Problematic use of the internet and smartphones in university students: 2006-2017. Int J Environ Res Public Health. 2018;15:pii: E475. [PMID: 29518050 PMCID: PMC5877020 DOI: 10.3390/ijerph15030475]

The experiences in close relationship and internet addiction among college Students: A moderated mediation model of anxiety and information cocoon

BACKGROUND AND AIMS

Internet addiction is one of the most serious behavioral addiction problems affecting the physical and mental health of college students. A model is constructed to reveal the mediating role of anxiety and the moderating role of information cocoons in the relationship between the experiences in close relationship and internet addiction among college students in this article.

METHODS

A cross-sectional survey investigated 2946 college students in China who had experienced close romantic relationships. A questionnaire was used to measure the general information, the experiences in close relationship, internet addiction, anxiety, information cocoons among participants.

RESULTS

The poorer experiences in close relationship were directly associated with a higher risk of internet addiction among college students. Anxiety mediated the relationship between the experiences in close relationship and internet addiction. Additionally, the information cocoon was also found to moderate an indirect effect: a higher level of information cocoons diminished the impact of the experiences in close relationship on anxiety, while information cocoons intensified the association between anxiety and internet addiction.

CONCLUSIONS

A positive close relationship can alleviate anxiety and thereby help prevent internet addiction. Meanwhile, various interventions should be implemented to avoid falling into the information cocoons to promote mental health and reduce internet addiction among college students.

The relationship between loneliness and psychological distress among Chinese college students: the mediating role of mobile phone addiction and the moderating role of core self-evaluation

Previous studies showed that loneliness and psychological distress are related. However, the potential mechanisms involved in this relationship are unknown. This study examined the mediating effect of mobile phone addiction and the moderating effect of core self-evaluation on the relationship between mobile phone addiction and psychological distress. A total of 826 college students were recruited. A cross-sectional study design and an online questionnaire survey were employed to measure loneliness, mobile phone addiction, core self-evaluation, and psychological distress in college students, and used the PROCESS macro program to conduct moderated mediation analysis. Loneliness was significantly and positively associated with psychological distress, mobile phone addiction partially mediated the relation between Loneliness and college students' psychological distress and this indirect path was moderated by core self-evaluations. Specifically, the effect of mobile phone addiction on psychological distress was stronger for college students with lower core self-evaluations than for those with higher core self-evaluations. The results are helpful to comprehend the producing mechanism of psychological distress and provide a theoretical basis for the intervention of psychological distress.

Trends and Influencing Factors in Problematic Smartphone Use Prevalence (2012-2022): A Systematic Review and Meta-Analysis

Given that problematic smartphone use (PSU) has been researched for a long time, it becomes necessary to assess how the trends of PSU prevalence have evolved over time. In total, 106 articles from 2012 to 2022 with 109 studies covering 97,748 individuals were included in this systematic review and meta-analysis. The estimation of the global pooled PSU prevalence was 37.1% (95% confidence interval, 33.5 - 40.8%) and the PSU prevalence is growing over time in total. Although the PSU prevalence exhibited wide variation between regions and measurement scales, the increasing trend remained. In addition, the regression slope of the PSU prevalence trend in males was higher than that in females. Males initially had a lower prevalence of PSU than females, but this steadily changed over time until it was greater in males than in females. Moreover, the prevalence of PSU showed an increasing trend across all age groups, with a faster growth rate in the older age group. Considering the aforementioned results, it's necessary to implement proper interventions to do with this phenomenon. In addition, considering the differences in prevalence brought by regions, and measurement scales, in practice and research, we should not only take into account the disparities of PSU between countries or cultures, but also to concern about establishing unified standard and measurement tools to confirm it.

Effects of social and environmental restrictions, and changes in alcohol availability in adolescents' binge drinking during the COVID-19 pandemic

AIMS

The aim of the present study was to estimate the evolution of binge drinking since the pre-pandemic period, and throughout the pandemic period with the application and lifting of the restrictions in adolescents aged 12 to 19 years old in school in Central Catalonia.

METHODOLOGY

Quasi-experimental time series study with two samples of adolescents. The first sample (1st wave of survey, pre-pandemic period) was obtained between the months of September 2019 to March 2020 (n = 6621) and the second sample (2nd wave of survey, pandemic period) between the months of October 2021 and March 2022 (n = 7576). The dependent variable was monthly binge drinking. The main independent variable was the period of data collection (1st and 2nd wave), and gender and grade were also included. Twenty-one time slices were performed by fortnight and the binge drinking prevalence of the previous month was extracted in each of them. Interrupted time series analysis was performed and Poisson regression models with robust variance were estimated.

RESULTS

The data indicated a significant increase in the prevalence of binge drinking in certain periods in girls [easing of measures in October, aPR: 2.25 (1.03-4.89); and total lifting of restrictions in February, aPR: 3.29 (1.57-6.89)] and a reduction in consumption in periods of tightening of restrictions. After the upturn before the return to the pre-pandemic situation binge drinking followed a decreasing trend in both sexes [aPR boys: 0.73 (95%CI: 0.66-0.81); aPR girls: 0.78 (95%CI: 0.71-0.86)].

CONCLUSIONS

Periods of community interventions aimed at protecting people's health have had an impact on other health behaviors or aspects of health such as binge drinking, and differentially across groups and communities.

Wellbeing and Problematic Smartphone Use: Serial Mediation of Mindfulness and Self-Compassion

The relationship between wellbeing and Problematic Smartphone Use (PSU) has been explored in the past, however, the role of the potential mediators of this association is a relatively neglected area of research. Therefore, the current study examined mindfulness and self-compassion as mediators of the relationship between wellbeing and PSU in 220 university students. WHO-5 Wellbeing Index, Mindful Attention Awareness Scale- State, Self-Compassion Scale- Short form and Smartphone Addiction Scale- Short version were used for assessing wellbeing, mindfulness, self-compassion, and PSU respectively. Wellbeing had a direct and indirect effect on PSU. In addition, results supported a serial mediation model where wellbeing was found to influence PSU via mindfulness and self-compassion in a sequential manner. The results expanded the Compensatory Internet Use Theory (CIUT) to understand PSU and have implications for the management of PSU.

Nomophobia and Alcohol, Tobacco, and Cannabis Consumption in Adolescents in Galicia

This study aimed at exploring the association of nomophobia with alcohol, tobacco, and/or cannabis consumption among high school students. We carried out a cross-sectional study among high school and vocational training students in Galicia, Northwest Spain (N = 3,100). Collected data included nomophobia, sociodemographic variables, and alcohol, tobacco, and cannabis consumption. Nomophobia was measured using the validated Nomophobia Questionnaire. Adjusted odds ratios (ORs) and their 95 percent confidence intervals (CIs) were estimated using generalized linear mixed models. More than a quarter of the adolescents (27.7 percent) had nomophobia. We found an association between nomophobia and a high level of tobacco smoking in the last month in boys (OR = 2.16; 95 percent CI: 1.55-3.03). Nomophobia was also associated with higher odds of binge drinking in both genders (girls: OR = 1.86; 95 percent CI: 1.61-3.52; boys: OR = 2.29; 95 percent CI: 1.68-3.13) and with cannabis consumption in boys (OR = 1.74; 95 percent CI: 1.07-2.81). Our findings highlight the importance of a comprehensive investigation of the factors underlying alcohol, tobacco, and cannabis consumption in the adolescent population.

