LITERATUREREVIE

W
 CHAPTER – II
REVIEW OF LITERATURE
LITERATURE REVIEW:
Literature reviews provide a handy guide to a particular topic with the idea to convey to the
readers about the work already done and the knowledge and ideas that have been already
established on a particular topic of research. 51
Review of literature or survey is a significant advancement or step in the improvement of any
exploration project. It assists the examiner with analysis of what is known about the subject
and to depict the techniques for enquiry utilized in before work including the achievement
and weaknesses of the study. It gives the wide comprehension and understanding of the
problem.52
“Researchers almost never conduct a study in an intellectual vacuum their studies are usually
undertaken within the context of an existing basic knowledge” (Polit and Hungler 2005)
It aims to review the critical points of particular topic with its current knowledge and its
findings bring the researcher up to date with current literature and also future research that
may be needed in the area. An extensive review of literature relevant to the research study
topic was done to gain information and insight and to build foundation of the study. 53
Review of literature is important for broadening the understanding and insight necessary for
the development of a conceptual framework, which the problem fits and for the development
of the tool.
The review of literature of the present study is organized in the following headings
 Literature review related to the prevalence of nomophobia.
 Literature review related to the smart phone addiction.
 Literature review related to the effects of nomophobia among adolescents.
 Literature review related to the level of knowledge regarding nomophobia
among adolescents.
 Literature review related to the management and prevention of nomophobia.
 Literature review related to the impact of psycho-educational program on the
knowledge and levels of nomophobia.

Part A: Literature review related to the prevalence of nomophobia.

An investigation was done in the year 2015 eases or reveals that the present status of logical
information about the smart phone addiction or abuse. The basic search of the study was
carried out in international databases using the heading “cell phone”, “smart phone addiction
or abuse” and the main focus was basically on the prevalence studies, diagnostic studies and
associations with various psychological demographic variables and the gender differences.
The findings reveals that the estimated prevalence ranges from the 0-38% were dependent on
mobile phone but surprisingly the self-attribution of cell phone addiction exceeds from the
prevalence rates which was found in the study.54
The nomophobia phrase was coined in the year 2013 in UK and it was found that the two
third of the mobile phone users were readily become anxious specially when they used to
loss their mobile phone, running out of battery, or when they used to be in a location which is
out of network coverage. The findings of the study concluded that the young adolescents
especially in the age group of 14 to 25 years are more likely to suffer from nomophobia. The
prevalence of nomophobia has seen a drastic increase from 50 to 66% especially in the last
four years.55
A study conducted in the year 2017 reveals that the two-third of the young adolescents
suffers from nomophobia, they have fear of losing a mobile phone. A recently published
study suggests that the nomophobia is a new psychological disorder which is rising in an
alarming trend across the globe. Young adolescents while travelling, heading towards a
restaurant, or even walking down the street gives the impression that the young child is
absolutely in love or addiction with their mobile phones which is causing a serious health
problem among adolescents. According to a recent survey which was conducted by Secure
Envoy a private company, which has done specializations in digital passwords, using one poll
found that around 66% of the employed workers who have mobile phone have developed
nomophobia, the fear of being without mobile phone. 56
The over usage of mobile phone leads to nomophobia. Nomophobia is usually known as “No
Mobile Phone Phobia”. This is a kind of phobia or fear of losing the mobile phone. Here the
people feel fear and insecure when they don’t have mobile phone with them. People feel
when they don’t have mobile phone they feel potential danger can come to them which can
cause threatening to their life. The study highlighted the number of nomophobia is increasing
up to the level of 13% since last four years due to the ever increasing use of mobile
technology. The addiction towards mobile phone is ever increasing in and around 53% of the
mobile phone users suffer from nomophobia. 57
A descriptive study was conducted to assess the knowledge regarding nomophobia among
nursing students at Gandhinagar, Gujarat. 60 students were selected from simple random
sampling technique. A self structured questionnaire was prepared to assess the knowledge on
the nomophobia. 21.66% had poor knowledge, 75% had average knowledge, and 3.33% had
good knowledge regarding nomophobia.58
A study conducted in western Gujarat from the month of September to October 2018 to
assess the prevalence of nomophobia among 331 respondents. 58% were males and 42%
were females. There was no significant difference in average nomophobia scores with respect
to gender (p=0.401), age (p=0.135). 241 respondents which is 72.80% felt that there
consuming more time in the use of mobile phone and this was affecting their other daily
activities of life.59
A study was done in the year 2018 to assess the levels of nomophobia among higher
secondary students in Nagpur with a view to develop a pamphlet regarding the prevention of
nomophobia. Non experimental descriptive design was used and non probability convenient
sampling technique was used to select 100 samples from the higher secondary school Nagpur.
A structured questionnaire was used to assess the levels of nomophobia. 8% of the students
were at high risk of developing nomophobia 46% mild level of nomophobia, 33% had
moderate level and 13% had severe level of nomophobia. 60
A study conducted in the year 2020 to find out the prevalence and effectiveness of planned
teaching program on prevention and management of nomophobia among 200 undergraduate
students University students from Kanpur. NMP-Q, nomophobia questionnaire was used to
assess the prevalence of nomophobia. Knowledge was assessed by using the structured
knowledge questionnaire regarding prevention and management of nomophobia. The study
reveals that the 57% of under graduate students had moderate nomophobia, 21.5% had mild
and 21.5% had severe nomophobia. 85% had poor knowledge 15% had moderate knowledge
regarding prevention and management of nomophobia. 61
A mixed method study was done in the year 2019 to assess prevalence, associated factors,
and perception among college students in Pondicherry, India. Out of 714members 23.5% had
extreme nomophobia. More established age, male, sexual orientation; term and frequency of
Smartphone use, use for social networking communication, checking without reason, and
checking Smartphone after just waking up in the early morning were some of the factors
significantly associated with nomophobia. 62
A cross section study was done in Mandya Institute of Medical Sciences from May 2018 to
June 2018. 45 students were incorporated has study population. Structured questionnaire was
used to collect the data. The mean age of study participants was 20.1±1.3 years. Majority of
the students were residing in hostel. The amount spend on mobile recharge was
approximately was INR 354.1±185.0. The major reason of using mobile phones was to call
family members, using internet for study purpose and for social networking. The prevalence
rate was moderate to extreme nomophobia among the study subjects which was 99.0%. There
was no evidence of statistically significant difference observed among gender and
nomophobia.63
A cross sectional study was done among 130 medical students Sri Aurbuindo Medical
science, Indore in the year 2015 regarding the rising concern of nomophobia among Indian
medical students. A pretested questionnaire was used to collect the data. Response rate was
90.76%. All the participants had at least one mobile phone with activated internet services.
73% of students were nomophobics. 21% nomophobics had experienced anxiety. 83% of
students had panic attacks when their mobile phone was misplaced. Headache and lethargy
were the common side effects which were present among 61% of students. 64
A cross-sectional study conducted from May 2020 to August 2020 at Narayana Medical
College with pre-validated questionnaire. A Google survey form was created to assess the
prevalence of nomophobia among 600 students. 58.96% of females and 42.06% of males
were nomophobic. The most common usage of mobile phones was for mobile games among
79.67%. Deprived sleep and mobile phone dependence was 85.33% and 68%
[Link] addiction is more prevalent in younger adolescents 86.8%. The
prevalence of smart phone addiction was found in (17- 20 years) 81.5% and in (21 years and
older) 5.4%.65
A cross sectional study was conducted among the undergraduate medical students of
Government medical college, Ambajogai. All the MBBS students from 1 st to final year were
enrolled in the study. 346 medical students were administered pretested questionnaire on test
of mobile phone dependence. Nomophobia prevalence was 71.39%. 73% males were
nomophobic and 69.94% females were nomophobic. Disturbance of sleep was reported
among 41.33%.66
Part B: Literature review related to the smart phone addiction.
A study finding of the year 2015 reveals that the use of mobile phone has ever increased
around the globe during the last decade especially among the adolescents groups. Mobile
phone plays a vital role especially in the young school going student’s life, signs of smart
phone addiction and whether there are differences in the usage of phone among Polish and
Belarusian students. Total 160 students were enrolled from Belarus and 227 from Poland.
Structured tool was used to assess the prevalence of mobile phone addiction. Overall 22.9%
of the young students from Poland and 10.4% of the Belarusian students had the symptoms of
smart phone addiction.67
A study was conducted in the year 2016 to find out the various common health effects of
smart phone among college going students of both the gender belonging in the age group of
17 to 23 years from the urban and rural backgrounds were selected randomly. A self
administered questionnaire which was pre-tested was used for the study. The questionnaire
included items such as common adverse mental and physical health symptoms which was
attributed to the over usage of cell phone. The study revealed that almost all the subjects
96.1% had cell phones and used the device for various purposes throughout the day.
Headache was found to be the common symptom in 51.47% followed by irritability or anger
50.79%. The other common mental symptoms included lack of concentration and poor
academic performance, insomnia anxiety etc. Among the various physical symptoms the
body aches was found in 32.19%, eye strain in 36.51%, digital thumb was found among
13.8%. There were also many cases of accidents were reported while using mobile phone. 68
A self reported mobile phone dependence questionnaire was prepared with detailed
explanation and the purpose of the study was distributed among 43 male and 155 female
nursing college students in Osaka in the year 2012. The analysis of the study mainly focused
on the female population. All the items of the questionnaires were completed buy 132 which
is 85.2% of the female students who were chosen among the participants. The mean age of
the subject was found to be 24.5 or 5.7 years old with a range of 18 to 49 years. The
assessment of mobile phone addiction among the participants were based on the responses
given on 20 self rated items related to mobile phone usage in the mobile phone dependence
questionnaire. Each response was scored using a likert scale (0, 1, 2, and 3) and the likert
scores for each item were then summed up to provide a quantitative analysis to find out the
overall mobile phone dependence and the scoring range was from 0 to 60, with the higher
scores indication greater dependence of mobile phone. The internal consistency was also used
to measure the smart phone dependence.69
A study was conducted in the year 2015 to determine the prevalence of smart phone use and
its relationship with the mental health status and demographic factors of the students among
Gonabad University of medical sciences. Cross-sectional study was conducted among 700
students of the university. Students were surveyed and their complete demographic
information was collected. General health questionnaire which consisted of 28 items was
used to determine mobile phone addiction. That data was analyzed in SPSS 18 software. Chi-
square and student t test and ANOVA were used at the significant level of P< 0.005. The
prevalence of smart phone addiction was 36.7% among the students. There was significant
relationship between the prevalence of over usage of mobile phone and mental health status
in general (p>0.05) and also somatisation (P<0.05), anxiety and depression significantly
(P<0.05).70
A study conducted in the year 2013 was done to evaluate the threat of mobile phone addiction
among the university students of Belarusian. The study consisted among 160 students from
Belarus. A self-structured tool was used to test the mobile phone fascination. The instrument
was directed among the students who had mobile phones. 68.8% of the students experienced
the harmful impacts of mobile phone. Near about one-third of the study subjects confirmed
that mobile needs to kept switched off which was almost 33% of the subjects announced that
the mobile phone ought to be kept switch off mode. 30% of the study participants mentioned
that they switched off their mobile phones while watching movies in theatre and 33.8%
practiced the habit of switching their mobile phone off during their visit to church. 28.78% of
the students had information with respect to the meaning of nomophobia. Generally, 71.9%
of the respondents never turned off their mobile phones. Just 10.14% of the students had the
manifestations of cell phone addiction. 71
A new recent study was done in the year 2017 in the UK reveals that almost two-thirds of the
respondents were afflicted with nomophobia also known as no mobile phone phobia. Some
people used to get panic attacks when they were without their mobile phones. An adolescent
psychologist explains that the adolescents become exceptionally concerned and make all
endeavours to find their mobile phone when it is lost. The most youthful or youngest age
group 18 to 24 years tops the nomophobia list at 77% which is 11% more than that of next
group which is in the age group of 25 to 34 years. An adolescent wants to enjoy the company
of their friends. It is very difficult to make them stay in loneliness. 72
A cross-sectional study was carried out in the year 2016 which was conducted among 200
MBBS students from MGM medical college Indore. Thos students who were using mobile
phone for more than one year duration for at least one to 2 hours per day were included in the
study. 600 students of the college met above inclusion criteria. Samples were selected by
systematic random sampling. Every third students were selected. A pre designed and
pretested questionnaire was selected which was based on the line of Dr. Marcus L Raines was
used to study the mobile phone dependence. The questionnaire was modified based on the
local conditions. The mobile phone dependent students were then designated has
nomophobic. 56% of the students used to keep their mobile phones in pockets close to their
body.73
It is not a great secret that the adoption of mobile phone devices continues to grow across the
globe. The more amount of technology which we use has sophisticated and ingrained our
lives. But according to a recent research study in the year 2018 market peoples and traders
will increasingly take advantage of this trend. The spending on mobile advertisement has
reached $1.8 billion a whopping 47% increase. As the customers continue to adapt mobile
devices which is the mainstream way to access the web platform. When compared to
September 2017 there is a drastic increase in mobile phone use. 74
A study conducted in the year 2016 in UK among 2163 people found that 53% of the subjects
felt anxiety when they were unable to have access to their mobile phones. The study also
revealed that the 58% of male respondents and 48% of female respondents had nomophobia.
As opposed to a phobia in and of itself the reactions of respondents could be more of an
anxiety produced from the root fear of being alone. The vast majority part of which is 55%
told that the primary cause of their restlessness was when they feel that they are being
disconnected from their family, loved ones and friends. 58% of men and an extra of
additional 9% felt worried when their mobile phones were switched off. Around 53% of
individuals are getting restless and anxious when they cannot contact their friends and family
members through their cell phones. The study findings revealed that more than one out of two
confirmed cases of nomophobia never switched off their mobile phones. 75

