Contextualizing adolescents’ self-awareness of problematic mobile phone use: a preliminary study

Introduction

Following the release of the iPhone in 2007, estimated smartphone ownership in the United States has steadily increased to 81% in 2019 and 96% for 18-29 year-olds (www.pewresearch.org/internet/fact-sheet/mobile/#mobile-phone-ownership-over-time). Mobile phone dependency (a.k.a. problematic mobile phone use) has grown prevalent in keeping with this surge,^1–2 and has been framed in relation to behavioral addiction.³ For the purposes of this study, we used the definition “problematic mobile phone use is a habitual drive or compulsion to continue to repeat a human-technology interaction despite its negative impact on one’s well-being.”³ Among the general population, determinants and effects of problematic phone use have been studied, screening tools developed, and prevalence of mobile dependency measured.^2,4–5 While the detrimental effects of problematic mobile phone use on sleep, stress, anxiety, and depression can occur at various ages,² adolescents comprise a notably vulnerable age group. This relates to decreased levels of self-control and low resistance to peer pressure. Steinberg and Monahan (2007) noted “susceptibility to peer pressure in adolescence follows an inverted U-shaped curve, increasing during early adolescence, peaking around age 14, and declining thereafter.”⁶

We searched the PubMed database using the query “((Smartphone OR mobile phone OR cell phone) AND (dependency OR dependence OR problematic)) AND (adolescent OR adolescence OR teenage OR youth)” and found with regard to adolescents that studies are limited to reports of prevalence and associations with adverse wellness. More specifically: cross-sectional studies have measured prevalence of mobile phone dependency^1,7–8; mobile phone dependence correlated positively with unintentional injuries (odds ratio = 1.452)⁹; depressive symptoms, higher interpersonal anxiety, and lower self-esteem have been correlated with problematic cell phone use^10–12; and Walsh et al (2008) held qualitative focus groups with Australian 16-24 year-olds and found extreme attachment to phones with symptoms of behavioral addiction evident in participants' descriptions.¹³ Adolescent-specific investigations are limited to mobile phone dependency prevalence^1,7; and to correlation with depression, interpersonal anxiety, lower self-esteem, and symptoms of behavioral addiction evident.^10,13 Adolescents are knowledgeable agents capable of representing and articulating the different aspects of how they interact with smartphones. Yet little work has been devoted to exploring how adolescents experience mobile phone dependency and what meanings and interpretations they attach to it.

This preliminary study sought to contextualize 13-15 year-old adolescents’ self-awareness of problematic mobile phone use by exploring interconnections between mobile phone dependency phenomena, the context in which they occur (i.e., circumstances, factors, processes, constraints, or opportunities), and participants’ subjective experiences and interpretations. We believe this to be a crucial step towards generating hypotheses targeted at improving overall wellness and developing healthy habits in adolescence that can carry over into young adulthood and beyond.

Methods

Quinnipiac University’s Institutional Review Board approved this study (protocol #01018; 9 February 2018).

Results

PUMP Survey

One or more participants agreed or strongly agreed with items representing nine of the ten dimensions of the PUMP construct. Longer than intended, great deal of time spent, activities given up or reduced, and use despite physical or psychological problems were most frequently agreed with; use in physically hazardous situations, withdrawal, and craving least frequently (Figure 1).

Figure 1. Frequency distribution of responses on a 5-point scale (strongly disagree, disagree, neutral, agree, strongly agree) to the 10 dimensions of the PUMP survey; each bar represents one of eleven individual participants.

Discussion

Nine and six of the eleven participants agreed or strongly agreed with items representing the PUMP dimensions of longer than intended and great deal of time spent, respectively. We found that these phenomena occurred for our 13-15 year-olds when they were interacting with only a select number of social media or texting apps, and this was facilitated by habitual processes of evaluating and responding to notifications or checking and re-checking app content. This infers it is not the phone that drives problematic behavior, it is the apps. A significant reason that adolescents are attracted to social media apps is that they increase a sense of social inclusion and connectedness.⁸ Social media tech companies have capitalized on this for the sake of monetization. They compete with one another for finite attention in a zero-sum game. One example of this is Snapchat, an app where users snap each other (i.e., send pictures or videos with overlying captions, emojis, or animations); as of March 2020, Snapchat had 229 million daily active users and 4 billion+ snaps are sent each day (Snap Inc. First Quarter 2020 Financial Results https://investor.snap.com/news-releases/2020/04-21-2020-210949737). A design feature called Snapstreak involves two users seeing how many days in a row they can maintain snapping each other. Snapstreaks are considered an indicator of success and are viewed by adolescents as proof of friendship (Lorenz T. 17 teens take us inside the world of Snapchat streaks, where friendships live or die. Mic. https://www.mic.com/articles/173998/17-teens-take-us-inside-the-world-of-snapchat-streaks-where-friendships-live-or-die). Adolescents are often sensitive and acutely aware of their own, and peers’, social dynamics; therefore, having tangible evidence of committed friendships that endure over time can be a meaningful source of acceptance and recognition. One of our participants shared, “I'll get 30 Snapchat in an hour or something”. Adolescents can be devasted if months- or year-long snapstreaks lapse that they have poured an immoderate amount of time, energy, and self-validation into. Tristan Harris has stated, “Snapstreak is driving some teenagers nuts—to the point that before going on vacation, they give friends their log-in information and beg them to snap in their stead” (Harris T. What’s Now San Francisco with Tristan Harris. https://youtu.be/YQh2FQ7MZdA). Harris refers to the persuasive tactics behind Snapstreaks as hijacking techniques intended to maximize viewership and consequently advertisement revenue. In addition to these conditions and processes, peer pressure, emergent social media etiquette, and competition for approval were factors that also fed into and shaped the relevant context here. These represent reinforcers; an operant conditioning term referring to anything that strengthens or increases a behavior. Our participants recognized the pressure to conform and do what their peers are doing to be powerful and hard to resist. This manifested in the form of coercion to maintain Snapstreaks and have an active presence with multiple prevailing social media apps. Social media etiquette, in setting conventions and expectations for behavior, connects to adolescents’ group identity. This reinforcer increased app engagement by threatening a person’s sense of belonging and how they feel about themselves in relation to their peer group. In this sense, creating and posting a distinct version of a notable social media post and competing with peers for ‘likes’ is normalized and offers raised perceived social status as a reward. Problematic smartphone use has been negatively associated with adolescents’ mental well-being. Souza Pereiva et al. (2020),²³ in a study of 359 female and 308 male students aged 13-18 years, associated it adversely with physical activity levels, personal interactions, academic performance, and mood disturbances. Abi-Jaoude et al. (2020)²⁴ also report, “Evidence from a variety of cross-sectional, longitudinal and empirical studies implicate smartphone and social media use in the increase in mental distress, self-injurious behaviour and suicidality among youth; there is a dose–response relationship, and the effects appear to be greatest among girls.” As we also noted from our participants’ responses, Abi-Jaoude et al. describe smart phone app-facilitated social comparisons among adolescents that negatively affected their self-view and led to increased cyberbullying and promotion of self-harming behaviors. They call for an increase in public awareness of problematic smartphone use. The contexts highlighted by our study may help inform social policy interactions aimed at promoting safe, inclusive, and nourishing home or educational environments.

