Adolescence is a developmental period marked by rapid biological, cognitive and psychosocial change. The World Health Organization defines adolescence as 10–19 years of age and estimates that about one in seven adolescents experiences a mental health condition, emphasizing the importance of modifiable exposures during this stage.[1] Smartphones have become a major part of the adolescent environment, providing communication, education, entertainment, gaming and social participation. Their portability and continuous connectivity, however, also facilitate repeated checking, prolonged engagement and use late at night.

Problematic smartphone use (PSU) refers to a pattern of use characterized by impaired control, preoccupation, withdrawal-like discomfort, interference with daily activities or functional impairment. It should be distinguished from ordinary high-frequency use because duration alone does not necessarily indicate dysfunction. A systematic review and meta-analysis by Sohn et al. estimated that problematic use affected approximately one-quarter of children and young people across included studies and was associated with depression, anxiety, stress and poor sleep.[2] Yang et al. similarly found associations between problematic smartphone use, poor sleep quality, depression and anxiety.[3]

The Indian context is particularly important because smartphone access has expanded rapidly and adolescents increasingly use mobile devices for social media, gaming, entertainment and educational activities. Indian studies have reported widely varying prevalence estimates. Davey and Davey reported substantial levels of smartphone addiction among Indian adolescents,[7] while Gangadharan et al. found mobile-phone addiction in 33.0% of adolescents aged 10–19 years in low-income urban areas of Delhi.[8] More recent school-based studies have reported estimates ranging from 12.5% to 64.6%, illustrating how prevalence depends on age, setting, sampling strategy, measurement instrument and cut-off criteria.[6,11]

The SAS-SV is a brief 10-item measure developed for adolescents and has become widely used in international and Indian research.[14] Its use permits standardized assessment of symptoms related to impaired control and interference, while descriptive measures such as daily duration, checking frequency, night-time use, age at first use and purpose provide complementary information. This multidimensional approach is important because two adolescents with similar daily screen time may have very different behavioral patterns and levels of functional interference.[2,5]

The present study therefore aimed to describe the pattern and intensity of smartphone use among school-going adolescents and to estimate the prevalence of PSU using the SAS-SV. It also examined variation in PSU by age and sex. Understanding these patterns may support age-appropriate school and family guidance without pathologizing beneficial or educational smartphone use.

Study design and participants: An analytical cross-sectional study was conducted among 400 school-going adolescents aged 10–19 years. The exact district/city/state, participating institutions and study dates were not specified in the uploaded thesis material and must be inserted from the approved study records before submission. Participants were selected using a multistage stratified random-sampling approach. Eligible adolescents were enrolled in selected schools/colleges, were available during data collection, could understand the questionnaire language, and provided consent/assent as applicable. Students who declined participation, could not complete the questionnaire adequately, or had substantial missing data in the primary exposure/outcome measures were excluded.

Data collection: A structured, self-administered questionnaire recorded age, sex, residence, family type and socioeconomic status together with smartphone-use characteristics. Exposure variables included average daily duration of use, regular night-time use, frequency of checking, age at first smartphone use and primary purpose. Night-time use was operationalized in the results as use after 10 pm on at least four nights per week, and frequent checking as >50 checks/day.

Problematic smartphone use: PSU was assessed using the Smartphone Addiction Scale–Short Version (SAS-SV), a 10-item scale developed for adolescent screening.[14] The scale yields a total score from 10 to 60. The analysis used the original sex-specific cut-offs: ≥31 for boys and ≥33 for girls. The mean SAS-SV score and categorical PSU prevalence were reported.

Sampling and quality control: The study used probability-based selection through stratification and multistage sampling. Standardized questionnaire administration and validated instruments were intended to reduce information bias. Privacy during questionnaire completion was used to limit social-desirability bias. Because smartphone duration and checking frequency were self-reported, recall error remained possible.

Statistical analysis: Categorical variables were summarized as frequencies and percentages and continuous variables as mean ± standard deviation where appropriate. PSU prevalence was presented with a 95% confidence interval. Chi-square tests assessed differences in PSU prevalence across sex and age groups. A p-value <0.05 was considered statistically significant for the reported analyses.

