substance addiction that has been previously defined as the compulsion by an individual to engage in some specific activity despite harmful consequences as deemed by the user himself/herself to his/her individual health, mental state, or social life [9]. Nomophobia is a related phenomenon that refers to discomfort, anxiety, nervousness, or anguish caused by being out of contact of mobile phone and associated technology. The characteristics of nomophobia vary and could include regular use of mobile phone, anxiety or nervousness caused in the absence of access to mobile phone or mobile network, repeated checking of the mobile screen for notifications, sleeping with mobile device in bed, and preference for mobile interaction opposed to face‑to‑face exchanges [1]. Some studies had reported the presence of a high burden of Internet addiction and mobile phone addiction like behavior and nomophobia among Indian youth [10-15]. However, the previously validated instruments used for assessment of mobile phone addiction and nomophobia in Indian populations have certain limitations. The Nomophobia Questionnaire (NMP‑Q) developed by Yildirim, et al. measures nomophobia in mobile phone users [16]. However, some items in the NMP‑Q, like a person’s annoyance on not being able to access, or feeling stranded in absence of the mobile phone, may not necessarily reflect nomophobia in the Indian scenario where mobile Internet is the principal means of Internet access for millions of young people, but safety concerns in public spaces for women can be ameliorated through mobile phone connectivity [17].

The questionnaire to assess mobile phone addiction like behavior by Aggarwal et al belongs to the pre-smartphone era and does not consider the potential for technological addiction arising from the built‑in Internet facilities, social networking, and the Internet‑based messaging services available in smartphones [18]. It is important to develop and validate a mobile phone addiction scale in a suitable Indian population, which takes into account the combined risk arising from both the conventional mobile phone and the Internet‑based applications available in smartphones. Furthermore, the high prevalence of stress and burnout in medical students during their period of education is well established, which renders them at risk of developing addictions [19,20].

Internet addiction disorder has effected from education to entertainment, there is certainly no area in life that has not been changed by the advent of the internet. It has consequently given rise to a new set of mental health disorders, including, but not limited to internet addiction disorder, online gaming addiction, online shopping addiction, and online gambling addiction. The increasing prevalence of digital access has caused another concern, especially among children and adolescents known as internet gaming disorder. The condition is still under research and its real impact is still being studied. Internet addiction and gaming disorder have the risks as follows: (i) Can affect the day-to-day life and thought process of the person. (ii) Can lead to mood swings and mood instabilities. (iii) Hamper creativity and imagination. (iv) Can lead to social isolation and withdrawal. (v) Put the person's relationship with partner, family, and friends at risk. (vi). The person can start living a fake life. (vii) It can lead to reckless behavior and spending a lot more money than it rightfully should be. (viii) Severe impairment, lack of cognitive functions, and mental distress. (ix) Depression. (x) Academic non-performance. (xi) Worsening of relationship with parents and peers. (xii) Aggressive behavior and violent streaks. (xiii) Living in a fantasy world. (xiv) Suicidal tendencies [21].

Aim and Objective

To study and compare the addiction like behaviour of mobile phone using adolescent and young adult medical students of SGRDIMSAR

Materials and Methods

This was a cross sectional type of study conducted amongst the medical students of SGRDIMSAR, Sri Amritsar. The students of SGRDIMSAR, Sri Amritsar were contacted to conduct the study. They were explained the purpose of the study and were assured to keep the results of their study confidential. Their consent to participate in the study was taken. The study was conducted from October 2018 to January 2019 upon 412 medical students willing to participate in the study. These medical students were divided into two groups depending upon their age; adolescents (age <19 years) and young adults (age >19 years). Adolescents were most of the medical students studying in 1st year MBBS (Bachelor of Medicine and Bachelor of Surgery) course of study and the young adults were the medical students studying in 2nd, 3rd and 4th year of MBBS. A pretested self-administered questionnaire comprising of a series of 20 standardised questions to assess the addiction like behaviour of adolescents and young adults was used for the study.

