ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
Research Article

Influence of Smartphone Usage on development of Sexuality among Late Adolescent Boys in Health Sciences Colleges of South India

[version 1; peer review: 1 approved with reservations]
PUBLISHED 20 Sep 2024
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

This article is included in the Manipal Academy of Higher Education gateway.

Abstract

Background

Better affordability of data plans and an increase in “budget” smartphones have resulted in an exponential rise in internet and smartphone users. The ease of access to sexually explicit material (SEM) coupled with adolescents’ impulsivity makes them prone to excessive SEM exposure and may affect the development of sexuality via the perceived realism of such content. This study was done to study the influence between problematic smartphone usage (PSU) and sexuality development among late adolescent boys.

Methods

One hundred and thirty-four adolescents aged 18-19 years, studying in a medical university, participated in this cross-sectional study. Smartphone Addiction Scale – short version (SAS-SV) to evaluate PSU and a content validated semi-structured proforma to evaluate gender identity, sexual orientation, sources of information on pubertal changes, and exposure to pornographic content was used. We expressed results as proportion and summary measures (Mean±SD), Chi-square test to find influence between PSU and adolescent sexuality development.

Results

We found a 45.5% prevalence of PSU. Among study participants, 88% were attracted to the opposite sex, 6% were attracted to the same-sex, and 6% were attracted to both sexes. Three per cent of participants liked wearing clothes of the opposite sex, 7.5% wanted to be members of the opposite sex, whereas 10.4% were not comfortable with their genitalia. They obtained information regarding pubertal changes from friends (85) and media (78). Many had exposure to pornographic content (90%), with the youngest being nine years old.

Conclusion

Nearly half of the late adolescents have PSU. Pornographic contents are accessed through Smartphones.

Keywords

Adolescent boys, sexual orientation, gender identity, smartphone addiction, pornography, problematic smartphone usage

Introduction

Adolescence is a stage of transition from childhood to adulthood that includes rapid physical, cognitive, and psychosocial growth.1,2 It is a critical period, as many behavioral patterns emerge during this period, which may persist throughout life.3 Psychological well-being and overall health of adolescents are major concerns worldwide.4 Adolescents engage in life-threatening behaviors, such as alcohol and substance use, unsafe sex, poor eating, and heightened risk-taking, which affects their psychological well-being.4,5 According to the 2011 census, in India, 1/4th of the population are adolescents (253 million), and 54% belong to the 10-14 age group, and nearly 46% are in the 15-19 years of age.6

Adolescents are highly attracted to modern technologies because they are psycho-socially immature and more prone to smartphone addiction due to the influence of the environment and peers.7 Reports highlight that adolescents are highly addicted to smartphones, equivalent to substances and various types of behavioral addiction.8 A meta-analysis by Davey et al. showed prevalence of smartphone abuse among Indian adolescents to be approximately 39% - 44%.9 Billieux et al. documented that problematic smartphone use (PSU) is defined as “an inability to regulate one’s use of the smartphone, which eventually involves negative consequences in daily life”.10 It is a type of behavioral or psychological dependence on mobile devices that is closely linked to excessive digital media use, such as Internet addiction disorder.11 PSU has been associated with various psychopathologies.12

Adolescents with PSU are highly exposed to viewing sexualized content through videos and reality programs. In addition to these sources, social media platforms and various mobile applications have increased sexual content.13 The adolescents are more frequently engaged in online sex chat, and are thereby exposed to cyberbullying and online harassment.14 PSU may lead to impulsiveness, which plays a pivotal role in an increased number of sexual partners.15

The term sexual orientation refers to the sex to which individuals are sexually or romantically attracted. Gender identity refers to an individual’s basic sense of being male, female, transgender, or something else.16 Gender orientation is biologically determined, and sexual expressions have many external influences, such as the media. However, there is a paucity of information on how PSU affects sexuality in adolescence. The present study aimed to understand the existing patterns of smartphone usage among late adolescents and their association with the development of adolescent male sexuality.