An investigation which was carried out in the year 2014 revealed that nine out of
every ten individuals who were under the age 30 years concededthemselves that they were
enduring with another age marvel phenomena known as “Nomophobia”. The thought or fear
of having no mobile phone. The Telecom goliath Ciasco conducted a overview survey
among 3800 people in Australia found that the nine out of 10 under the age group of 30 years
were dependent to their advanced new technology smart phones. They become restless and
anxious when their phone gets turned off because of variousdifferent issues. 76
The outcomes likewise uncovered that, cell phone reliance was available among 20% of the
undergraduate students. The outcome clarified that the cell phone use was related with female
sex, rural school area, higher monthly family economy, tobacco smoking, over consumption
of liquor, depression, cell phone reliance or dependence and school disappointment or failure.
The examination presumed that, the variables related with serious use and reliance ought to
be considered for conceivable intercession activities. So there was need for possible
interventional studies in this regard to the nomophobia. 77
A cross-sectional review was directed to evaluate the pattern of smart phone use and
the perceived reliance towards the cell phone utilization. Nomophobia Severity Index-Self
appraised variant (NSISR) among the male college UG students of thehealth sciences were
selected. There were around 547 study subjects and they were chosen by snowball
samplingprocedure technique. The reliance ordependency status detailed by the
undergraduate students was more or less similar among undergraduate students from various
courses of studies. There was huge positive relationship was discovered to be set up between
the example of cell phone use and with the seriousness of nomnophobia. 78
A descriptive study was conducted to survey the segregating force of socio segment
and mental factors on the compulsion of cell phone use among centre school going UG
students and to recognize the different separating elements of the habit-forming utilization of
cell phone among the socio segment and the mental factors. Among the 123 centre school
going UG students in Busan, the potential members were distinguished through separated
arbitrary examining strategy. 747 centre school understudies took part in the investigation.
57% of the respondents were male and from that 89.7% utilized PDAs at school. The
members were assembled into three classifications relying upon the degrees of cell phone
use. 117 examples were discovered to be dependent, 418 were discovered to be reliant and
212 were discovered to be non-dependent. Among the three gatherings two capacities were
delivered and just one capacity was discovered to be huge, separating the habit bunch from
the non compulsion bunch. An extra separate examination of the members was accurately
done into the two gatherings. Lack of caution, nervousness, stress were discovered to be
critical separating factors.79
An article published in the general Sang Yuplee for examining the factor that
influences early adopters’ smart phone adoption. The purpose of this paper was to examine
the factors that influence the adoption behavior of smart phone and also to examine the
influence of other factors such as self innovativeness, self efficacy, decision maker’s attitude
towards a product, familiar influence and other demographic factors. It finds that important
influence of friends, financial burden and other family members on the smart phone adoption
of college students. The report found that younger people tend to adopt a smart phone earlier
than older people. A report from e-Marketer (2012) shows that 61% of college students had
owned smart phones in 2011. It focused on the smart phone adoptions behavior of college
students. In future studies it might be interesting to examined the different smart phone
adoption behaviors of students depending on when they adopt a smart phone. 80
A Cross sectional study examining nomophobic behaviors of Indian medical students
has reported that almost 75% of the participant students are nomophobes and 83% experience
panic attacks. The purpose of the current study was to investigate the prevalence of
nomophobia and demographic factors affecting their nomophobic behaviors. Considering the
proliferation of smart phones in Turkey, as evidenced by the increase in the Smartphone
penetration rate from 14% in 2012 to 39% in 2014 and the adoption of smart phones mainly
by young adults, investigating the prevalence of Nomophobia among Turkish young adults
will contribute to the understanding of how mobile technologies are impacting young adults
in Turkey.81
A study investigated the relationship between the frequency of mobile phone use and
mobile phone involvement. They argued that the frequency of use and involvement were not
identical concept by conceptualizing involvement as people’s cognitive and behavioral
interaction with their mobile phone. The questionnaire was administered to a sample of 946
young Australian people. It results; they eliminated several items and ended up with
questionnaire of 8 items (using a 7 point rating scale). They found a weak relationship
between mobile phone involvement and frequency of daily use. It involved mobile phone
users used their phone more frequently than did those who were not highly involved. Itshows
that the mobile phone involvement questionnaire is valid and reliable questionnaire and that
self identity and validation from others affecting peoples mobile phoneinvolvement.82