Stress and suicide risk among adolescents: the role of problematic internet use, gaming disorder and emotional regulation

BACKGROUND

Previous studies have associated videogame playing and social media use with suicidal behaviors together with lower stress coping or poor emotion regulation strategies. Due to the inconclusive evidence regarding the factors associated with suicidal behavior, the present study aimed to overcome the limitations of previous research and explored the relationship between adolescent stress, problematic internet use (PIU), gaming disorder (GD), and emotional regulation (ER) in a cross-section design. It was hypothesized that stress would have a direct effect on suicide risk (SR) as well as being mediated by PIU, GD, and ER.

METHODS

The participants comprised 430 adolescents (58.4% male) aged between 16 and 19 years. They completed an online survey including the Mobile-Related Experiences Questionnaire, Internet Gaming Disorder Scale-Short Form, Meta-Mood Trait Repair Scale, and Spanish version of the Suicidal Behaviors Questionnaire.

RESULTS

A total of 34.2% of the adolescents (N = 147) were at risk for SR. Results also indicated that 30,7% had experienced suicidal ideation at some point in their life, 12.1% had at least one plan to die by suicide, and 5.1% had attempted suicide. Results of path analysis confirmed that stress appeared to be a risk factor for suicide, but that its effects were not mediated by PIU. However, ER and GD mediated the effect of stress on SR. The results suggest that stress is a main risk factor for suicide, especially among adolescents with poor emotional regulation or problematic gaming.

CONCLUSIONS

Considering the prevalence of suicide among adolescents, the results of the present study suggest that suicide prevention programs should include emotional regulation strategies, stress coping, and videogaming management skills in the early stages of high school. Providing these protective resources to adolescents will help them face the stressful and changing situations typical of adolescence and will help them to attain greater well-being and satisfaction with life.

Fun in a Box? Loneliness and Adolescents' Problematic Smartphone Use: A Moderated Mediation Analysis of the Underlying Mechanisms

Addictive smartphone use is one of the most concerning behaviors among adolescents. The present study investigated the indirect effects of self-esteem and boredom proneness and the moderating role of the need to belong on the link between loneliness and addictive smartphone use (ASU). Our sample included 357 adolescents aged 12 to 19 (Mage = 15.56, SD = 1.01, 57.42% males) from ten public schools in Romania. We used a moderated mediation approach, with moderation of the both second mediation paths and the direct effect path. Results suggested that the influence of loneliness on ASU was statistically significant and partially mediated both by self-esteem and boredom proneness. Adolescents' need to belong significantly moderated the positive association between boredom proneness and ASU, and the direct negative association between loneliness and ASU; however, it did not moderate the negative association between self-esteem and ASU. Thus, high levels of the need to belong also increased the influence of boredom proneness on AUS and had a marginally significant effect on the relation between loneliness and ASU. These results suggested that adolescents' need to belong, self-esteem, and boredom proneness might contribute to developing ASU. Interventions centered around countering the adverse effects of excessive technology use ought to consider group activities that facilitate social bonding to satisfy the participants' need to belong, reduce their levels of boredom, and, thus, reduce the risk of developing ASU symptoms.

Attachment Anxiety and Nomophobia: A Moderated Parallel Mediation Model

Nomophobia is the state of being anxious or disturbed when feeling disconnected from the digital world and can have a significant impact on individuals' health and well-being. Drawing upon attachment theory and the previous literature on nomophobia, this study aims to understand how attachment anxiety influences nomophobia and whether this relationship differs between males and females. In the Human Penguin Project (HPP) (N = 1221; 12 countries; participants aged ≥20 years), the Experiences in Close Relationships Questionnaire-Revised (ECR-R), the Toronto Alexithymia Scale (TAS-20), the Perceived Stress Scale (PSS), and the Nomophobia Questionnaire (NMP-Q) were used to assess attachment anxiety, alexithymia, perceived stress, and nomophobia, respectively. The results demonstrated that (1) there were significant positive correlations between attachment anxiety, nomophobia, alexithymia, and perceived stress. Additionally, (2) there was a direct and significant effect of attachment anxiety on nomophobia, and alexithymia and perceived stress partially mediated this relationship. Finally, (3) gender significantly moderated the relationship between attachment anxiety and nomophobia. Specifically, the predicted effect was significant in both males and females, but the direct effect of attachment anxiety and nomophobia was stronger in males.

Problematic Internet use and attitudes towards persons with disabilities - cross-sectional research among Polish students

BACKGROUND

Problematic Internet use (PIU) can have detrimental effects on physical, emotional, psychological, and social functioning. Besides well-described PIU correlations in psychological domains such as personality traits, or life satisfaction, and self-assessment, the social aspect of PIU risk also appeared to be important. This study aimed to investigate the association between PIU and attitudes towards persons with disabilities.

METHODS

A total of 595 Polish students aged 18-29 participated in this research by completing the Internet Addiction Test, Multidimensional Attitudes Scale Towards Persons With Disabilities, and personal information form.

RESULTS

The findings revealed that 30.6% of the respondents were at high risk for PIU. Moreover, heightened levels of PIU were more prevalent among male participants and students in technical fields of study than in those in medical and social fields of study. Increased PIU was also associated with more negative attitudes towards persons with disabilities in general and in the domains of emotions and behaviours. Additionally, prior personal contact with individuals with disabilities was related to both PIU rates and attitudes towards persons with disabilities in the domain of emotions and beliefs.

CONCLUSIONS

This study highlights the prevalence of PIU among Polish students and emphasizes the need for preventive measures, particularly targeting male students and those in technical fields of study. The results indicate a relationship between PIU and attitudes towards individuals with disabilities. Further research is required to determine the direction of the relationship. It is recommended that educational programs provide opportunities for interaction with individuals with disabilities to promote understanding and acceptance.

Childhood neglect and problematic smartphone use among chinese young adults: the mediating roles of peer attachment and fear of missing out

BACKGROUND

Research has revealed that childhood neglect may be a risk factor for problematic smartphone use among young adults in China. However, few studies have examined the mediating roles of peer attachment and the fear of missing out in the relationship between childhood neglect and problematic smartphone use. To fill this gap, the present study proposes a multiple mediation model to understand the relationships among childhood neglect, peer attachment, fear of missing out, and problematic smartphone use among young adults.

METHODS

A total of 869 young adults in China completed questionnaires for evaluating different levels of the relationships between childhood neglect, peer attachment, the fear of missing out, and problematic smartphone use. The collected data were analyzed using SPSS 23.0 and MPLUS8.3.

RESULTS

The results showed that childhood neglect was positively associated with problematic smartphone use among young adults in China. Moreover, peer attachment and the fear of missing out had partial mediating effects as well as sequential mediating effects in the relationship between childhood neglect and problematic smartphone use among young adults.

CONCLUSION

Based on these findings, peer attachment and the fear of missing out, as mediators, could be considered proximal factors affecting problematic smartphone use among young adults. These findings broaden our understanding of the psychological processes that underlie the association between childhood neglect and problematic smartphone use and afford practical guidance on reducing the risks associated with problematic smartphone use.