Methods

Study design & participants

We conducted a cross-sectional study among male students pursuing medical, dental, and allied health sciences courses aged between 18 and 19 years at a medical university in Mangalore, an urban area in the South Indian State of Karnataka. Late adolescent boys who were unwilling to participate were termed non-responders and were excluded from the study. The study duration was 11 months (November 2019–September 2020). We followed a convenience sampling method to recruit study participants. The STROBE guidelines were adhered to, and a complete checklist was provided in the reporting guidelines.

Sample size

All male students aged between 18 and 19 years who pursued the above-mentioned courses in the study institute were screened, and those over age and unwilling to participate were excluded from the study. The study flow diagram is shown in the following Figure 1:

f7eb3fd3-759f-4e80-b256-b888cf3c8994_figure1.gif

Figure 1. The study flow diagram.

Study tool

Following the consenting process, a content-validated semi-structured questionnaire (Google Form) was electronically mailed to all participants who were willing to participate in the study, and responses were collected. Students who had not completed the Google form were reminded using a WhatsApp message (24 hours after sending the questionnaire) and telephonic conversation (48 hours after sending the questionnaire). The questionnaire included demographic details, The Smartphone Addiction Scale – short version (SAS-SV),17 and questions on gender identity, sexual orientation, sources of information regarding pubertal changes, and body image issues. Smartphone usage and addiction using SAS-SV developed by Kwon et al.,17 consists of 10 items with 6 point Likert type scale. The scale items were scored from 1 to 6, with 1 being ‘strongly disagree’ and 6 being ‘strongly agree.’ The total possible score was between 10 and 60, with higher scores indicating higher chances of smartphone addiction. Based on the findings of a previous study, the cut-off for smartphone addiction was determined to be 31 in the present study.17

Data analysis

Data analysis was performed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Results are expressed as proportions and summary measures (mean ± standard deviation) using appropriate tables and figures. The influence between smartphone usage and sexual development was assessed using the chi-square test and independent sample t-test. Statistical significance was set at P <0.05.

Results

A total of 149 students were screened, and nine were excluded from the study because they were older. Among the remaining 140 students, 6 were unwilling to participate in this study; hence, they were excluded. The response rate was 95.7%. Of the 134 students, 98 were medical students, 20 were dental students, and 16 were allied health sciences students. Among the students, 90.3% were permanent residents of India, followed by 6.7% nonresidential Indians, and 3% foreign nationals. Most of the students resided in the hostel (85.1%), while 13.4% of the students lived at home, and 1.5% stayed in an apartment with friends.

In the present study, based on a predetermined cut off score of 31 on SAS-SV, the prevalence of problematic smartphone use (PSU) was 45.5% among the students.

As shown in Figure 2, 85 students obtained information about pubertal changes from friends, followed by books/magazines (81), schoolteachers (79), and movies (78). In contrast, fewer adolescents turned to mothers,16 fathers,17 or doctors18 for information related to pubertal changes,16 fathers,17 or doctors18 for information related to pubertal changes.

f7eb3fd3-759f-4e80-b256-b888cf3c8994_figure2.gif

Figure 2. Source of understanding about pubertal changes.

As shown in Table 1, regarding sexual orientation and gender identity among the students, 3% of the students desired to wear the dress of the opposite sex, while 94.8% did not, and 2.2% were not unsure. Among these students, 87.3% were happy with their current sexual identity, while 7.5% of them wanted to be members of the opposite sex. 86.6% Of students were comfortable with their genitalia, whereas 10.4% were unsatisfied. Romantic feelings towards the opposite sex were perceived to be normal by 91.8% of the students, while 5.2% felt abnormal, and 3% were not unsure. Out Of these students, 88% were attracted to the opposite sex, while 6% were attracted to the same sex, and 6% were attracted to both sexes.

Table 1. Smart phone usage and body characteristics of the study participants (n=134).