In the article Paper on Hooked on Smart phones: An Exploratory Study on

Smartphone Overuse among College Students. This emerging issue motivated to analyze the
usage patterns related to Smartphone overuse. Investigation on Smartphone usage for 95
college students using surveys, logged data, and interviews was carried out. They divide the
participants into risk and non-risk groups based on Self-reported rating scale for Smartphone
overuse. Compared with the non-risk group, results show that the risk group has longer usage
time per day. Also, the risk group users are more susceptible to push notifications, and tend to
consume more online content. The article titled positive impact of Smartphone Application:
Whatsapp and Face book for online business tries to highlight that science and technologies
contribute to the development and improvement of various activities globally. The survey
was conducted on 100 respondents and findings are as follows almost 88% agreed that they
have knowledge on certain products via online browsing, another benefit is that it can
automatically sync with desktop computer, creating a Smart Phones app or advertising
through text message helps in increase in brand awareness, building relationships and grow
business by using Smart Phones, easy product feedback is available, it is time saving. Further
author has highlighted negative aspects of Smartphone overuse on young adults, such as sleep
deprivation and attention deficient, are being increasingly recognizedrecently.83
An article titled on proposal for including Nomophobia in the new DSM-V. The main
purpose of this study or the fundamental motivation behind this investigation was to consider
the incorporation of nomophobia in the DSM-V and make a thorough comprehensive outline
and overview of the current existing literature, talking about the clinical significance,
epidemiological highlights, psychometric scales and proposed treatment. Despite the fact that
Nomophobia has not been remembered for DSM-V significantly more consideration is paid
to the psychopathological impacts of the new media. It presumes that cell phones and new
innovation has formed our day by day life, with both positive and negative viewpoints.
Further examinations needed to research more inside and out the mental parts of nomophobia
and to give a normalized and functional definition. 84

The investigation was directed on investigating the impact of example of portable web
use on college understudy's nomophobia levels. The reason for this investigation was to look
at the alleged impacts of the span of the versatile web proprietorship as far as a long time the
length of every day portable web use and monthly mobile internet. The study group consists
of a total of 645 students, of who are 429 females and 216 males, are studying in different
departments and come from different age groups.85
The outcomes are individuals with PD showed huge expansions in nervousness,
tachycardia, respiratory adjustments, shuddering, sweat, frenzy, dread and sorrow identified
with the absence of a MP contrasted with the benchmark group. This examination reasons
that the two gatherings displayed reliance on and were support by having a MP;
notwithstanding, individuals with PD and agoraphobia showed altogether more enthusiastic
adjustments just as extreme physical and mental manifestations when they were separated
from or unfit to utilize a MP contrasted or when compared with healthy volunteers. 86
An Exploratory investigation of Nomophobia in post alumni occupants of a showing
medical clinic in focal India. The fundamental point of this investigation to evaluating the
pervasiveness of Nomophobia and its relationship withvarious clinical and socio
demographic factors. The sample was 100 post graduate residences were included in the
study after informed consent and ethics committee approval. Results were seen in 38% of
participants with significantly more prevalence in younger age group and in females.
Majority of the participants were using mobile phones since 5 to 10 years [71%]. Around
46% participants used mobile phone for 2 to 3hours per day with most of them [47%]
checking their phones 25-50 times per day. More than half of the participants (59%) spent
500-1000 rupees per month as their mobile expenses. Physical symptoms due to mobile
phone use were reported by 37% of the participants and they were seen significantly more in
those with Nomophobia. It concludes that this study not only gives useful insight into
Nomophobia and its risk factors, but also it reduces the more usage of mobile phones.87
A cross sectional, observational study was conducted in prevalence of mobile phone
dependence in secondary school Adolescents. The aim of the study is to the prevalence of
Mobile phone dependence [MPD] in secondary school adolescents. The samples are 450
students studying in 8th, 9th and 10th standards of school at Navy Mumbai. Participant
information like age, gender, family type, phone type, duration of use per day. They were
administered an MPD questionnaire based upon dependence. The result was found
that31.33%of sample students. It was significantly associated with gender (p=0.003,
OR=1.91, CI=1.23-2.99), family type (p=0.0012), type of mobile phone
use(p>0.001,OR=2.6,CI=1.63-4.35), average time per day spent using mobile
phone(p>0.001) and years of mobile phone usage. It concludes that MPD has been found to
be an emerging public health problem. There is need to recognize and identify early the
growing trends and negative consequences, so as to prevent a major public health concern.89
A cross sectional study was conducted on rising concern of nomophobia amongst
Indian medical students. The intention of the study is to evaluate the example of cell phone
utilization and predominance of Nomophobia among third year clinical understudies in north
India. The examples are 130 clinical understudies of third year MBBS of AIMS. A pre-
shaped pre-tried survey was utilized. Result was discovered that reaction rate was 90.76%.
87% of students utilizing internet providers, 34% were having 2 cell phones, 4% had multiple
cell phones, 61% students needed to re-energize the internet providers, 28% two times per
month, 11% students needed to re-energize 3 times each month. 73% students were
nomophobics, 21% of nomophobics experienced nervousness. 83% students experienced fits
of anxiety. Headache and dormancy commonest incidental effects that was capable by 61%of
students. It reasons that itgives a short thought regarding the sad results of Nomophobia. The
future discoveries are an unmistakable need of future examinations in this field. 90
Smart phone addiction is a very common problem among adolescents across the
worldwide. A cross-sectional study was conducted in the year 2017 with a web-based
questionnaire distributed through the use of social media. Six point liker scales was used to
assess the smart phone addiction. Becks depression inventory was also used. The mean
percentage score of addiction was found to be 50.2±20.3 and the mean score of depression
was found to be 13.6±10.0. There was a significant positive linear relationship was present
between depression and smart phone addiction. Significantly higher mobile phone addiction
scores were associated with younger age users, (β = − 0.203, adj. P = 0.004). Factors
associated with higher depression scores were school educated users (β = − 2.03, adj.
P = 0.01) compared to the university educated group and users with higher smart phone
addiction scores (β =0.194, adj. P > 0.001). 91
A study was conducted to assess the prevalence of internet addiction among adolescents.
Adolescents in the age group of 12 to 15 years were assessed with the Young’s Internet
addiction test (IAT), the Japanese version of the general health questionnaire was used. Based
on the total IAT scores 2.1% male and 1.9% female were addicted to internet. The total
general health questionnaire score was significantly higher in the addicted (12.9 ± 7.4) and
possibly addicted groups (8.8 ± 6.0) than in the non-addicted group (4.3 ± 4.6; P > 0.001,
both groups). A comparison of the percentage of students in the pathological range of GHQ
scores revealed significantly higher scores in the possibly addicted group than in the non-
addicted group. Further, accessibility to smart phones was significantly associated with
Internet addiction. The study concludes that the students are addicted. The over usage of
smart phones warrants a special attention among the adolescents community. 92
A study was conducted to assess the smart phone addiction prevalence and to
ascertain whether depression or anxiety, independently contributes to mobile phone
addiction. 688 undergraduate students were selected by random sampling technique.
Prevalence of mobile phone related compulsive behaviours; functional impairment, tolerance
and withdrawal symptoms were substantial. 35.9% felt tried during day time due to use of
mobile phone till late night.38.1% had poor sleep quality, 35.8% had slept less than four
hours due to smart phone use more than once. Depression and anxiety scores emerged as
independent positive predictors of Smartphone addiction, after adjustment for confounders. 93

Part C: Literature review related to the effects of nomophobia among adolescents.