Ethics: Data collection was to commence only after Institutional Ethics Committee and administrative approval, with parent/guardian consent and adolescent assent as applicable. The exact committee name, approval number and date must be inserted from the actual approved protocol. Participation was voluntary and data were to be reported in aggregate with confidentiality safeguards.

A total of 400 adolescents completed the questionnaire. The mean age was 15.2 ± 2.4 years. Boys constituted 53.0% of the sample, 59.0% lived in urban areas, and 68.0% belonged to nuclear families.

 Table 1. Sociodemographic characteristics of participants (n=400)

The largest age group was 14–16 years (42.0%). The sample was fairly balanced by sex. Approximately three-quarters of participants were from lower-middle or lower socioeconomic groups.

 Table 2. Pattern of smartphone use among participants (n=400)

Smartphone engagement was frequently prolonged: 39.0% used the device for more than four hours daily. Almost half reported regular night-time use, and one-third checked their phone more than 50 times per day. Recreational purposes dominated, with social media and gaming accounting for 59.0% of primary use.

 Table 3. Prevalence of problematic smartphone use by sex and age group

Overall PSU prevalence was 34.0% (95% CI 29.4–38.6%). Although prevalence was numerically higher among boys, the sex difference was not significant. In contrast, PSU increased significantly across age groups, reaching 41.7% among adolescents aged 17–19 years.

This study found that smartphone use was intensive and predominantly recreational among school-going adolescents. Thirty-nine percent used smartphones for more than four hours daily, 47.0% reported regular use after 10 pm, and 33.0% checked their phones more than 50 times a day. Social media was the leading primary purpose, followed by gaming. These findings reinforce the importance of examining timing, purpose and checking behavior in addition to total duration. Stiglic and Viner found only weak evidence for simple screen-time thresholds and emphasized heterogeneity across outcomes,[5] while broader literature has similarly argued that the context of use may be more informative than hours alone.

The prevalence of PSU was 34.0%, with a 95% confidence interval of 29.4–38.6%. This is higher than the median prevalence of 23.3% reported in the systematic review by Sohn et al.,[2] but closely resembles the 33.0% prevalence reported by Gangadharan et al. among Indian adolescents aged 10–19 years.[8] Indian estimates are notably heterogeneous. Davey and Davey reported a range of approximately 39–44% in their earlier synthesis,[7] whereas Vaghasiya et al. reported 12.5% among school-going adolescents and Yogesh et al. reported 64.6% among adolescents aged 15–19 years.[6,11] Amudhan et al. reported phone addiction in 8.91% of users in a district-wide cluster survey.[13] These differences caution against treating prevalence as a fixed population characteristic; age range, sampling, setting, instrument and threshold all influence estimates.

No statistically significant sex difference was observed. The prevalence was 36.8% among boys and 30.9% among girls, a pattern similar to Gangadharan et al., who also reported comparable prevalence between sexes.[8] By contrast, a clear age gradient was present: PSU increased from 21.4% in early adolescence to 41.7% in late adolescence. Greater autonomy over device access, increasing social-media engagement and changing academic and peer demands may contribute to this pattern, although the cross-sectional design does not establish causation.

The study also demonstrates why PSU should not be equated with long duration. The SAS-SV captures impaired control, withdrawal-like experiences and interference with daily life,[14] while duration measures only quantity. A teenager using a smartphone for several hours for schoolwork and communication may differ substantially from another with repeated checking, night-time use and difficulty disengaging. This distinction is important for school-health messages: blanket restriction may overlook beneficial use, whereas guidance on sleep-compatible timing, self-regulation and balanced activities may be more appropriate.

The principal limitations are the cross-sectional design, reliance on self-report and lack of objective device logs. In addition, the SAS-SV cut-offs were developed in another population and may not have identical diagnostic meaning in Indian adolescents. The study setting and ethics details must also be verified from the final approved study documentation before publication. Longitudinal studies combining validated symptom scales with objective usage data would help clarify temporal relationships and improve exposure measurement.

Problematic smartphone use affected approximately one-third of the adolescents in this study and increased significantly with age. Regular night-time use, frequent checking and recreational use were common. The findings support multidimensional assessment of adolescent smartphone behavior, with attention to impaired control, timing and purpose rather than total duration alone. School and family guidance should promote balanced, self-regulated use while preserving legitimate educational and social benefits.

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