Are you worried about your:ResponsesSmart phone usage*P value
<31 No. (%)>31 No. (%)
PhysiqueNo27 (36.9)23 (37.7)0.932
Yes46 (63.1)38 (62.3)
WeightNo35 (47.9)24 (39.3)0.318
Yes38 (52.1)37 (60.7)
HeightNo52 (71.2)47 (77.0)0.445
Yes21 (28.8)14 (23.0)
Skin colourNo59 (80.8)49 (80.3)0.943
Yes14 (19.2)12 (19.7)
Scalp hairNo46 (63.0)34 (55.7)0.392
Yes27 (37.0)27 (44.3)
Body hairNo59 (80.8)55 (90.2)0.131
Yes14 (19.2)06 (09.8)
Optic aidNo60 (82.2)49 (80.3)0.783
Yes13 (17.8)12 (19.7)
GenitalsNo66 (90.4)51 (83.6)0.239
Yes07 (09.4)10 (16.4)

* ≥31 on SAS-SV scale was considered problematic for smartphone use.

Table 2 shows no significant association between PSU and gender identity or PSU and sexual orientation. Regarding the knowledge of adolescent sexuality, 72% attended classes on the topics related to sex in schools, 19% had not attended, and 9% were not sure.

Table 2. Gender identity and sexual orientation (n=134).

ResponsesYes
n (%)
No
n (%)
Don’t know
n (%)
Do you like wearing clothes of the opposite sex?04 (03.0)127 (94.8)03 (02.2)
Would you like to be a member of the opposite sex?10 (07.5)117 (87.3)07 (05.2)
Do you feel uncomfortable with your genitalia?14 (10.4)116 (86.6)04 (03.0)
Do you feel romantic feeling towards the opposite sex is normal?123 (91.8)07 (05.2)04 (03.0)
Do you have attraction/feeling towards another person of the opposite sex?123 (91.8)04 (03.0)07 (05.2)
Do you have attraction/feeling towards another person of the same-sex?08 (06.0)119 (88.8)07 (05.2)
Do you have attractions/feelings toward people of both sexes?08 (06.0)114 (85.1)12 (09.0)

Regarding normal male sexuality, 92.5% of the students were aware of the mental changes occurring during puberty, 90.3% were aware that adolescence was the final opportunity for growth (final height), and 83.6% of the study population indulged in masturbation. Among the adolescents indulged in masturbation, 28% felt guilty after masturbation, 30% felt masturbation caused severe damage to health, and 99.1% of the students preferred masturbation in private and thought it was not normal to masturbate in public. There was no statistically significant association between PSU on gender identity and sexual orientation (Table 3)

Table 3. Effect of PSU on Gender Identity and sexual orientation (n=134).

ResponsesProblematic smartphone usageP value
No
n (%)
Yes
n (%)
Liking wearing clothes of the opposite sexNo71 (54.6)59 (45.4)1
Yes02 (50.0)02 (50.0)
Liking to be a member of the opposite sexNo69 (55.6)55 (44.4)0.511
Yes04 (40.0)06 (60.0)
Feeling uncomfortable with own genitaliaNo65 (54.2)55 (45.8)1
Yes08 (57.1)06 (42.9)
Feeling that romantic feeling towards the opposite sex is normalNo08 (72.7)03 (27.3)0.344
Yes65 (52.8)58 (47.1)
Having attraction/feeling towards another person of the opposite sexNo06 (54.5)05 (45.5)1
Yes67 (54.5)56 (45.5)
Having attraction/feeling towards another person of the same sexNo67 (53.2)59 (46.8)0.290
Yes06 (75.0)02 (25.0)
Having attractions/feelings toward people of both sexesNo66 (53.7)60 (46.3)0.071
Yes07 (87.5)01 (12.5)
.

In our study, 90% students had watched pornographic content and one of the students had watched when he was 9 years old, 4.2% watched porn content before they turned 10, and 58% watched the porn content between 15-18 years. Most of the students (95%) wanted to watch the porn content alone, and 90.8% watched the porn content through smartphones. Regarding the frequency of watching porn content, 45% viewed less than once a week, and 37% watched 2-3 times per a week.

After watching the pornographic content, the psychological behaviour shows that 7.5% of the students felt altered perception of communicating with the opposite sex, 11.7% responded that watching porn content had altered the study pattern, and 12.5% answered that it affected their academic performance. However, 71% of the students revealed that they had been sexting at least once. Our study did not find a statistically significant association between PSU and exposure to pornographic content (Table 4).

Table 4. Association between smartphone usage and pornography.