An exploratory study was carried out in the Chinese University of Hong Kong for
linking psychological attributes like loneliness, shyness, symptoms and patterns of use to
predict smart phone addiction and to social capital. The data was gathered from 414
university students in mainland China aged fewer than 30 and they were selected by the snow
ball sampling method. The Mobile Phone Problem Use Scale (MPPUS), the Internet
Addiction Test and the Television Addiction Scale were used to measure the smart phone
addiction in this study. Exploratory factor analysis identified five addiction symptoms:
disregard of harmful consequences, preoccupation, inability to control craving, productivity
loss, and feeling anxious and lost. The study results showed that the higher one scored in
loneliness and shyness, the higher the likelihood one would be addicted to smart phone. The
most powerful predictor inversely affecting both bonding and bridging social capital was
loneliness. The study results also showed that the advanced functions might have increased
the chances of getting addicted and developing other smart phone addiction symptoms such
as preoccupation and disregard of harmful consequences, beyond those levels noted for a
standard mobile phone. The study also found that shyness was the only predictor for inability
to control craving, productivity loss, and feeling anxious and lost.94
A cross sectional study was directed on Nomophobia seriousness among male under
graduate understudies of wellbeing sciences in Kerala. The investigation embraced a cross
sectional engaging examination plan and pointed toward assessing the danger of creating
Nomophobia among male Under Graduate understudies of wellbeing sciences by evaluating
the example of portable use and the degree of mental reliance among them utilizing
Nomophobia Severity Index-Self appraised adaptation (NSISR). An example of 547
understudies of wellbeing sciences (Nursing, Dental Science, Physiotherapy and Ayurveda)
were chosen for the investigation utilizing snowball examining technique. Mean age of the
subject was 23.48 and normal year of portable utilization among them was 4.87. Information
gathered was pooled and dissected. The examination results showed that larger part (91.04%)
of the investigation subjects were utilizing cell phones for over 3 years, 76.78% of them used
to check their cell phones more often about in excess of 35 times each day. Among them
74.04% have a web association in their mobile phone. A couple (14.81%) revealed that they
used to convey a cell phone charger consistently with them. The study found that there is a
critical positive relationship (r = 0.67) seen between the general scores on example of
portable utilization to the general scores on Nomophobia seriousness. The consequence of the
investigation shows that seriousness scores are equivalent among the examination populace
independent of their surge of education. 95

A study was conducted to assess the dependence of mobile phone usage, the results of
the study revealed that the 58% of men and 48% of women suffer from the nomophobia. It
was also found that the additional 9% felt stressed when their mobile phones are switched off.
The study sample comprises of 2163 people. 55% of those surveyed cited keeping in touch
with friends or family has the main reason that they got anxious when they could not use their
mobile phones. Head ache and Eye burning (37%); Back pain and Neck pain (31%) and
sleeplessness (23.3%) were the commonest health problems that were experienced by
adolescents’ boys, which might be because of overuse of mobile phones. In a study, the
scenario of subjective symptoms of Headache and lethargy (61%) by Sharma, [Link] and the
neck disability by Alabdulwahab. [Link] and Annapoorani [Link], among Smartphone and digital
users was similar.96
A study conducted to assess the discriminating power of socio-demographic variables and
psychological variable on the addictive use of mobile phones among the middle school going
students. The basic purpose of the study was to examine the degrees of cellular phone usage
among the school going children from 123 schools were selected in Busan the potential
participants who were identified through stratified random sampling technique were 747
middle school going students participated in the study. 57% of the participants were male and
89.7% used cellular phones at school. The participants were grouped into three categories
depending on the level of mobile phone usage. It was found that the 117 were addicted, 418
were dependent and 212 were non-addicted. Within the three groups the two functions were
produced and only one function was found to be significant, discriminating the addiction
group from non addiction group. Additional discriminate analysis with only two group’s
produced one function which classified has 81.2% of the participants correctly into two
groups. Impulsiveness, anxiety and stress were significant discriminating factors. 97
A descriptive study was conducted to assess the impact of mobile phone use on
various dimensions of students’ life in Mangalore. The study was carried out among 500
students studying for different courses (MBBS, MLT, BPT, [Link]. Nursing and GNM) in an
institution. A cross sectional survey research design was used. The samples were selected
using proportionate stratified random sampling technique with 50% of the subjects drawn
from each stratum. A self-administered impact scale was used for data collection. The study
findings showed that the students have more negative impacts (52.22%) than positive impacts
(47.78%) except in social dimension. Thus the study concluded that the impact of the use of
mobile phone has both positive and negative impacts and also stressed on the need for
conducting an educational programme to impart knowledge of the hazards of the use of
mobile phone.98
In an article “Cell Phone Dependence- a new diagnostic entity” published by the
Department of Psychiatry, UCMS & GTB Hospital, Delhi stressed the need for a new
diagnostic entity as the mobile phone addiction has been included in the new classificatory
systems- ICD- 10 and DSM- V. They stress that dependence on space, time, and social
relations is replaced by the dependence on the mobile phones and 60% of the teenagers in
America spend an average of an hour a day talking on them. They also mentioned on the
health risk associated with the mobile phone use such as addiction, low self-esteem, anxiety,
depression, bullying, eye strain, motor vehicle accidents, lack of sleep, head ache etc. Along
with mobile phone dependency, there may be psychiatric co-morbidity, physical disturbances
or behavioural co morbidity. They concluded that mobile phone addiction will constitute a
challenge to mental health profession because it is a socially-tolerated behavioural
addiction.99
A study was conducted by the Department of Psychiatry of the Medical University of
Lublin, Poland regarding gender and severity of symptoms of mobile phone addiction in
polish gymnasium, secondary school and university students. The main aim of the study was
to provide answer to the questions of whether and what differences occur between women
and man in the severity of symptoms of mobile phone addiction. The study included a total of
493 persons, among which there were 99 gymnasium students (65 girls and 36 boys) aged 13
– 16 years, 186 secondary school students (124 girls and 62 boys) aged 17 – 19 years and 208
university students (140 women and 68 men) aged 20 to 22 years. The study was conducted
using a socio-demographic questionnaire and the Mobile Phone Addiction Assessment
Questionnaire. A t-test comparison of the scores was obtained by the surveyed women and
men on KBUTK scales and the study revealed that women significantly more frequently than
men use the mobile phone to satisfy their need for acceptance and closeness, to establish and
maintain social relationships and to express their emotions; women are characterized by a
higher severity of symptoms of addiction to voice calls and text messages than men and men
significantly more frequently than women use the mobile phone to listen to music, take
pictures and videos, play games, and connect to the internet.32 In May 31 2011, WHO/
International Agency for Research on Cancer (IARC) classified electromagnetic fields as
possibly carcinogenic to humans, citing an increased risk of glioma associated with wireless
phone use. A working group of 31 scientists from 14 countries has met at IARC in Lyon,
France to assess the potential carcinogenic hazards from exposure to radiofrequency
electromagnetic fields. The IARC Monograph Working group discussed the possibility that
these exposures might include long-term health effects, in particular an increased risk for
cancer. They found that this has relevance for public health, particularly for users of mobile
phones, as the number of users is large and growing, particular among young adults and
children.100
A descriptive cross sectional study was conducted by Department of Oncology, University
Hospital, Sweden among Swedish adolescents aged 15–19 years and selected from the
population registry using a stratified sampling technique. The aim of this descriptive cross-
sectional study was to assess the use of wireless phones and to study the relation to
explanatory factors and self-reported health symptoms. The questionnaire was answered by
63.5% of the study subjects. Most participants reported access to a mobile phone (99.6%) and
use increased with age; 55.6% of the 15-year-olds and 82.2% of the 19-year-olds were
regular users. Some of the most frequently reported health complaints were tiredness, stress,
headache, anxiety, concentration difficulties and sleep disturbances. Regular users of wireless
phones had health symptoms more often and reported poorer perceived health than less
frequent users. The study further showed that perceived health and certain health symptoms
seemed to be related to the use of wireless phones. Thus the study concluded that almost all
adolescence used a wireless phone, girls more than boys and the most frequent use was seen
among the older adolescents, and those who watched TV extensively. 101
An imminent companion study was completed in Sweden to research whether there
are relationship between psychosocial parts of cell phone use and emotional wellness
manifestations in a forthcoming companion of youthful grown-ups. The examination was
directed among 4156 haphazardly chose youthful grown-ups of 20 – a long time from
everyone. A survey containing inquiries regarding wellbeing, work, and recreation related
openness factors, foundation factors, and psychosocial factors was sent by post to the chose
populace. Cell phone openness factors included recurrence of utilization, yet in addition more
subjective factors: requests on accessibility, seen density of availability, being stirred around
evening time by the cell phone and individual abuse of the cell phone. Psychological well-
being results included current pressure, rest problems and indications of discouragement.
Predominance proportions (PRs) were determined for cross-sectional and planned
relationship between openness factors and emotional wellness results for people
independently. The investigation results showed that in planned examination, abuse was
related with pressure and rest unsettling influences for ladies and high availability stress was
related with pressure, rest aggravations and manifestations of misery for all kinds of people.
Consequently, the investigation presumed that high recurrence of cell phone use at standard
was a danger factor for emotional well-being results at 1-year follow-up among the youthful
grown-ups. They recommended that general wellbeing anticipation systems zeroing in on
mentalities could incorporate data and exhortation, assisting youthful grown-ups with
drawing certain lines for their own and others' accessibility. 102