Risk and Protective Factors Associated With Smartphone Addiction and Phubbing Behavior Among College Students in China

Both smartphone addiction and phubbing are emerging behavioral problems. The present study investigates potential risk and protective factors of smartphone addiction and phubbing behavior, including demographic factors, personal factors, and interpersonal factors among Chinese college students. A total of 866 college students (Mage = 21.01, SD = 1.60) completed self-reported questionnaires in classroom settings. Collected data were analyzed by using Pearson's correlation and hierarchical linear regression analyses. The risk factors for smartphone addiction were phubbing behavior, depression, and social anxiety, while the protective factors were self-control and sense of security. In addition, the risk factors for phubbing behavior included female sex and smartphone addiction, while the protective factors included sense of security and interpersonal adaptability. Our findings help to enhance understanding of the general and specific risks and protective factors for smartphone addiction and phubbing behavior, which can benefit intervention development for related behavior prevention and reduction.

Monitoring health and health behaviors among adolescents in Central Catalonia: DESKcohort protocol

The objective of the prospective cohort study (the DESKcohort project) is to describe and monitor health, health behaviors, and their related factors among 12 and 19-year-old adolescents schooled at centers of Compulsory Secondary Education or post-compulsory secondary education in Central Catalonia, considering social determinants of health. The DESKcohort survey is administered biannually between the months of October and June, and the project has been running for three years. We have interviewed 7319 and 9265 adolescents in the academic years 2019/20 and 2021/22, respectively. They responded a questionnaire created by a committee of experts, that included the following variables: sociodemographic factors, physical and mental health, food, physical activity, leisure and mobility, substance use, interpersonal relationships, sexuality, screen use and digital entertainment, and gambling. The results are presented to educational centers, county councils, municipalities, and health and third sector entities to plan, implement, and evaluate prevention and health promotion actions that address the identified needs.

[The problematic use of the mobile phone: cross-sectional analysis of the individual profile and associated factors.]

OBJECTIVE

The problematic use of mobile phones is a phenomenon that can be associated with a specific individual profile and it has been seen that there are associated factors, although most of them have been studied in a limited way and in small samples. The aim of this study was to describe the association between the problematic use of the mobile phone and social traits, health, and health-related behaviors among high school students.

METHODS

This is a cross-sectional study performed in a representative sample of students aged 13-18 years in the Lifestyle Risk Factors in Secondary School Students (FRESC) survey conducted in 2016 in Barcelona (n=3,778). Problematic mobile phone use was obtained from the Mobile Related Experiences Questionnaire (CERM). Multivariate logistic regression models were built to assess the relationship between this variable and social, health and behavioural variables.

RESULTS

A total of 52% of girls and 44% of boys reported frequent or occasional problems with their mobile phone usage. The factors associated with the dependent variable were poor relationships with the family, mobile phone usage before sleeping or during dinner, inadequate hours of sleep, sedentariness, substance consumption and poor mental health.

CONCLUSIONS

The problematic use of the mobile is frequent among students and there are several associated social, health and behavioral factors. There are substantial differences by sex and age, with the strongest associations in younger girls.

Gender inequalities in the prevalence of low mood and related factors in schooled adolescents during the 2019-2020 school year: DESKcohort project

BACKGROUND

Mood disorders are the second most prevalent mental disorders in childhood and adolescence. Many undiagnosed people manifest subthreshold symptoms, like low mood, and present worse prognoses than asymptomatic healthy subjects. The aim of this study was to estimate the prevalence of low mood, gender inequalities, and associated factors, in 12- to 18-year-old adolescents in the rural and medium-sized urban areas of Central Catalonia during the 2019-2020 academic year.

METHODS

Cross-sectional study with data from a cohort of high-schooled students (2019-2020), with a convenience sample of 6428 adolescents from the Central region of Catalonia (48.3 % boys and 51.7 % girls). Prevalence of low mood was estimated by gender and exposure variables, and ratios were obtained using Poisson regression models, adjusting for several exposure variables one by one, and for all of them jointly.

RESULTS

The prevalence of low mood was 18.6 %, with statistically significant differences between genders (11.6 %, 95 % CI: 10.5-12.8 in boys and 25.1 %, 95 % CI: 23.7-26.6 in girls). Being an immigrant, dieting, and daily tobacco smoking were only associated with low mood in girls, whereas risky alcohol consumption was only associated in boys. Sexual violence was found to account for 36.2 % of low mood problems in girls.

LIMITATIONS

The main limitation of the study is its cross-sectional design, which means that no casual relationships can be extracted of this study.

CONCLUSIONS

The prevalence of low mood varies between the sexes, highlighting the importance of developing gender-specific interventions to reduce its incidence in young people, considering the factors associated with this condition.

Effect of Mobile Phone Addiction on Physical Exercise in University Students: Moderating Effect of Peer Relationships

OBJECTIVE

The influence of mobile phone addiction (MPA) on physical exercise in university students was explored, and peer relationships were introduced as a moderating variable.

METHODS

A cross-sectional study design was adopted, and an online survey questionnaire was conducted to investigate two universities in Nantong City, Jiangsu Province, and Chongzuo City, Guangxi Zhuang Autonomous Region. A total of 4959 university students completed the questionnaire. Measurement tools included the Mobile Phone Addiction Tendency Scale, the Physical Activity Rating Scale, and the Peer Rating Scale of university students.

RESULTS

University students scored 39.322 ± 15.139 for MPA and 44.022 ± 7.735 for peer relationships, with 87.8% of their physical exercise, in terms of exercise grade, being classified as medium or low intensity. The MPA of the university students was negatively correlated with peer relationships (r = -0.377, p < 0.001) and physical exercise behavior (r = -0.279, p < 0.001). The moderating effect of peer relationships on the MPA-physical exercise behavior relationship was significant (ΔR² = 0.03, p < 0.001).

CONCLUSIONS

The physical exercise of university students was at a medium or low intensity. The more serious the university students' addiction to mobile phones was, the lower the amount of physical exercise. The physical activity of males was higher than that of females. MPA and peer relationships were the limiting factors of the physical exercise behavior of university students. Under the lower effect of peer relationship regulation, MPA had a greater negative impact on physical exercise behavior. The data from this research can provide theoretical support to improve the participation of university students in physical activities.

Problematic Internet Use among Polish Students: Prevalence, Relationship to Sociodemographic Data and Internet Usage Patterns

Problematic Internet Use (PIU) is a broad term that covers problems with Internet use that result in psychological, social, academic or professional difficulties. The aim of our study was to identify individuals particularly vulnerable to developing PIU among Polish students, taking into account sociodemographic characteristics and Internet use patterns. A total of 1008 students of Polish universities took part in the survey. The research tool was The Problematic Internet Use Test-the Polish version of the Internet Addiction Test. Among the respondents, 10.2% showed signs of PIU-high or very high risk of addiction. Significantly higher levels of PIU were found in males than females, science students than medical and humanities students, and Internet users using a computer, as opposed to students using only a phone/tablet. A decrease in PIU was observed as students improved their assessment of their material situation. The severity of PIU increased significantly as the importance of Internet use for entertainment increased. Our research indicates that it is worth implementing measures to prevent the development of PIU in Poland, e.g., screening educational campaigns, especially for science students. It is also necessary to offer students at lower levels of education, especially the less affluent, forms of leisure time other than computer activity with the use of the Internet.