The questions asked in this study regarding their addiction like behaviour were as following: (i) Worry of their missed calls when they did not possess their mobile phones (ii) Feeling better after using their mobile phone (iii) Finding difficulty in switching off their mobile phones (iv) Feeling nervous on checking their mobile phones infrequently (v) Preference of their mobile phone over urgent matters (vi) Getting angry on turning off their mobile phones (vii) Their feeling of not having enough time for mobile phone use (viii) Facing problems due to preferring their mobile phone than important work (ix) Loosing track of important things while using their mobile phone (x) Their gradually increasing mobile phone usage time over the past 1 year (xi) Failure to reduce the number of hours spent on their mobile phones (xii) Complaining by friends and family about their excessive mobile phone use (xiii) Use of mobile phone so as to remain in touch with their friends and family (xiv) Their feeling of being overly attached to their mobile phones (xv) Being found busy on their mobile phones rather than dealing with their urgent matters (xvi) Missing their appointments because of being busy on their mobile phones (xvii) Getting in trouble while their mobile phone rang in the class (xviii) Being disliked by their friends when their mobile phone is switched off (xix) Feeling lost without their mobile phones (xx) Using their mobile phones as the first thing  on waking up in the morning and last thing at night before sleeping [3]. In the questionnaire each question was having two responses i.e. agree and disagree. It was distributed amongst these students and they were told to fill this questionnaire under the supervision of the authors. The medical students who responded ‘Agree’ to these questions were considered as having addiction like behavior and those who responded ‘Disagree’ to these questions were considered as not having addiction like behavior.

To find the difference statistically in the addiction like behaviourof adolescents and young adults regarding the variables under study, ꭓ2 test was applied. SPSS 25.0 version was used to apply the ꭓ2 test. Difference in the addiction like behaviour of adolescents and young adults regarding the variables under study was considered significant at 95% level and highly significant at 99% level statistically.

Results

Total 412 medical students of SGRDIMSAR were studied. Among these students 102 (24.7%) were the adolescents and 310 (75.3%) were young adults. The results of the study are given in the following tables.

Table 2 is showing distribution of medical students according to their addiction like behavior with anxiety. For question number i to iii higher number and percentage of young adults agreed for their addiction like behavior than the adolescents. This difference in the addiction like behaviour of adolescents and young adults was highly significant for question number i and iii while significant for question number ii statistically. For question number iv higher number and percentage of young adults agreed for their addiction like behavior than the young adults and the difference in their addiction like behaviour was insignificant statistically.

Table 3 is showing distribution of medical students according to their addiction like behavior with lack of control. For all the questions higher number and percentage of young adults agreed for their addiction like behavior than the adolescents. The difference in the addiction like behaviour of young adults and adolescents was found highly significant for question number i while it was insignificant for question number ii to iv statistically.

Like behavior with lack of priority. For all the questions higher number and percentage of young adults agreed for their addiction like behavior than the adolescents. The difference in the addiction like behaviour of young adults and adolescents was found highly significant for question number i and iv while it was insignificant for the remaining questions.

Table 5 is showing distribution of medical students according to their addiction like behavior with trouble caused to mobile phone user. For all the questions higher number and percentage of young adults agreed for their addiction like behavior than the adolescents. The difference in the addiction like behaviour of young adults and adolescents was found insignificant statistically for all.

Table 5 is showing distribution of medical students according to their addiction like behavior with other addiction like effects of mobile phone use. For all the questions higher number and percentage of young adults agreed for their addiction like behavior than the adolescents. The difference in the addiction like behaviour of young adults and adolescents was found insignificant statistically for all questions.

Strength of the Study

The strength of the present study was that it assessed mobile phone addiction like behavior using a self-designed questionnaire.  The items in the questionnaire were localized and suited to the Indian context.

Limitations of the Study

The limitation of our study was that it was conducted in a single medical college in Amritsar.

Discussion

Among the 20 questions related to the addiction like behaviour of the medical students using the mobile phones, for the 19 questions, higher percentage of young adults was found than the adolescents who agreed for the questions asked i.e. showed their addiction like behaviour. This might be due to the reason that young adults being higher in age used the mobile phones for the longer period of time than adolescents. It was only question number 12 shown as part ii of table number 5 regarding complaining by friends and family about their excessive mobile phone use for which higher number and percentage i.e. 163 (55.8%) of adolescents agreed than young adults i.e. 57 (52.5%). This was contrary to the responses given by them to the other questions. However, the difference in the addiction like behaviour for this question was found insignificant statistically. Hence this might be due the natural variation only. The difference in the addiction like behaviour of adolescents and young adults for using their mobile phones was found statistically significant or highly significant in question number 1 to 7 and 15. This resembled with the previous studies [11,22]. However, for question number 8 to 21 (except 15 and 16) our findings showed that there was insignificant difference statistically in mobile phone addiction rates between adolescents and young adults. This was in agreement with a previous study [3]. It is recommended that further studies should be conducted on (i) The smartphones and (ii) large sample size of study subjects. 

Conclusion

The use of mobile phones among the medical students had shown the development of addiction like behavior that increased with prolonged use of time. More over now the mobile phones are being replaced by smartphones by the addition of internet in mobile phones that are prone to develop the more severe addiction like behavior due to both of these. Hence among the students using mobile phones/smart phones early diagnosis and management of addiction like behavior should be done. 

Figure 1: Hands holding smartphone with Mobile Phone Addiction displayed on the screen [8].

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