A cross-sectional examination was led in Egypt in 2007 with 85 occupants living

close by the cell phone station. Among them 37 were living in a structure under the station
radio wire while 48 inverse the station. The point of the investigation was to recognize the
conceivable neurobehavioral shortages among occupants living close by cell phone base
stations. All members finished an organized poll containing: individual, instructive and
clinical chronicles; general and neurological assessments; neurobehavioral test battery
(NBTB) [involving tests for visual-engine speed, critical thinking, consideration and
memory]; notwithstanding Eysenck character survey (EPQ). The outcomes showed that, the
commonness of neuropsychiatric grievances as cerebral pain (23.5%), memory changes
(28.2%), tipsiness (18.8%), quakes (9.4%), burdensome manifestations (21.7%) and rest
aggravation (23.5%) were altogether higher among uncovered occupants than controls:
(10%), (5%), (5%), (0%), (8.8%) and (10%), separately (P>0.05). The outcomes likewise
showed, NBTB demonstrated that the uncovered occupants displayed an altogether lower
execution than controls in one of the trial of consideration and transient hear-able memory
[Paced Auditory Serial Addition Test (PASAT)]. Likewise, the occupant’s inverse the station
showed a lower execution in the critical thinking test (block plan) than those under the
station. The investigation along these lines inferred that occupants living close by cell phone
base stations are in danger of creating neuropsychiatric issues and a few changes in the
presentation of neurobehavioral works either by assistance or inhibition.103

An examination was directed by Department of Physiology, College of Medicine,

Riyadh, and Kingdom of Saudi Arabia during the year 2002 to 2003. In the current
investigation, an aggregate of 437 subjects (55.1% male and 39.9% female) were welcomed,
who have and had been utilizing cell phones. The point of the examination was to research
the relationship of utilizing portable telephones with weakness, cerebral pain, unsteadiness,
and pressure and rest aggravation inthe Saudi populace and to give wellbeing and social
mindfulness in utilizing these gadgets. The consequences of the study showed a relationship
between the utilization of cell phones and wellbeing risks. The general mean rate for these
clinical discoveries in all gatherings were migraine (21.6%), rest unsettling influence (4%),
pressure (3.9%), exhaustion (3%) and unsteadiness (2.4%).Based on the aftereffects of the
current examination, they reasoned that the utilization of cell phones is a danger factor for
wellbeing risks and propose that long haul or unreasonable utilization of cell phones ought to
be kept away from by wellbeing advancement exercises, for example, bunch conversations,
public introductions and through electronic and print media sources. 104

A contextual investigation on cell phone use by youthful grown-ups in India was led
in two stages utilizing a blended techniques approach. The principle objective of the
investigation was to look at the utilization of cell phones to satisfy correspondence, media
and age-related requirements by youngsters in India and to research provincial and sex
contrasts. In the main stage, top to bottom meetings were directed with 30 school going
youthful grown-ups (18 – 24 years) in Mumbai and Kanpur in December 2007 and January
2008. In the subsequent stage, a study was led among 400 school going youthful grown-ups
(18 – 24 years) in Mumbai and Kanpur. The subjective investigation of the information
showed that youngsters in both the urban areas utilized cell phones for an assortment of
correspondence, news and diversion needs. They likewise viewed as cell phones as close to
home things and utilized them to store private substance, keep up with security and have
private discussions. The outcomes showed that they utilized cell phones to arrange freedom
from guardians and to keep up with fellowships and make companionships with individuals
from other gender. The information uncovered that youngster in the two urban community’s
utilized cell phones distinctively because of the distinctions in their ways of life and socio-
social factors.105

An investigation was directed by the Department of Psychology, University of

Barcelona among undergrads that manages maladaptive utilization of the Internet and the cell
phone and its relationship to side effects of mental misery and mental issue, just as to the
conceivable job of Perceived Emotional Intelligence. An example of 365 understudies from
undergrad college rookies at Ramon Llull University, Spain were chosen for the examination
studying four distinct investigations (Psychology, Education, Journalism and Broadcasting
and Health considers) answered to scales evaluating the adverse results of maladaptive
utilization of both the web and the cell phone. A self-report scale on Perceived Emotional
Intelligence and a clinical instrument to check for protests identified with the presence of
mental misery. Aftereffects of the examination showedthat, mental trouble is identified with
maladaptive utilization of both the Internet andthe cell phone; females scored higher than
guys on the cell phone survey, showing more adverse results of its maladaptive use.
Understudies of Journalism and Broadcasting showed a more maladaptive example of web
use than understudies of other majors. 106

A study was led by Habbo, part of Sulake, an online diversion and interpersonal
interaction organization in Finland in October and November 2007 in regards to the insights
of utilization of cell phones by young people and overview report (2008) uncovered that 88%
of youngster routinely imparts through SMS, 76% adolescents utilize the web to text, 71%
utilize their mobiles as a versatile MP3 player, 70% of teens take photographs and recordings
and 64% mess around. Hence the insights affirmed that the cell phones are at the focal point
of changing youngster propensities including computerized media. 107