A bidirectional association between smartphone addiction and depression among college students: A cross-lagged panel model

Background

Smartphone addiction (SA) is associated with adverse consequences, especially for freshmen. Evidence indicates that SA is associated with depression, and it is necessary to conduct a longitudinal study to explore the association further.

Methods

SA (measured by the Smartphone Addiction Scale-Short Version) and depression (measured by the Zung's Self-Rating Depression Scale) among 1,186 freshmen were surveyed at baseline and a respective 12-month follow-up for each participant. The application of a cross-lagged panel model approach (CLPM) revealed an association between SA and depression after adjusting for demographic variables.

Results

The CLPM results showed a significant path from baseline SA to follow-up depression (β = 0.08, P < 0.001) and a significant path from baseline depression to follow-up SA (β = 0.08, P < 0.001). Compared with the overall cross-lagged model, the cross-lagged coefficient of the path from baseline SA to follow-up depression increased in the female group (β = 0.10, P = 0.015), and the cross-lagged coefficient of the path from baseline depression to follow-up SA also increased significantly (β = 0.15, P < 0.001). In contrast, the cross-lagged model in the male group showed no predictive effect between SA and depression (P > 0.05).

Conclusions

The current study showed a significant bidirectional association between smartphone addiction and depression among freshmen, but only in the female population.

Prevalence of Dry Eye Symptoms and Associated Risk Factors among University Students in Poland

Aim: The aim of the study was to demonstrate the prevalence and risk factors of dry eye symptoms (DES) among university students in Poland. Material and methods: A cross-sectional study survey was conducted among 312 Polish university students. The questionnaire consisted of the Ocular Surface Disease Index (OSDI), the 5-Item Dry Eye Questionnaire (DEQ-5) and questions regarding medical history and risk factors. Results: According to the OSDI, more than half of respondents (57.1%) have symptoms of ocular surface disease. Time spent using electronic devices is correlated with scores gathered in both OSDI and DEQ-5 (p < 0.001). There is a statistically significant dependence between psychotropics (p = 0.002), glucocorticosteroids usage (p = 0.026), the presence of depression (p < 0.001), diabetes (p = 0.01) or allergy (p = 0.008) and dry eye symptoms proved in both questionnaires. Respondents with refractive errors and those living in metropolitan areas have a statistically higher symptom intensity(p < 0.022). Stress felt by students is associated with higher DES risk. No correlation between DES and smoking habits was observed. The history of SARS-CoV-2 infection was associated with the severity of DES (p = 0.036). Conclusion: Pathogenesis of DES is multifactorial and its severity depends on several factors, both genetic and environmental. Its prevalence among the young population is underestimated. Determining risk factors will enable the implementation of appropriate prophylaxis and early diagnosis.

Eye discomfort at close work in Portuguese university students: A comparative analysis between the pre-COVID and confinement period

BACKGROUND

Many individuals experience visual symptoms associated with near work. The level of discomfort appears to increase with the amount of digital screen use.

OBJECTIVE

To study the eye discomfort with near tasks in university students in the pre-COVID period and in the period of confinement due to the pandemic.

METHODS

Two independent samples of students, aged between 18 and 35 years, were used to assess symptomatic behaviour with the Convergence Insufficiency Symptom Survey (CISS) questionnaire. In the pre-COVID period the sample had 342 participants, 64.6% females and in the COVID period 322 students participated, 71.4% females. The study of differences was carried out by the Mann-Whitney U test. The interpretation of the statistical inference was performed for a significance level≤0.05.

RESULTS

There was an increase in the number of symptomatic cases in the COVID period without statistical evidence of differences in the frequency of symptoms reported in the two periods. The dimensions "somatic sensations" and "cognitive performance" were the typology of symptoms that most contributed to visual complaints with near vision. There was a significantly different symptomatic behaviour between genders in the period of confinement (p = 0.001), worsening in females and improving in males.

CONCLUSION

These findings suggest that females and males exposed to digital environments, over time, may exhibit different symptomatic behaviour. Our results suggest that boys adapt more quickly than girls. Factors that predispose to these changes, aetiology and potential intervention actions still need further study.

APP-guided assessment of acetabular defects in hip revision arthroplasty: a structured approach to a complex situation

INTRODUCTION

Acetabular defect recognition and classification remains a challenging field of practice for orthopedic surgeons. Recently, the Acetabular Defect Classification (ADC) has been introduced to provide a reliable, reproducible and intuitive classification system. In order to improve ease of use and efficiency of the ADC, a browser-based application has been created. We hypothesized that the ADC application can improve rating performance of non-specialists (medical students) to achieve good inter- and intra-rater agreement and will compare favorable to the results of specialists (experienced surgeons) without the help of the application.

MATERIALS AND METHODS

The ADC is based on the integrity of the acetabular rim and the supporting structures. It consists of four main types of defects ascending in severity. These defects are further subdivided in A-C, narrowing down defect location. 80 randomized radiographs were graded according to ADC by three non-specialists (medical students) with help of the ADC application and by three specialists (orthopedic surgeons) without help of the application to evaluate the difference in inter-rater agreement between groups. To account for intra-rater agreement, the rating process was repeated after a reasonable wash-out period.

RESULTS

Inter-rater and intra-rater agreement within the non-specialist group rated lower when compared to the specialist group while still falling into the good agreement range. The student group presented with k values of 0.61 for inter-rater agreement and 0.68 for intra-rater agreement, while the surgeon group displayed k values of 0.72 for inter-rater agreement and 0.83 for intra-rater agreement.

CONCLUSION

The app-guided assessment of acetabular defects offers a promising innovative approach to simplify complex situations. It makes the challenging field of acetabular revision arthroplasty more approachable especially for less experienced surgeons and offers insight and guidance in the planning stage as well as intra-operative setting.

Problematic smartphone use and specific problematic Internet uses among university students and associated predictive factors: a systematic review

University students are a high-risk population with problematic online behaviours that include generalized problematic Internet/smartphone use and specific problematic Internet uses (for example, social media or gaming). The study of their predictive factors is needed in order to develop preventative strategies. This systematic review aims to understand the current state of play by examining the terminology, assessment instruments, prevalence, and predictive factors associated with problematic smartphone use and specific problematic Internet uses in university students. A literature review was conducted according to the PRISMA guidelines using four major databases. A total of 117 studies were included, divided into four groups according to the domain of problem behaviour: problematic smartphone use (n = 67), problematic social media use (n = 39), Internet gaming disorder (n = 9), and problematic online pornography use (n = 2). Variability was found in terminology, assessment tools, and prevalence rates in the four groups. Ten predictors of problematic smartphone use, five predictors of problematic social media use, and one predictor of problematic online gaming were identified. Negative affectivity is found to be a common predictor for all three groups, while social media use, psychological well-being, and Fear of Missing Out are common to problematic smartphone and social media use. Our findings reaffirm the need to reach consistent diagnostic criteria in cyber addictions and allow us to make progress in the investigation of their predictive factors, thus allowing formulation of preventive strategies.

