1 Faugami

Quantitative Research Paper On Cell Phone Use

A survey study of the association between mobile phone use and daytime sleepiness in California high school students

1Mountain View High School, Mountain View, 3535 Truman Avenue, Mountain View, CA 94040, USA

2Department of Psychiatry and Behavioral Sciences, Stanford University, 3801 Miranda Avenue (151Y), Stanford CA 94305, Palo Alto, CA 94304, USA

3Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA 94304, USA

Corresponding author.

Nila Nathan: moc.liamg@zgodnalin; Jamie Zeitzer: ude.drofnats@reztiezj

Author information ►Article notes ►Copyright and License information ►

Received 2012 Nov 10; Accepted 2013 Sep 10.

Copyright © 2013 Nathan and Zeitzer; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Background

Mobile phone use is near ubiquitous in teenagers. Paralleling the rise in mobile phone use is an equally rapid decline in the amount of time teenagers are spending asleep at night. Prior research indicates that there might be a relationship between daytime sleepiness and nocturnal mobile phone use in teenagers in a variety of countries. As such, the aim of this study was to see if there was an association between mobile phone use, especially at night, and sleepiness in a group of U.S. teenagers.

Methods

A questionnaire containing an Epworth Sleepiness Scale (ESS) modified for use in teens and questions about qualitative and quantitative use of the mobile phone was completed by students attending Mountain View High School in Mountain View, California (n = 211).

Results

Multivariate regression analysis indicated that ESS score was significantly associated with being female, feeling a need to be accessible by mobile phone all of the time, and a past attempt to reduce mobile phone use. The number of daily texts or phone calls was not directly associated with ESS. Those individuals who felt they needed to be accessible and those who had attempted to reduce mobile phone use were also ones who stayed up later to use the mobile phone and were awakened more often at night by the mobile phone.

Conclusions

The relationship between daytime sleepiness and mobile phone use was not directly related to the volume of texting but may be related to the temporal pattern of mobile phone use.

Keywords: Adolescent, Sleep deprivation, Mobile phone, Survey

Background

Mobile phone use has drastically increased in recent years, fueled by new technology such as ‘smart phones’. In 2012, it was estimated that 78% of all Americans aged 12–17 years had a mobile phone and 37% had a smart phone [1]. Despite the growing number of adolescent mobile phone users, there has been limited examination of the behavioral effects of mobile phone usage on adolescents and their sleep and subsequent daytime sleepiness.

Mobile phone use in teens likely compounds the biological causes of sleep loss. With the onset of puberty, there are changes in innate circadian rhythms that lead to a delay in the habitual timing of sleep onset [2]. As school start times are not correspondingly later, this leads to a reduction in the time available for sleep and is consequently thought to contribute to the endemic sleepiness of teenagers. The use of mobile phones may compound this sleepiness by extending the waking hours further into the night. Munezawa and colleagues [3] analyzed 94,777 responses to questionnaires sent out to junior and senior high school students in Japan and found that the use of mobile phones for calling or sending text messages after they went to bed was associated with sleep disturbances such as short sleep duration, subjective poor sleep quality, excessive daytime sleepiness and insomnia symptoms. Soderqvist et al. in their study of Swedish adolescents aged 15–19 years, found that regular users of mobile phones reported health symptoms such as tiredness, stress, headache, anxiety, concentration difficulties and sleep disturbances more often than less frequent users [4]. Van der Bulck studied 1,656 school children in Belgium and found that prevalent mobile phone use in adolescents was related to increased levels of daytime tiredness [5]. Punamaki et al. studied Finnish teens and found that intensive mobile phone use lead to more health complaints and musculoskeletal symptoms in girls both directly and through deteriorated sleep, as well as increased daytime tiredness [6]. In one prospective study of young Swedish adults, aged 20–24, those who were high volume mobile phone users and male, but not female, were at greater risk for developing sleep disturbances a year later [7]. The association of mobile phone utilization and either sleep or sleepiness in teens in the United States has only been described by a telephone poll. In the 2011 National Sleep Foundation poll, 20% of those under the age of 30 reported that they were awakened by a phone call, text or e-mail message at least a few nights a week [8]. This type of nocturnal awakening was self-reported more frequently by those who also reported that they drove while drowsy.

As there has been limited examination of how mobile phone usage affects the behavior of young children and adolescents, none of which have addressed the effects of such usage on daytime sleepiness in U.S. teens, it seemed worthwhile to attempt a cross-sectional study of sleep and mobile phone utilization in a U.S. high school. As such, it was the purpose of this study to examine the association of mobile phone utilization and sleepiness patterns in a sample of U.S. teens. We hypothesized that an increased number of calls would be associated with increased sleepiness.

Methods

We designed a survey that contained questions concerning sleepiness and mobile phone use (see Additional file 1). Sleepiness was assessed using a version of the Epworth Sleepiness Scale (ESS) [9] modified for use in adolescents [10]. The modified ESS consists of eight questions that assessed the likelihood of dozing in the following circumstances: sitting and reading, watching TV, sitting inactive in a public place, as a passenger in a car for an hour without a break, lying down to rest in the afternoon when circumstances permit, sitting and talking to someone, sitting quietly after a lunch, in a car while stopped for a few minutes in traffic. Responses were limited to a Likert-like scale using the following: no chance of dozing (0), slight chance of dozing (1), moderate chance of dozing (2), or high chance of dozing (3). This yielded total ESS scores ranging from 0 to 24, with scores over 10 being associated with clinically-significant sleepiness [9]. We also included a set of modified questions, originally designed by Thomée et al., that assess the subjective impact of mobile phone use [7]. These included the number of mobile calls made or received each day, the number of texts made or received each day, being awakened by the mobile phone at night (never/occasionally/monthly/weekly/daily), staying up late to use the mobile phone (never/occasionally/monthly/weekly/daily), expectations of accessibility by mobile phone (never/occasionally/daily/all day/around-the-clock), stressfulness of accessibility (not at all/a little bit/rather/very), use mobile phone too much (yes/no), and tried and failed to reduce mobile phone use (yes/no).