ResponsesProblematic smartphone usageP value
No (n=66)
n (%)
Yes (n=54)
n (%)
At what age did you first watch a pornographic movie (PORN)? Mean (SD)14.43 (1.99)15.16 (2.16)0.056
How frequently do you watch PORN?≤once a week29 (43.9)25 (46.3)0.841
≥once a day07 (10.6)04 (07.4)
2-3 times a week23 (34.8)21 (38.8)
once a day7 (10.6)04 (07.4)
Does it affect academic performance?No60 (90.9)46 (85.2)0.331
Yes6 (9.1)8 (14.8)

Discussion

Sexuality, which involves showing interest in a desired activity, orientation, and preference, is a normal phenomenon during adolescence. Adolescent sexuality includes an array of factors, such as intimate partnerships, gender identity, sexual orientation, religion, and culture.19 Adolescent sexuality development correlates better with the biopsychosocial model.20 The array of biological, psychological, and social factors plays a predominant role in the progression of adolescent sexuality. Social factors such as parents’ attitudes related to sexuality, parenting style, relationship with peers, and cultural influence are the major attributes of adolescent sexual attitudes.21 Recently, the media have also greatly influenced adolescent sexuality. Adolescents have easy access to information on sexuality, sex crimes, and violence through the media, influencing their perceptions and attitudes toward sexuality.22 Further, television and the Internet also provide fast access to sexual content, altering adolescents’ perception towards sexuality.23 Smartphone provides various benefits such as fast internet access, video calling, easy access to social media, and gaming.24 Increased smartphone use leads to addictive behavior. One commonly referred term is Problematic Smartphone Use (PSU), similar to behavioral addictions such as substance-related, gambling, and Internet addiction disorder.25 Adolescents are more vulnerable to problematic smartphone use because of the imbalance between the reward and behavioral control systems.18 A recent meta-analysis showed that Indian adolescents are highly addicted to smartphones and exhibit problematic sexual behaviors.9 So, we conducted the present study to evaluate the impact of problematic smartphone use on male adolescent sexuality development.

The prevalence of smartphone addiction based on the SAS-SV cut off score of 31 was found to be 45.5%, which reflects a higher PSU as compared to Chinese students (38.5%),26 European countries Belgium (21.5%)25 and American university students (20.1%).15 This discrepancy might be due to differences in sampling methods and the rapid development of telecommunication with cheaper and faster internet along with an increase in the budget of smartphones in India.27

In our study, transvestism, is observed in 3% of the students. Among the participants, 10.4% reported dissatisfaction with their genitalia. Men’s attitudes toward genitals have been shown to affect their psychological status. Thus, in men with dissatisfied genitals, it creates a state of insecurity, and in men with contented genitals, it gives confidence.28 The majority of the participants, 91.8%) thought romantic feelings towards their female counterparts were normal. Romantic relationships during adolescence are essential for development and well-being. Further, it has a positive association with the development of personal identity, self-esteem, and social competence and is useful for career planning. It has been positively associated with the formation of personal identity, adaptability to change, self-esteem, social competence, scholastic achievement, and career planning.29 Late adolescence (16–18 years) occurs when consolidation of romantic bonds occurs, elevating the risk of a poor-quality romantic relationship.30 In our study, normal romantic relationships towards the opposite sex might be due to a greater preference for cyber-relationship applications such as web chats and social networking chat rooms. These social networking chat rooms offer online romantic relations, which might be heightened by excessive or problematic internet use.31 We report 6% of same-sex attraction among the students; however, in a study conducted by Nama et al. among Canadian medical students in Ottawa, 18% of the medical students were involved in same-sex attraction or gay behavior.32 Further, our study reported no significant associations between sexual orientation, gender identity, and PSU. In this study, a higher number of students (85%) obtained information regarding the pubertal changes from their friends. Previous studies have also revealed that males share information regarding puberty and first wet dreams with their friends.33

In this study, 72% of adolescents attended sex education in schools. In a study done by Kumar et al. shows that 97.1% of students like to have sex education during their school life period.34 Further, genital growth in boys has been reported to be associated with altered cognitive function.35 In this study, 92.5% of students were aware of mental changes during puberty, 90.3% aware that adolescence is a final opportunity for growth, and 83.6% of students had self-explored genitalia.