As indicated by an article in the Times of India Bangalore, May 18, 2005 as the hand
held specialized gadget topping so is the harm from abuse. One of the conditions is thumb-
apt. In case one is running off SMS, messaging or punching quantities of letters in order
utilizing only the thumbs one could be experiencing abuse disorder of thumb adroit. Ortho
forecasts and Repetitive Stress Injury (RSI) specialists all throughout the planet are
announcing expanding adolescents are enduring with this condition. Dr. Deepak Sharan who
is RSI expert says he has experienced expanding instances of this thumb-handy condition in
Bangalore and other Indian urban communities in the course of the last two-three years and
practically every one of the patients have been the undergrads in mid 20's. 108
Mobile telephones had become a vital piece of children's lives in the current
situation. As per research by C and R Research, 22% of little youngsters own a cell phone
(ages 6 – 9), 60% of teenagers (ages 10 – 14) and 84% of adolescents (ages 15-18) and cell
phone organizations are presently advertising to more youthful kids with beautiful child well
disposed telephones and simple to-utilize highlights. As indicated by statistical surveying
from the Yankee Group, 54% of 8 – long term olds will include cell phones inside the
following three years. By this examination, they uncovered that more established ones as well
as the more youthful understudies are additionally dependent on versatile phone.109
An exploration study was finished by Market Analysis and Consumer research
Organization in Mumbai in the year 2004 among 175 young people and adolescents picked
on an arbitrary comfort testing premise in the age gathering of 15 – 30 years. This
investigation was an endeavour to show up at the latest things, particularly in metros like
Mumbai where cell phone appears to have had a monstrous effect. The strategy utilized for
information assortment was One-On-One Interview. The instrument as organized survey was
intended to inspire data on segment and psychographic parts of respondents. Discoveries
showed that, out of 165 respondents met 58% were guys and 42% were females. The
proportion of cell phone proprietors to non-cell phone proprietors was discovered to be 7:3
and the outcome showed that the extent of cell phone proprietors among female respondents
(75%) was barely higher than on account of guys (66%). Among them 60% of the
respondents revealed the essential utilization of portable to stay in contact with companions
and to call up their home at whatever point they are out. It additionally uncovered that the
view of security in regards to the data put away in their handsets is predominate. 110
A research study was done by Market Analysis and Consumer research Organization
in Mumbai in the year 2004 among 175 teenagers and youths chosen on a random
convenience sampling basis in the age group of 15 – 30 years. This study was an attempt to
arrive at the current trends, especially in metros like Mumbai where mobile phone seems to
have made an immense impact. The technique used for data collection was One-On-One
Interview. The instrument in the form of structured questionnaire was designed to elicit
information on demographic and psychographic aspects of respondents. Findings showed
that, out of 165 respondents interviewed 58% were males and 42% were females. The ratio of
mobile phone owners to non-mobile phone owners was found to be 7:3 and the result showed
that the proportion of mobile phone owners among female respondents (75%) was marginally
higher than in the case of males (66%). Among them 60% of the respondents reported the
primary usage of mobile to keep in touch with friends and to call up their residence whenever
they are out. It also revealed that the perception of privacy regarding the information stored in
their handsets is predominating among the teenagers (15 – 19 years and 20 – 24 years) and
among females.111
An article in the Tribune News service on September 8, 2007 stated that the mobile phone
users have been warned against the long-term health hazards posed by the device in a specific
paper prepared by two professors of Punjab Engineering College (PEC). The paper was
presented by Dr. Gurjit Kaur and R.S. Prasad of the electronics department at the two day
symposium on ‘emerging’ trends in networking and mobile communications and the paper
emphasized on prevention is better than cure. The paper said that various researchers
indicated that between 20 and 60 percent of the energy emitted from a mobile phone was
absorbed by the user’s head. The type of aerial or antenna which could not extend was worse
because they concentrated energy into the users’ brain. The mobile phones heat up brain
structures. The study found that the rate of death from brain cancer among hand held phone
users was higher than the rate of brain cancer death among those who used non-hand held
phones.112

A study was carried out among seven healthy men and three women volunteers aged
between 26 and 36 years. The participants underwent a single-blind placebo-controlled
protocol to investigate the influence of the EMF of a mobile telephone (GSM 900 MHz, 2
Watt, and 217 Hz frame repetition rate) on blood pressure (BP), heart rate (HR), capillary
perfusion (CP) and subjective well-being. The telephone was fixed in a typical position on
the right-hand side of the head and operated by remote control, so that the volunteer did not
know whether or not the phone emitted EMF. BP and HR were measured continuously with a
Finapres device and CP with an infrared plethysmograph on the right hand. The EMF
exposure was for about 35 min. After 35 min of exposure, values during supine rest and
responses to standing up over 60seconds, deep breathing with six breathing cycles per
minute, and Valsalva manoeuvre with 40 mm Hg expiratory pressure were measured. Well-
being was assessed with a visual analogue scale at the beginning and the end of both periods.
The study concluded that exposure of the right hemisphere to a radio-frequency EMF for 35
min causes an increase in sympathetic efferent activity with increases in resting BP between
five and ten mm Hg, most likely due to more pronounced vasoconstriction. Baroreflex-
mediated BP regulation during standard autonomic function tests was not influenced.113

A descriptive study was conducted among 1129 French adolescents, on how the
adolescents perceive the risks related to mobile phone use (i.e., two types of physical risk-
microwave radiation and decreased attention while driving), in France. The results have
shown that 63% of adolescents have an acute perception of the risks associated with using
mobile phones while driving and social risks related to incivility. Gender, ethnicity, and age
were not predictive for perceived risks. Level of schooling had a positive influence on
perceived risks related to decreased attention during driving and social risks (incivility and
impoliteness) and mobile phone ownership had an inverse relationship with perceived risks
related to social risks.114

A qualitative study was conducted regarding the impact of mobile phone on teenagers
among 83 males and 78 female students between the age group of 13 – 19 by using
questionnaire method. Stratified random sampling technique was used. The study results
showed that 23% of the students spend between three and four hours per day using instant
messaging, six percent between five and six hours and three percent more than six hours. It
also showed that 91% of the girls and 90% of the boys use their phone less than one hour and
90% of the boys and girls prefer to use private chatting to that of the public chat rooms. It
also leads to social anxiety and social isolation. Thus the study concluded that there is a
negative impact of mobile phone on teenagers. 115
Recent studies have shown that the statistical value of mobile phone usage is 87% worldwide,
78.29% in India and 92% in Karnataka State. About 40% of young adults admit that they use
their mobile phones for more than four hours a day. Eighty percentages of humans own a
mobile phone. Out of the five billion mobile phones in the world, 1.08 billion are smart
phones. The Information and Communications for Development 2012: Maximizing Mobile
report released by the World Bank on Tuesday says mobile communication has arguably had
a bigger impact on humankind in a shorter period of time than any other invention in human
history. The report also suggests that with the ownership of multiple subscriptions now
common, mobile usage may outnumber the world's population in the near future. In February
2010, there were six billion mobile phone subscribers. Three-quarters of the world's
population now have access to a mobile phone. 116
An explorative study was conducted regarding mobile phone usage among 158
students and staffs of various colleges and Universities of Kanchipuram by using data mining
technique. Random sampling technique was used to select sample and the data was collected
through self-administered questionnaire. The analysis was carried out by using a survey
dataset and using the J48 decision tree algorithm implemented in WEKA (Walkato
Environment for Knowledge Analysis). The study also determined gender differences in
mobile phone usage of prepaid and post-paid and general opinion of the respondents about
mobile phone. The study results showed that 97% of the respondents has their own mobile
phones, 26% use mobile phones to talk,18% use for sending sms,14% use of listening to
songs and 10% of internet and email access. The study concluded that mobile phone has an
extensive and continuing effect on day to day life of young generation. 117
A survey was conducted by Central Michigan University regarding the impact of
mobile phone use on social networking and development among 501 college students by
using questionnaire method. The survey consisted of 44 questions that dealt with various
aspects of mobile phone use, such as mobile phone ownerships, time spent for mobile phone
calls, monthly mobile phone bills, communication networks, text messaging and mobile
phone dependency. The study results showed that 99% owned mobile phones and nearly 90%
have had mobile phones for more than three years. Excessive internet use, along with
pathological gambling and addictive disorder, health risk from mobile phone radiation and
mobile phone dependency are the major social impacts found in teenagers. The study
concluded that there is a negative impact of mobile phone use on social networking among
adolescents.118
A study conducted in Spain, discovered that a mobile phone call lasting just two
minutes can alter the natural electrical activity of a child's brain for up to an hour afterwards.
The alteration in brain waves could lead to things like a lack of concentration, memory loss,
inability to learn and aggressive behavior. Prominent Swedish scientist suggests mobile
phones and the new wireless technology could cause a "whole generation" of today's
teenagers to go senile in the prime of their lives. It warned that long-term exposure could
potentially lower brain reserve capacity and exposed to medium and high levels of radiation
had an abundance of dead brain cells. The study suggests that this kind of damage in humans
could trigger the early onset of Alzheimer's disease.119