Problematic internet usage: the impact of objectively Recorded and categorized usage time, emotional intelligence components and subjective happiness about usage

Most research on Problematic Internet Usage (PIU) relied on self-report data when measuring the time spent on the internet. Self-reporting of use, typically done through a survey, showed discrepancies from the actual amount of use. Studies exploring the association between trait emotional intelligence (EI) components and the subjective feeling on technology usage and PIU are also limited. The current cross-sectional study aims to examine whether the objectively recorded technology usage, taking smartphone usage as a representative, components of trait EI (sociability, emotionality, well-being, self-control), and happiness with phone use can predict PIU and its components (obsession, neglect, and control disorder). A total of 268 participants (Female: 61.6%) reported their demographic and completed a questionnaire that included Problematic Internet Usage Questionnaire short form (PIUQ-SF-6), Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), level of happiness with the amount and frequency of smartphone use, and living conditions (whether alone or with others). Their smartphone usage was objectively recorded through a dedicated app. A series of one-way ANOVA revealed no significant difference in PIU for different living conditions and a significant difference in the subjective level of happiness with phone usage (F (3, 264) = 7.55, p < .001), as well as of the frequency of usage where the unhappy group had higher PIU (F (3, 264) = 6.85, p < .001). Multiple linear regression analysis showed that happiness with phone usage (β = -.17), the actual usage of communication (β = .17), social media (β = .19) and gaming apps (β = .13), and trait EI component of self-control (β = -.28) were all significant predictors of PIU. Moreover, gender, age, and happiness with the frequency of phone usage were not significant predictors of PIU. The whole model accounted for the total variance of PIU by 32.5% (Adjusted R2 = .287). Our study contributes to the literature by being among the few to rely on objectively recorded smartphone usage data and utilizing components of trait EI as predictors.

The Influence of Acute Aerobic Exercise on Craving Degree for University Students with Mobile Phone Dependency: A Randomized Controlled Trial

These days, mobile phone dependency (MPD) has become one of the most imperative and impressive puzzles in the area of behavioral addictions and public health across the world, especially the individuals with MPD that might frequently crave using mobile phones themselves. The target of the current study was to determine whether moderate-intensity aerobic exercise could reduce the craving degree for mobile phones for university students with MPD by a randomized, controlled trial. Sixty Chinese undergraduates, including 30 male and 30 female students aged from 18 to 22 years (20.08 ± 1.94 years) with MPD were recruited and then randomly assigned to the exercise group (n = 30) or the control group (n = 30) with even numbers by gender and major. Participants in the exercise group were required to perform an acute moderate-intensity treadmill exercise lasting for 30 min at 45−68% heart rate reserve (HRR) with background music, while the control group were only asked to listen to the same music for 40 min without any exercise. Sport watches were employed to monitor their heart rate (HR), and the exercise group was also obliged to report their rating of perceived exertion (RPE). After completing the experimental task, a visual analog scale (VAS) was used to evaluate their craving degree for mobile phones, and an independent samples t-test was computed to reveal the difference in the scores of craving degree for mobile phones between the two groups. The results showed that the VAS score for the exercise group (3.77 ± 1.36) was significantly lower (p < 0.001) than that of the control group (6.11 ± 1.39). The findings suggested that acute moderate-intensity aerobic exercise could be an effective and reliable means to help deal with the issue of mobile phones craving for the undergraduates with MPD, and more longitudinal intervention studies and control trial designs should be conducted in the near future to further test the long-term effects of this exercise.

Pattern of mobile phone and internet use among 11-15-years-old

OBJECTIVE

To assess the pattern of problematic internet and mobile use in a sample of adolescents.

METHOD

Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected.

RESULTS

446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11-15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12h on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001).

CONCLUSIONS

The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.

Smartphone and internet addiction as predictors of cyberloafing levels in students: A mediated model

This study aims to determine the predictors of cyberloafing behaviors of university students. In this context, we examined the effects of smartphone and internet addiction variables on cyberloafing levels. Besides, the mediator effect of internet addiction was determined in the impact of smartphone addiction on cyberloafing. We conducted the questionnaire-based study with 341 students studying at different departments of a state university (faculty of education, faculty of engineering, and vocational school) in Turkey. Participants consisted of 182 male and 159 female. Students filled out the smartphone addiction scale, the internet addiction scale, and the cyberloafing activities scale. The data obtained from the 5-point Likert type scales were evaluated with correlation and regression analyses. The results showed that there is a significant positive relationship between smartphone addiction, internet addiction, and cyberloafing. While internet addiction was a predictor of cyberloafing, it mediated the effect of smartphone addiction on cyberloafing. We discussed the results of this study and offered suggestions for future research.

Problematic use of digital media in children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder compared to controls. A meta-analysis

Objective

Problematic use of digital media and problematic use of the internet (PUI) in particular are growing problems in the general population. Moreover, studies have shown links between PUI and symptoms of attention-deficit/hyperactivity disorder (ADHD). This meta-analysis investigated whether children and adolescents with ADHD are more often affected by PUI compared to control groups.

Method

Multiple databases (EBSCOhost, Pubmed) were reviewed. Studies were eligible if individuals (aged 6-18 years) were diagnosed with ADHD, assessed on PUI-related measures, and compared to non-clinical or/and clinical controls without a diagnosis of ADHD. Out of 3,859 identified studies, 14 studies assessing 2,488 participants met all inclusion criteria. Four meta-analyses examining time-based and scale-based measures, different informants and non-clinical vs. clinical controls using random-effects models were performed. Funnel plots were used to investigate publication bias.

Results

The analyses revealed significantly more severe PUI in individuals with ADHD compared to controls, both when PUI was assessed via rating scale (scaled-based) and via units for time (time-based measures). Different informants (self- vs. parent-rating) had no impact on results. Differences in PUI between groups with ADHD and non-clinical controls were significant, whereas differences between ADHD and clinical controls were not. Due to the high heterogeneity observed and the small sample sizes, these latter findings should be interpreted cautiously.

Conclusion

Children and adolescents with ADHD show more severe PUI compared to non-clinical controls without ADHD. However, the small number of studies does not allow for a systematic comparison between ADHD and groups with other psychopathologies.

Prevalence of dry eye disease among Chinese high school students during the COVID-19 outbreak

Purpose

The study aimed to investigate the prevalence of dry eye disease (DED) and relevant risk factors among Chinese high school students during the COVID-19 outbreak.

Methods

A cross-sectional study was conducted from November to December 2020, and 4825 high school students from nine high schools in Shanghai were recruited. All students completed ocular surface disease index (OSDI) and perceived stress scale (PSS) questionnaires and answered other questions designed to ascertain information on the risk factors related to DED. DED was diagnosed when OSDI scores were greater than or equal to 13. The prevalence of symptomatic DED was determined. A T-test, Kruskal-Wallis test, Chi-square test, and logistic regression analysis were used to examine the possible risk factors.

Results

The prevalence of symptomatic DED among Chinese high school students was 70.5%. In univariate analysis, higher PSS scores (P<0.001), prolonged video display terminal (VDT) use (P<0.001), wearing contact lenses (P=0.001), poor sleep quality (P<0.001), and being female (P<0.001) were significantly correlated with dry eyes. In multivariate logistic regression analysis, higher PSS scores (P<0.001, OR=1.20), prolonged VDT use (P<0.001, OR=1.07), poor sleep quality (P<0.001, OR=1.84), and being female (P=0.001, OR=1.25) were significant risk factors associated with DED.