Almost half of the participants agreed or strongly agreed with items representing the PUMP dimensions of activities given up or reduced and use despite physical or psychological problems. With regard to these phenomena, adolescents’ experiences were shaped by both constraints and opportunities. Problematic use of smartphones was limited when some participants were gathered socially with close family; they acceded to restrictions placed on their phone access. In contrast, when gathered for social activities with close friends, phone interactions were prioritized and quality time forfeited. Participants could not fully rationalize this behavior. Physical restrictions on the proximity of smartphones to adolescents’ beds at night was another relevant constraint that directly impacted sleep hygiene, wellness, and next day preparedness for education. Likewise, Smetaniuk (2014) studied 301 undergraduates and found that more than 20% deprived themselves of sleep due to late-night phone use.⁵ Smartphone interactions provided adolescents with opportunities to delay or avoid something unpleasant (e.g., putting off studying for a test) or to manage stress. One of our participants noted, “You don't wanna work at school and then come straight home and start working again … I take a little break, but sometimes I'm on my phone for a long period of time … . I'm procrastinating, procrastinating, procrastinating, making myself more stressed for this test that I still have to study for.” This is consistent with the understanding that we mis-regulate ourselves by believing task avoidance will make us feel better.²⁵ By engaging with their smartphones as a coping mechanism, adolescents choose to focus on feeling good in the moment, in the now.

Implications for Research and Practice

The 21^st century has seen the convergence of widely accessible software apps, participatory media, and internet connectivity such that virtual learning and online coaching are no longer uncommon. Having reflected on our findings, we suggest that future studies explore the effectiveness of app-based digital coaching and management techniques to scaffold adjustments to adolescents’ habits in favor of a healthy phone-life balance. For example, Moment (Moment Health Inc., Burlingame CA) offers features suited to the contexts described here including goal-setting and guided coaching to: track phone and app usage, establish phone-free times with friends and family, stop sleeping with your phone, reduce distractions, role-model accountability, and stop aimless browsing. This could affect a novel approach to reducing mobile phone use that would place some of the impetus for change upon the adolescent and facilitate conversations between teens, parents, and care providers.

Limitations

This preliminary study was limited in that it involved only two adolescent cohorts from one geographical region of the United States. A minimum sample size of twelve participants is recommended for qualitative studies to reach data saturation (i.e., the point where redundancy signals to researchers that data collection may cease).^26–28 Given this, our sample of eleven participants isn’t quite sufficient for us to assert that our qualitative data achieved thematic saturation. The timeline of recruitment, data collection, and data analysis for this study necessarily followed the availability of the first author A.K. while he was in medical school. The authors had intended to recruit a third group of adolescents in 2020 to increase the participant number above twelve but the SARS-CoV-2 coronavirus pandemic prevented this.

In addition, no cut-point(s) for the PUMP scale have been established, preventing us from making more concrete judgments about the problematic mobile phone use construct with regard to our participants.

Conclusions

Smartphones have ensconced themselves into the everyday lives of consumers around the globe. The prevalence of problematic phone use amongst adolescents and its connection with adverse wellness is a growing public health concern because harmful behaviors established in childhood can shape one’s subsequent life course. Context is important for most phenomena of health care and health. This preliminary study supplies a contextualized glimpse into the adolescent assessment of perceived proper versus problematic smartphone use, potentially allowing parents, educators, and clinicians to reframe their approach to this critically important topic with the adolescents themselves.

Ethics statement

This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Human Experimentation Committee/Institutional Review Board of Quinnipiac University (#01018; 9 February 2018).

Consent statement

Written informed consent for publication of the participants’ details was obtained from the participants and parents/guardian/relative of the participant.

Data availability statement