A double-blind study was conducted by the Department of psychology, University of

Essex, United kingdom to examine whether acute exposure to radio frequency
electromagnetic fields emitted by mobile phone may affect subjective symptoms .Three large
group of volunteers (496) were exposed to Radio electromagnetic field (REF) emitted by
mobile phones in one session and sham signals in different session. Participants were exposed
to either Global system for mobile communication or un-modulated signals and the mobile
phone was positioned either on the left or on the right side of the head. Before and after REF
and sham exposure participants completed a questionnaire to rate five symptoms. Any
changes in the severity of the symptoms after REF exposure were compared with changes
after sham exposure. The result of the study showed that one group of participants had
dizziness and this was not consistently found with the other two groups of participants. 120

A study was conducted in Sahlgren’s Academy in Gothenburg, Sweden to find out the
effects of excessive mobile phone use on sleep among teens. Sample consisted of 21 healthy
safeties between the age group of 14 – 20years, with regular working/studying hours and
without sleep problems. The subjects were broken up into two groups: a control group (three
men, seven women) and the experimental group (three men, eight women). The control group
made less than five calls and/or sent five text messages a day, while the experimental group
made more than 15 calls and/or sent 15 text messages a day. The subjects were then asked
questions regarding their lifestyle and sleep habits. The results of the study revealed that
young people with excessive use of mobile phones have increased restlessness with more
susceptibility to stress, restlessness, disrupted sleep and fatigue. This indicates that it is
necessary to increase the awareness among youngsters of the negative effect of excessive
mobile phone use on their sleep-wake patterns with serious health risks as well as attention
and cognitive problems.121
A survey report of the study which was to investigate the mobile phone use and
dependence in Tunisian high school students. Questionnaires were anonymously distributed
among 120 adolescents who were looking for the modalities of the use of mobile phones.
SMS dependency was checked with the French version of the Igarashi scale. The two most
common used means for communication and SMS and missing calls. 83.2% of the samples
used to send more than 6 missing calls per day. According to the Igarashi scale, the
perception of the adolescents was reported is of excessive use among 31.7% of the cases.
Emotional reaction was found among 33.4% of cases and exclusive relationship maintenance
thanks to the usage of mobile phone was found among 18% the cases.122
A qualitative exploration of the relationship between the Australian youth and the
usage of their smart phones. In Australia youth were the most prolific users of mobile phones
however there is little research done in this area to describe the phenomena. The findings of
the qualitative exploration reveal that the physiological factors related to the mobile use
among Australian youth. 32 participants in the age group of between 16 to 24 years took part
in the focus group discussion. Thematic data analysis mainly focused on the psychological
benefits which aroused from the mobile phone usage, and whether mobile phone addiction
was occurring among this age group. The use of smart phone was believed to provide
numerous benefits to the users and is the intrinsic part of the youngest people’s lives. During
the study it emerged that the young people are extremely attached to their mobile phone with
the symptoms of behavioural addiction were revealed. This study provides the solid
foundations for further investigations regarding the addictive patterns of the mobile use
among young adolescents.123
A cross-sectional survey was conducted with the help of Google from by the help of
validated nomophobia questionnaire (NMP-Q). A self reported questionnaire to collect socio-
demographic data, information about mobile phone usage, academic performance of the
students, musculoskeletal disorder was collected. The findings of the study reveal that the
mean age of students was 22.2±3.2 years. 42.9% were male and 57.17% of the students were
female. About 45% of the students were using mobile phone for a period of over 5 years.
About 54% of the students had musculoskeletal disorders due the over usage of smart phone
for longer periods. The mean nomophobia score with 95% confidence interval was 77.6
(72.96±82.15). it was found that there was an inverse relation between the nomophobia
scores and the academic performance of the students. No significant difference was found
between nomophobia scores, p=0.152.124
Part D: Literature review related to the level of knowledge regarding nomophobia
among adolescents.
A mixed method study by systematic- review and Meta analysis approach to the
assessment of emerges of smart phone abuse in Indian adolescents. The purpose is to know
the currently required comprehensive information and communications technology system
such as Smartphone addiction management system for objective assessment and intervention.
It calculated effect estimates and used both fixed as well as random effects meta-analysis. It
concludes that it has raised concern about social and psychological effects of excessive use of
smart phones especially among Indian adolescents. Smart phone abuse to addiction has
become more serious since adolescents can download and run numerous applications with
smart phone even without internet connection. It is suggested that there is need for more in
depth qualitative and quantitative studies in future and the development of policies
awareness.125
An exploratory survey done to assess the knowledge and effect of nomophobia among
students of selected degree colleges in Mysore. The aim of study to assess the mobile phone
dependence, knowledge, effect of nomophobia and to determine the relationship between
knowledge and effect of nomophobia. The sample consisted of 200 degree college students
were age group of 18-23 years was selected by non probability purposive sampling technique.
Tool consists of Performa for selected personal variables, self administered structured
knowledge questionnaire among Nomophobia, rating scale. It results majority (83%) of the
sample were 18-20years, 41.5% of them were interested in mobile or computer games and
chat. And 59.5%of the sample were never heard the term Nomophobia. Thus, it was
concluded that majority(89.5%) of the degree college students had poor knowledge and
half(51%) of them had moderate effect of Nomophobia. This emphasis the urgent need to
sensitize and alert them regarding the ill effects of mobile phone use. 126
A Descriptive study was conducted to assess the knowledge and attitude regarding
Nomophobia, internet usage and its addiction level among students studying in selected
colleges of Ambala, Haryana. The purpose of this study was to assess the knowledge and
attitude of nomophobia among students and to assess the level of usage of internet and
addiction among students. The study group covered 300 students from various department of
engineering, arts, commerce. The study findings revealed that 59.66% of student’s often
switched to excessive computer use and internet access it also shows that 72% females
residing in hostel (48.55%) use of Nomophobia, internet in android. 75% with main purpose
to update knowledge (43.33%) using 4g data (33.33%). About58% of students had average
knowledge regarding Nomophobia, 66.33% majority of students had average attitude, 31% of
adults had below average attitude. It concludes that Nomophobia is a growing problem
among students of professional courses. Hence awareness should be created and strategies
should be developed to bring out positiveoutcome.127
A study conducted on Prevalence of Phantom Vibration Syndrome and Phantom
Ringing Syndrome (Ringxiety): Risk of Sleep Disorders and Infertility among Medical
Students. This study was designed to determine the prevalence of newly reported disorders,
like Phantom Vibration Syndrome, Phantom Ringing syndrome (Ringxiety), nomophobia and
possible risk for sleep disorders and infertility. The method is used in this study is a
questionnaire was designed having twenty-nine questions which were enough to explore the
prevalence of Phantom Vibration Syndrome and its consequences on sleep and fertility.
Around 150 questionnaires were filled with the consent of the study participants. The results
showed that the frequency of Phantom Vibration Syndrome on daily, weekly, rarely and
never observed basis was found to be 19%, 18%, 56% and 7% respectively. It means overall
93% students feltPhantom Vibration Syndrome but in different frequencies. It is concluded
that the use of information and communication technology has reached uncontrolled level
causing psychological and biochemical changes in human beings. Counseling especially with
our youth is necessary, should we want to have mentally healthy generation infuture.128
Part E: Literature review related to the management and prevention of nomophobia.
A cross sectional exploratory study was carried on nomophobia to evaluate the mobile
phone dependency and impact of cell phone on the parameters of health. The major
objectives were to study the prevalence of nomophobia among the mobile phone users, to
study the pattern of dependence among the adolescents and to study the health effects of
mobile phone usage. The result was prevalence of Nomophobia study was 68.92%. a higher
proportion of males(82.91%) were dependent on mobile phone compare to
females(31.25%).The common self perceived symptom due to increase mobile phone usage
was lack of sleep(70.61%) followed by eye strain(42.46%). This study concludes that
prevention is better than cure, mobile phone belong to younger age therefore health education
strategies should be targeted to youth to prevent harmful effects of this great invention. 129
A descriptive study was conducted on mobile phone usage among nursing students