Conclusions

Due to the epidemic, most Chinese high school students are in a high-risk environment in which they are more likely to suffer from DED, such as long online courses and heavy stress from school. Relevant preventive measures that may have a positive impact on public health and quality of life for high school students should be brought to the forefront.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02408-9.

The Impact of Nomophobia, Stress, and Loneliness on Smartphone Addiction among Young Adults during and after the COVID-19 Pandemic: An Israeli Case Analysis

Technological development in recent times has dramatically changed the way people live, interact with, and consume information. Since the emergence of the first iPhone in January 2007 until today, mobile phones are used daily for a range of purposes. Using mobile phones for various purposes intensified during the COVID-19 pandemic due to isolation or government lockdown regulations. However, along with the advantages of smartphone usage there are many disadvantages such as smartphone addiction and continuous exposure to digital screens, behaviors known as PSU—problematic smartphone use. This study explores the impact of several variables on PSU: loneliness, the need for social interaction, sleep hours, fear of losing phone access (nomophobia), and stress among young adults in Israel. The variables are examined with respect to two time periods: 1. During the COVID-19 pandemic lockdowns (defined as “T1”) and 2. Following the end of the first wave of COVID-19 lockdowns (defined as “T2”). The results indicated that nomophobia, social affiliation, and sleep hours affect PSU. In addition, the indirect effect of the number of sleep hours on stress and PSU was found to be significant in T2 and in T1. The findings and their implications are discussed.

The Relationship Between Physical Exercise and Mobile Phone Addiction Tendency of University Students in China: A Moderated Mediation Model

This study aims to explore the relationship between physical exercise (PE), self-control (SC), physical exercise atmosphere (PEA), and mobile phone addiction tendency (MPAT) among Chinese university students. Through the quota sampling, 1,433 students complied with the requirements were surveyed from 10 universities in China. PE, SC, PEA, and MPAT were assessed using standard scales. For data analysis, common method deviation test, mean number, standard deviation, correlation analysis and structural equation model analysis were carried out in turn. The results showed PE and MPAT were negatively related (r = -0.158, p < 0.05); PE significantly positively predicted SC (β = 0.082, t = 3.748, p < 0.01), and SC significantly negatively predicted MPAT (β = -0.743, t = -19.929, p < 0.01). Bootstrap method was used to test the mediating effect of SC. The results showed that 95% confidence interval did not include 0. After adding the mediating variable of SC, PE did not significantly negatively predict the tendency of MPAT (β = -0.027, t = -1.257, p > 0.05). The interaction item PEA and SC could significantly positively predict the tendency of MPAT (β = 0.165, t = 2.545, p < 0.05). In the high PEA group, SC had a significant negative predictive effect on the tendency of MPAT (β = -0.665, t = -14.408, p < 0.01); However, in the low PEA group, the negative predictive effect was stronger (β = -0.834, t = -15.015, p < 0.01). The present study shows that PE significantly negatively predicted the tendency of MPAT, and SC played a complete mediating role in the relationship between PE and MPAT; The second half of the indirect effect of PE and MPAT was regulated by the PEA. The PEA will enhance the influence of SC on MPAT, but the high PEA will increase the level of MPAT of individuals at a very high level of SC.

Impact of a Digital Intervention for Literacy in Depression among Portuguese University Students: A Randomized Controlled Trial

Digital interventions are important tools to promote mental health literacy among university students. “Depression in Portuguese University Students” (Depressão em Estudantes Universitários Portugueses, DEEP) is an audiovisual intervention describing how symptoms can be identified and what possible treatments can be applied. The aim of this study was to evaluate the impact of this intervention. A random sample of 98 students, aged 20–38 years old, participated in a 12-week study. Participants were recruited through social media by the academic services and institutional emails of two Portuguese universities. Participants were contacted and distributed into four study groups (G1, G2, G3 and G4): G1 received the DEEP intervention in audiovisual format; G2 was given the DEEP in text format; G3 received four news articles on depression; G4 was the control group. A questionnaire was shared to collect socio-demographic and depression knowledge data as a pre-intervention method; content was then distributed to each group following a set schedule; the depression knowledge questionnaire was then administered to compare pre-intervention, post-intervention and follow-up literacy levels. Using the Scheffé and Least Significant Difference (LSD) multiple comparisons test, it was found that G1, which received the DEEP audiovisual intervention, differed significantly from the other groups, with higher depression knowledge scores in post-intervention stages. The DEEP audiovisual intervention, compared to the other formats used (narrative text format; news format), proved to be an effective tool for increasing depression knowledge in university students.

A two-generation study: The transmission of attachment and young adults' depression, anxiety, and social media addiction

Social media use is on the rise among young adults (YA) and evidence suggests a positive association between social media addiction (SMA) and the psychological symptoms of depression and anxiety globally. However, the contribution of attachment and its transgenerational influence on YAs' SMA and psychological symptoms have not been widely explored. Thus, we examined how parental reports of attachment (anxiety and avoidance) can directly and through YAs' attachment predict YAs' SMA, depression and anxiety symptoms. A sample of 375 YAs (M_Age = 21.22) and their parents completed the Emotions in Close Relationships-Revised Questionnaire (Fraley et al., 2000), and the Brief Symptom Inventory (Deragotis, 1992). The SMA Scale (Sahin, 2018) was responded to by only YAs. We tested the pattern of associations in a path model. Parental attachment anxiety predicted YAs' attachment anxiety and only paternal attachment avoidance predicted YAs' attachment avoidance. YAs' attachment anxiety and avoidance predicted their depression and anxiety. However, YAs' attachment anxiety uniquely predicted their SMA. Both parents' attachment anxiety indirectly predicted the link between YAs' attachment anxiety and depression, but only paternal attachment avoidance indirectly predicted the association between YAs' attachment avoidance and depression. Furthermore, paternal attachment avoidance indirectly predicted the association between YAs' attachment avoidance and anxiety symptoms. Maternal attachment anxiety indirectly predicted SMA via YAs' attachment anxiety. While parental anxiety and paternal avoidance may impact YAs' symptoms, YAs' and maternal attachment anxiety can shape SMA. The findings about the differential role of attachment in YAs' psychological symptoms and SMA can facilitate further research and interventions.

Mobile Phone Addiction and Academic Procrastination Negatively Impact Academic Achievement Among Chinese Medical Students

The problem of mobile phone addiction and academic procrastination among medical students has been widely acknowledged. This study aimed to explore the influence of demographic factors on mobile phone addiction, academic procrastination, and academic achievement among medical students. Further, it investigated the association between mobile phone addiction, academic procrastination, and academic achievement. This cross-sectional study was conducted between May and June 2019. A total of 3 511 medical students participated in an online questionnaire survey (effective response rate = 81.7%). Demographic factors, the Scale of Academic Achievement, the short scale of the Mobile Phone Problem Use (MPPUS-10), and the Academic Procrastination Scale–Short (APS-S) were used. Hierarchical multiple regression analysis revealed that the average scores for academic procrastination, mobile phone addiction, and academic achievement were 2.66 ± 0.91, 5.13 ± 1.53, and 4.51 ± 0.71, respectively. Moreover, there were significant differences in gender, grade, leadership experience, and family monthly income across mobile phone addiction, academic procrastination, and academic achievement. Mobile phone addiction was negatively associated with learning dedication, learning performance, and relationship facilitation. Academic procrastination was negatively associated with learning dedication, learning performance, relationship facilitation, and objective achievement. Mobile phone addiction and academic procrastination was revealed as prevalent among Chinese medical students, and negatively influences their academic achievement. It is critical to establish a more efficient learning environment for Chinese medical students to minimize the negative impact of mobile phone addiction and academic procrastination.