In this study, 28% of students felt guilty after masturbation, 30% felt masturbation could induce serious damage to health, and 99.1% preferred private masturbating practice and not in public. Similar to our report, a study conducted among Chinese students showed an association between floating anxiety, somatic and hysterical symptoms, and masturbation.2

In our study, 90% of the students had viewed porn content, which is comparable to other studies conducted among adolescent boys in Sweden (98%)36 and Australia (87%).37 In the current study, 45% viewed porn content less than once a week, and 37% watched 2-3 times per a week, which is higher as compared to a study done among Polish students, where 34% viewed pornographic content once a week and 24% few times a week.38

In this study, watching pornographic content did not influence students’ psychological behavior and study patterns. Similar to our report, a study conducted on Croatian adolescents showed that viewing pornography displayed no significant negative alteration in adolescent subjective well-being, depression or anxiety, or self-esteem.39 In a study conducted by Šević et al. among Croatian adolescents, watching porn content or sexually explicit material online did not affect academic grades, study patterns, or well-being.40 In contrast, Beyens et al. reported that watching online pornographic content has a negative association with students’ academic performance when compared between baseline and six months.41 Further, we did not observe a significant association between problematic smartphone use and pornographic content exposure.

The strength of this study is that it is the first of its kind to correlate adolescent sexuality with smartphone usage using a standardized questionnaire (Smartphone Addiction Scale – short version, SAS-SV). This study has some limitations. Considering the smaller sample size and enrolment of only health sciences students, the results cannot be generalized.

This study implies the formulation of structured awareness programs to be carried out by health professionals and to educate parents about handling adolescent issues. In addition, it encourages adolescent health programs to create knowledge about risky behaviors and community support groups. This study highlights the need to include comprehensive sex education as part of the school curriculum and to educate young Internet users on the safe and responsible use of the Internet.

Ethics and consent

The study was approved by the Institutional Ethics Committee on 15/01/2020 (approval number: IEC KMC MLR 01/2020/36) and the Head of the Institute. Eligible participants were contacted individually using the MS Teams platform. The purpose of the study, the role of their participation, the study procedure, and confidentiality were explained, and informed consent was obtained online using google forms from each participant.

Comments on this article Comments (0)

Version 2
VERSION 2 PUBLISHED 20 Sep 2024
Comment
Author details Author details
Competing interests
Grant information
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
- -
Citations
CITE
how to cite this article
Manya SM, K J, Mithra P et al. Influence of Smartphone Usage on development of Sexuality among Late Adolescent Boys in Health Sciences Colleges of South India [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:1079 (https://doi.org/10.12688/f1000research.150657.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 20 Sep 2024
Views
28
Cite
Reviewer Report 11 Oct 2024
Sudhir Prabhu, Department of Community Medicine, Father Muller Medical College, Mangalore, India 
Approved with Reservations
VIEWS 28
The research article submitted by the authors clearly answers the research question about the impact of problematic smartphone usage and sexuality among late adolescent males, both of which are important public health issues. However I have a few concerns about ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Prabhu S. Reviewer Report For: Influence of Smartphone Usage on development of Sexuality among Late Adolescent Boys in Health Sciences Colleges of South India [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:1079 (https://doi.org/10.5256/f1000research.165247.r326604)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 07 Jan 2025
    Jayashree K, Department of Pediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India
    07 Jan 2025
    Author Response
    Major:
    1. How was development of sexuality defined for this descriptive study: was it sexual orientation or sexual identity or something else?

    Author response: Thank you for ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 07 Jan 2025
    Jayashree K, Department of Pediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India
    07 Jan 2025
    Author Response
    Major:
    1. How was development of sexuality defined for this descriptive study: was it sexual orientation or sexual identity or something else?

    Author response: Thank you for ... Continue reading

Comments on this article Comments (0)

Version 2
VERSION 2 PUBLISHED 20 Sep 2024
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
Sign In
If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

The email address should be the one you originally registered with F1000.

Email address not valid, please try again

You registered with F1000 via Google, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Google account password, please click here.

You registered with F1000 via Facebook, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Facebook account password, please click here.

Code not correct, please try again
Email us for further assistance.
Server error, please try again.