studying in [Link]. and [Link]. nursing courses in KCN, Amritsar (India). A total of 187
students using mobile for at least since last 6 months were selected by purposive sampling.
Mobile dependence consisting of 22 items, based upon [Link] scale. The mobile dependency
scale scoring revealed that 10.2% as normal users, 64.7% as case of mild, and 25.1% as
moderately dependent to mobile. It concludes that mobile usage is growing problems nursing
students. For further studies its necessary to develop strategies for prevention of mobile
dependency as well therapeuticinterventions. 130
 A comparative study investigated the emotional alterations resulting from
Nomophobia in patients with panic disorder and agoraphobia. The purpose of this study, they
compared the emotional alterations of the patient with volunteer healthy individual in control
group. They developed a structured questionnaire to measure Nomophobia; they reviewed by
two clinicians and consulted a third clinician who was unfamiliar with the questionnaire.
They piloted the questionnaire with 7 patients. They found out that compare to healthy
individual patient with panic disorder and Acrophobia expressed significantly more intense
feeling of anxiety anddistress.131
A cross sectional study on Nomophobia severity among male Under Graduate
students of Health sciences. The main aim of this study is to find out the pattern of mobile
use and perceived dependency towards the mobile phones using Nomophobia Severity Index-
Self rated version (NSISR) among male Under Graduate students of Health sciences (N=547)
who were selected using snow ball sampling method. The methods used data collected were
pooled and analyzed using SPSS v.12. The results are students were similar among different
courses. There was a significant positive correlation was established between the pattern of
mobile usage with the severity of Nomophobia. This study concluded that Nomophobia as an
emerging behavioral addiction among student populations in professional college was well
evident through the present study. Adequate prevention strategies in the form of health
awareness campaign specifying the physical as well as psychological impact of the chronic
mobile usage would be appreciated.132
An Exploratory study conducted in Taiwanese College Students to assess the several
issues relating to self-reported mobile phone usage, mobile phone addiction, depression,
social capital, and academic performance. This survey was administered online (due to
geographic limitations) in the spring of 2004. Each participant was given an identification
code to avoid double responding. A total of 169 Taiwanese college students participated in
the study, with three not fully completing the questionnaire. Participation was on an
anonymous, voluntary basis. Of the 166 responses 54.4% were female. 71% were between 20
and 23 years old. All of the Taiwanese participants either currently have or used to have (i.e.,
2 of the 166 participants no longer have mobile phones) their own mobile phones. Most of
the students (i.e., 77.5%) have owned their mobile phones for more than three years. It
concludes that reduction in the mobile phone addiction demographic and geographic
limitations.133
A study conducted on a threat of mobile phones and addiction at Belarus university,
revealed that only 28.8% had knowledge about Nomophobia and 1/10 th(10.4%)of the students
had the symptoms of addiction. Nearly half (43.16%) of the sample had knowledge about
mobile phone addiction and only 28.8% were familiar with the term Nomophobia. Hence, it
was concluded that, majority of youngsters are being addicted to mobile phones and were
unaware of Nomophobia.134
A study conducted to assess the knowledge about management of insect bite. Pre-
experimental with single group pre-test post-test design was adapted. The study was
conducted at primary school in Mysore district for the purpose of prevention and first aid
management of insect bite. The study revealed that 6.7% primary school teachers had poor
knowledge, 80% of primary school teachers had average knowledge, 13.3% primary school
teachers had good knowledge and none of them had very good knowledge in pre-test,
whereas in post-test 65% primary school teachers had very good knowledge and 35% primary
teachers had average knowledge. This concludes that structured teaching programme
prevention and first aid management of insect bite was effective in enhancing the knowledge
of primary schoolteachers.135
Part F: Literature review related to the impact of psycho-educational program on the
knowledge and levels of nomophobia.
A study was done to assess the mediator effect of mindfulness awareness levels to
find the relationship between nomophobia and academic performance of 286 students of
Aydin Adnan Menderes University were recruited for the study. The tools used for the study
were mind-full attention awareness scale, University life scale, and not being able to access
information factor of nomophobia scale was used to assess data from the participants. 196
were female and 90 were male participants. The age group of participants was between 17 to
29 years. 68.9% of students were living in dormitory, 15.6% with flat-mates, and 6.2% with
their family. University life scale is type of 7 point likert scale which consisted of 48 items
and 6 sub scales. Adaptation to university environment (12 items). Emotional adjustment (9
items), Personal compliance (7 items), Counter-Sex relations (7 items), Academic
compliance (7 items), Social cohesion (6 items). Mindful attention awareness scale indicated
if the score is high then conscious awareness is also high. Not being able to access
information factor of nomophobia scale was used to assess the level of nomophobia. The
outcome of the study revealed that there was significant positive relationship between
academic university adjustment and mindfulness awareness scale. Further there was negative
significant association between mindfulness awareness and nomophobia levels of university
students.136
 A study was done to assess the existing knowledge of adolescents on nomophobia and
to evaluate the effectiveness of structures teaching program on nomophobia. A pre
experimental research design with one group pre test and post test was used. Purposive
sampling technique was done to select 50 students from pre university college of Hassan,
Karnataka. Data was collected by using structured knowledge questionnaire. Teaching
program was administered after conducting the pre test knowledge score related to
nomophobia. Post test was conducted after seven days. The mean post test knowledge score
was 85.55% which was higher than the mean pre-test knowledge score 38.2%. The
calculated t value 30.25% is greater than the table value (0.05, 49df) =9.49. No significant
association was found between post test knowledge score with demographic variables. 137
A quasi experimental study was done to assess the effectiveness of nomophobia
therapy package on self esteem and nomophobia symptoms among high school students. Pre
test, post-test, with follow up design and a control group approach was used for the present
study. All the students who had symptoms of nomophobia were included in the study.30
students were selected using purposive sampling technique. 15 in the experimental and 15 in
the control group. Nomophobia therapy was given to the experimental group 75 minute
session per week. The follow up was performed after 2 months. 138
A study was conducted to assess the side effects of mobile phone usage among
children studying in selected school of Ghaziabad. School children were in the age group of
10-15 years. One group pre-test and post test research design was used for the present study.
60 children were selected through stratified random sampling technique. Structured
questionnaire was prepared for data collection. Majority of the school children had moderate
knowledge regarding side effect of mobile phone usage. With regard to the presence of side
effects, psychological problems, due to smart phone usage were highest among children.
Among The Physical Hazards, the Most Frequently Occurring Problem Were Eye Strain
(70%) And Headache (60%), Followed By Common Cold (50%), Tiredness (58.3%),
Irritation, Hearing Problem (51.6%), Wrist Pain and Backache. (Table 1) Ÿ Among The
Psychological Hazards, The Most Frequently Occurring problem were lack of concentration,
violent behaviour and love to be alone(61.65),followed by degradation in studies(58.3%),
skipping meals(56.6%), irritable behaviour, feels lonely(48.3%), and feeling sleepy during
day time (48.3%) respectively. (Table 1) Ÿ Out of these two areas, the children had highest
Mean Score (5.23) in Psychological Hazards which means that the psychological problems
were highest among children followed by physical problems with a mean score of 3.8. Ÿ
16.66% (10) children had mild health hazards, 63.33% (38) children had moderate health
hazards and 20% (12) children had severe health hazards related to side effects of smart
phone usage. The standard deviation of pre-test (10.86) is more than the standard deviation of
post-test (3.4), therefore the STP regarding on knowledge regarding side effects of smart
phone usage was effective. Ÿ The Mean Knowledge Score of Pre Test Is 7.9, And Post Test
Is 16.69. The Calculated T Test Value (0.99) at 0.05 level of significance is more than the
Table Value (-10.71), which indicates that the Structured Teaching Program was effective. 139
A study done in the year 2018 to assess the effectiveness of organized teaching
programme on the knowledge regarding the hazards of using mobile phones among 50 high
school students in selected school Bangalore, Karnataka. Majority of the students 63.3% were
in the age group of 13 to 14 years. Most of the students 60% were female. The mean pre test
knowledge score was inadequate 70%. The post test knowledge score was adequate 72%. 140

SUMMARY
This chapter had dealt with review of research and non-research literatures to the problem
stated. This chapter consisted of literatures related to knowledge and effect of nomophobia.
This review has provided an understanding and broadened the investigator’s outlook
necessary for the research study.