How Does Psychological Distress Due to the COVID-19 Pandemic Impact on Internet Addiction and Instagram Addiction in Emerging Adults?

International research has underlined a worrying increase in Internet and Instagram addiction among emerging adults during the COVID-19 pandemic. Although the role played by alexithymia and psychological distress due to COVID-19 has been evidenced, no study has explored their complex relationship in predicting emerging adults' Internet and Instagram addiction. The present study aimed to verify whether peritraumatic distress due to the COVID-19 pandemic mediated the relationship between emerging adults' alexithymia and their Internet/Instagram addiction, in a sample composed of n = 400 Italian emerging adults. Results showed that females had higher peritraumatic distress due to COVID-19 than males, whereas males had higher externally oriented thinking and higher levels of Internet addiction than females. Emerging adults' psychological distress due to COVID-19 significantly mediated the effect of alexithymia on Internet and Instagram addiction. Our findings supported the presence of a dynamic relationship between individual vulnerabilities and the co-occurrence of other psychological difficulties in predicting emerging adults' Internet and Instagram addiction during the pandemic, with important clinical implications.

Problematic Internet Use Associated with Symptomatic Dry Eye Disease in Medical Students from Peru

PURPOSE

Dry eye is a multifactorial ocular surface disease (DED) characterized by a loss of tear film homeostasis, which is widely associated with alterations in mental health. Problematic internet use (PIU) is defined as the feeling of concern about using this tool irresistibly, for longer periods than usual, accompanied by anguish that results from not doing so without reaching mania or hypomania behaviors. Both PIU and DED present a theoretical link; however, there are no published studies that report its relationship with problematic internet use. Therefore, this study aims to determine the association between PIU and symptomatic DED in Peruvian medical students.

PATIENTS AND METHODS

Analytical cross-sectional study that included human medical students from Peru. For the measurement of main variables, the Ocular Surface Disease Index (OSDI) and the Internet Addiction Test (IAT) were used. To study their relationship, the Poisson regression analysis was used, we consider a p-value <0.05 as significant.

RESULTS

Data from 844 medical students were analyzed, 35.7% male and 64.3% female, with an average age of 21.8 ± 3.3 years. Likewise, the prevalence of symptomatic DED was 70.9%, and the internet's controlled use was 85.3%. In the analysis adjusted for symptomatic DED, the men showed significant differences in the controlled use of the internet (p <0.003), of which those who had PIU, 50% had severe symptomatic DED, as well as 80% of those addicted to the internet. The adjusted model showed that the PIU increases the prevalence of symptomatic DED in men (PR = 1.17, 95% CI: 1.06-1.29); however, in women, no association was found between both variables.

CONCLUSION

PIU and symptomatic DED showed a significant association in male medical students from Peru.

Extended Reality in Higher Education, a Responsible Innovation Approach for Generation Y and Generation Z

This study aims to provide a comprehensive overview of the XR challenges, opportunities, and future trends that will impact higher educational institutions. The article discusses (using observation, participatory observation and as well as document analysis) the potential for augmented reality to be used in higher education, having in mind characteristics of Millennials (Generation Y) and Post-Millennials (Generation Z) and raises issues about responsible innovation, the future of work, and formal education. Additionally, survey research was completed among students in Serbia and Romania (103 respondents) within selected generations regarding their knowledge of extended reality and their attitudes towards opportunities and challenges of extended reality in Higher Education Institutions, and thus this paper also utilises quantitative analysis. A correlation matrix, composite reliability, and regression model were used to code the data and extract knowledge. A thorough review of the existing literature on one hand and primary research as well, using the chosen scientific methods, the planned purpose of the research will be obtained: to gain a better-understanding of the education needs of Generation Y and Generation Z and the potential use of XR as a response to the needs observed. The results of the quantitative analysis confirmed our starting assumptions: XR is an excellent technology facilitating the teaching processes allowing learners to more actively control their learning strategies and supporting the interactivity and connectivity that students and faculties experience. Furthermore, Generation Z students are more applicative for stating XR’s opportunities (instead of challenges) in higher education institutions.

Cyberloafing behaviors among university students: Their relationships with positive and negative affect

With the technological advances, the use of digital devices, such as laptops, tablets, or smartphones in the educational setting has become prevalent among young people. Accordingly, there has been an increased concern among scholars on students' in-class Internet use for personal purposes; namely, 'cyberloafing'. Considerable research has demonstrated the adverse effects of in-class Internet use on students' learning environment and academic performance. The present study particularly investigates the relationship between cyberloafing behaviors and positive and negative affect among university students. It examines five different online activities including sharing, shopping, real-time updating, accessing online content, and gaming/gambling separately to gain greater insight into students' cyberloafing behaviors. The sample consisted of 267 undergraduate students who filled out questionnaires measuring cyberloafing behaviors, positive and negative affect, and demographical information including the use of the Internet and mobile technologies. The initial analyses showed that male students had higher scores in shopping, accessing online content, and gaming/gambling than females. The latent variable analysis revealed that among different activities of cyberloafing, accessing online content and gaming/gambling were positively correlated with positive affect, while sharing was positively associated with negative affect among students. The findings emphasize the importance of evaluating cyberloafing as a part of students' psychological well-being rather than a variable merely related to academic achievement. The findings of the study also enlighten researchers and educators in developing appropriate policies and interventions to manage misuse of the Internet in class.

Physical activity influences the mobile phone addiction among Chinese undergraduates: The moderating effect of exercise type

BACKGROUND AND AIMS

Mobile phone addiction (MPA) has recently aroused much attention due to its high incidence and considerable health hazards. Although some existing studies have documented that physical activity is negatively associated with MPA, it is little known about the potential effects underlying this relation. The aim of this study was to investigate the relationship between physical activity and MPA among undergraduates in China, and to further examine the moderating effect of exercise type in the relation between them.

METHODS

By the quota sampling, a total of 650 participants engaged in this survey and completed relevant measurements including physical activity rating scale-3 (PARS-3) and mobile phone addiction tendency scale (MPATS).

RESULTS

Gender (β = 0.271, P < 0.05) and major (β = -0.169, P < 0.05) could significantly predict MPA, respectively, and physical activity was an imperative protective factor to decrease MPA (β = -0.266, P < 0.001). While the physical activity level enhanced from none exercise to medium exercise, an optimum dose-response relationship would emerge between physical activity and MPA (F (3,604) = 4.799, P < 0.01). Most important, the relation between physical activity and MPA can be moderated by exercise type. Especially in terms of aerobic endurance exercise, the higher level of physical activity the undergraduates performed, the lower degree of MPA would be suffered by them (β = -0.266, P < 0.001).

DISCUSSION

These findings could be conducive to better understand the positive and potential effects of physical activity on the intervention in MPA, and served as a persuasive evidence that as for university students, actively engaging in aerobic endurance exercise with the medium activity level would be a practicable exercise strategy to deal with MPA in daily lifestyle behavior.

Prevalence and Factors Associated with Problematic Internet Use in a Population of Spanish University Students

(1) Background: To examine the prevalence, and associated factors of, problematic Internet use in a sample of Spanish university students. (2) Methods: Cross-sectional descriptive study of a convenience sample of 698 university students. Self-esteem, alcohol consumption, perceived social support, depression, anxiety, stress and problematic Internet use were evaluated using the Rosenberg, CAGE, DUKE-UNC-11, DASS-21 and Young's Internet Addiction Test, respectively. (3) Results: Problematic internet use was reported by 21% of respondents. Risk of problematic Internet use was independently associated with the preferred use of the smartphone, time of exposure to the Internet, less perceived social support, problematic alcohol consumption and symptoms of stress and anxiety. We found significant association between problematic internet use and time of exposure to the Internet, residential status, alcohol consumption, self-esteem, perceived social support and psychological distress, after bivariate analysis. (4) Conclusions: A considerable prevalence of problematic Internet use was found; in our sample problematic Internet use was associated with stress, alcohol consumption, anxiety and perceived social support. Strategies aimed at the early identification of problematic Internet use may lead to an improvement in the psychosocial health of the university student population.

Patterns of digital information and communication technology use among patients at primary health care centres in Colombia: Phase I of the DIADA project

OBJECTIVE

Assess the prevalence and types of digital technology use, as well as the extent to which patients use the internet and mobile devises. Evaluate the socioeconomic characteristics of patients and the possible relation to patterns of technology use in Colombia. Understand the nature of patient technology use in primary care for finding medical information.

METHODS

A survey was applied to adult patients who attended primary health care centers systems in 6 Colombian cities. The survey inquired about demographic characteristics, insurance, access to services, cell phone use, internet access, and the use of such technology to access health-related services and information. Data was collected and managed using REDCap. Summary statistics on each survey item were calculated and the differences between discrete variables were analyzed using chi-square. Multivariate analyses were performed using logistic regression analysis for binary dependent variables.

RESULTS

A total of 1580 patients were surveyed across the six study sites. 93% of the patients reported they have a cell phone. Patients from urban healthcare centers showed a higher use of the Internet on their phone than less urban settings. Around half of the surveyed patients reported Internet use (49.7%). Among Internet users, 65% of participants use the Internet looking for health care information. Around one-third of patients use cellphones to arrange clinic visits. Around 24% of participants answered positively for both Whooley's questions. Of those who screened positive on the Whooley questions, 43% reported being moderately anxious, 47% reported being very anxious. 51% reported having moderate pain; 52% reported having severe pain.

CONCLUSIONS

The patterns of technology use identified in this study are essential for developing future health interventions based on ICT. The design of ICT clinical interventions must take into account the cellphone payment plans, availability of internet connection, advantages, and disadvantages of messenger services, including SMS as a possible alternative to people who do not have smartphones.

Utilization of Health Care Services and Common Disease Diagnoses among University Students: An Analysis of 35,249 Students from Thailand

The health care services for university students are important to improve student health and well-being. Analyzing the database of health conditions in the health service system will identify common health problems, which could be useful in further appropriate and specific health service planning. This study aims to investigate the utilization of health care services and common disease diagnoses among university students enrolled at Chiang Mai University during the academic year of 2018. A retrospective study was carried out using health data from the electronic health records (EHR) database of the university hospital. Ethical procedures were followed. Out of the overall 35,249 students in the academic year 2018, 17,284 students (49.03%) had visited an outpatient department (65,150 outpatient department visits), and 407 students (1.15%) had been admitted to the hospital (458 inpatient department admissions). The proportions of utilization between each field of education and training were similar across both groups. The top five categories of diagnosis, for both outpatient department visits and inpatient department admissions, differed between gender. Some of the most common diseases included trauma and injury conditions, respiratory diseases, and mental health. The conclusion of the study is that integration of a health promotion program with preventive methods, especially regarding traffic injury, transmitted diseases, mental health support, and safe environments are essential for university students. A general overview of utilization and common diseases among university students, which is still lacking in the literature, could be useful as a platform to enhance health care services for common diseases.

Impact of Reducing Sitting Time in Women with Fibromyalgia and Obesity: A Randomized Controlled Trial

BACKGROUND

Sitting time has negative effects on health, increasing the risk of obesity, osteoporosis, diabetes, and cancer. Thus, primary health care education interventions aimed to reduce sitting time and sedentary behavior could have beneficial effects on people's health and wellbeing. The purpose of this study was to assess the effectiveness of an intervention based on reducing sitting time to decrease cardiometabolic risk on a sample of women diagnosed with fibromyalgia and moderate obesity.

METHODS

Randomized controlled trial to evaluate the effectiveness of an intervention to decrease cardiometabolic risk in 84 participants. Sedentary behavior was monitored using an accelerometer before and at 3-month follow-up.

RESULTS

Compared with the control group, body mass index decreased, and the number of steps taken increased, in the intervention group 3 months after the intervention. No significant differences were found in the rest of the variables measured.

CONCLUSION

The intervention group decreased sitting time after the intervention. Group activities and support from primary care may be useful to improve treatment adherence. RCT registration: NCT01729936.

Can Adverse Childhood Experiences Heighten Risk for Problematic Internet and Smartphone Use? Findings from a College Sample

Background: College students are among the heaviest users of smartphones and the Internet, and there is growing concern regarding problematic Internet (PIU) and smartphone use (PSU). A subset of adverse childhood experiences, household dysfunction [(HHD) e.g.; parental substance use, mental illness, incarceration, suicide, intimate partner violence, separation/divorce, homelessness], are robust predictors of behavioral disorders; however, few studies have investigated the link between HHD and PIU and PSU and potential protective factors, such as social support, among students. Methods: Data are from a diverse California student sample (N = 1027). The Smartphone Addiction Scale—Short Version and Internet Addiction Test assessed dimensions of addiction. Regression models tested associations between students’ level of HHD (No HHD, 1–3 HHD, ≥4 HHD) and PSU and PIU, and the role of extrafamilial social support in these relationships, adjusting for age, gender, ethnicity, SES, employment loss due to COVID-19, and depression. Results: Compared to students reporting no HHD, students with ≥4 HHD had twice the odds (AOR: 2.03, 95% CI: 1.21–3.40) of meeting criteria for PSU, while students with 1–3 HHD and ≥4 HHD had three and six times the odds of moderate to severe PIU (AORs: 2.03–2.46, CI:1.21–3.96) after adjusting for covariates. Extrafamilial social support was inversely associated with PIU and moderated the HHD–PSU association for students with 1–3 HHD. Conclusion: Students exposed to HHD may be especially vulnerable to developing behavioral addictions such as PSU and PIU. Extrafamilial social support offset the negative effects of HHD for PSU among the moderate risk group; implications for prevention efforts are discussed.