An email invitation to complete an electronic form of the survey (http://www.surveymonkey.com) was sent to the entire student body of the Mountain View High School, located in Mountain View, California, USA, on April 5, 2012. Out of the approximately 2,000 students attending the school, a total of 211 responded by the collection date of April 23, 2012. Data analyses are described below (OrginPro8, OriginLab, Northampton MA). Summary data are provided as mean ± SD for age and ESS and as median (range) for the number of texts and/or phone calls made or received per day as these were non-normally distributed (p’s <; 0.001, Kolmogorov Smirnov test). To examine the relationship between sleepiness and predictor variables, stepwise multivariate regression analyses were performed. Collinearity in the data was examined by calculating the Variance Inflation Factor (VIF). Post hoc t-tests, ANOVA, Mann–Whitney U tests, and Spearman correlations were used, as appropriate, to examine specific components of the model and their relationship to sleepiness. χ2 tests were used to examine categorical variables. The study was done within the regulations codified by the Declaration of Helsinki and approved by the administration of Mountain View High School.

Results

Sixty-eight males and 143 females responded to the survey. Most (96.7%) respondents owned a mobile phone. The remainder of the analyses presented herein is on the 202 respondents (64 male, 138 female) who indicated that they owned a mobile phone (Tables  1 and ​2). The youngest participant in the survey was 14 years old and the oldest was 19 years old (16 ± 1.2 years), representative of the age range of this school. The median number of mobile phone calls made or received per day was 2 and ranged from 0 to 60. The median number of text messages sent or received per day was 22.5 and ranged from 0 to 700. While about half of the respondents (53%) had never been awakened by the mobile phone at night, 35% were occasionally awakened, 5.9% were awakened a few times a month, 5.0% were awakened a few times a week, and 1.0% were awakened almost every night. About one-quarter (27%) of respondents had never stayed awake later than a target bedtime in order to use the mobile phone, however 36% occasionally stayed awake, 19% stayed awake a few times a month, 8.5% stayed awake a few times a week, and 10% stayed awake almost every night in order to use the mobile phone. In regards to feeling an expectation of accessibility, 7.5% reported that they needed to be accessible around the clock, 26% reported that they needed to be accessible all day, 52% reported they needed to be accessible daily, 13% reported that they only needed to be accessible now and then, and 1.0% reported they never needed to be accessible. Nearly half (49%) of the survey participants viewed accessibility via mobile phones to be not at all stressful, 45% found it to be a little bit stressful, 4.5% found it rather stressful, and 1.0% found it very stressful. More than one-third (36%) reported that they or someone close to them thought that they used the mobile phone too much. Few (17%) had tried but were unable to reduce their mobile phone use.

Table 1

Descriptive statistics - continuous variables

Table 2

Descriptive statistics - categorical variables

Subjective sleepiness on the ESS ranged from 0 to 18 (6.8 ± 3.5, with higher numbers indicating greater sleepiness), with 25% of participants having ESS scores in the excessively sleepy range (ESS ≥ 10). We examined predictors of subjective sleepiness (ESS score) using stepwise multivariate regression analysis with the following independent variables: age, sex, frequency of nocturnal awakening by the phone, frequency of staying up too late to use the phone, self-perceived accessibility by phone, stressfulness of this accessibility, attempted and failed to reduce phone use, excessive phone use determined by others, number of texts per day, and number of phone calls per day. Only subjects with complete data sets were used in our modeling (n = 191 of 202). Our final model (Table  3) indicated that sex, frequency of accessibility, and a failed attempt to reduce mobile phone use were all predictive of daytime sleepiness (F6,194 = 4.35, p <; 0.001, r2 = 0.12). These model variables lacked collinearity (VIF’s <; 3.9), indicating that they were not likely to represent the same source of variance. Despite the lack of significance in the multivariate model, given previously published data [4-6], we independently tested if there was a relationship between the number of estimated texts and sleepiness, but found no such correlation (r = 0.13, p = 0.07; Spearman correlation). In examining the final model, it appears that those who felt that they needed to be accessible “around the clock” (ESS = 9.2 ± 2.9) were sleepier than all others (ESS = 6.7 ± 3.4) (p <; 0.01, post hoc t-test). The relationship between sleepiness and reporting having tried, but failed, to reduce mobile phone use was such that those who had tried to reduce phone use were more sleepy (ESS = 8.3 ± 3.6) than those who had not (ESS = 6.5 ± 3.4) (p <; 0.01, post hoc t-test). While more females had tried to reduce their mobile phone use, sex did not modify the relationship between the attempt to reduce mobile phone use and sleepiness (p = 0.32, two-way ANOVA), thus retaining attempt and failure to reduce mobile phone use as an independent modifier of ESS scores.

In an attempt to better understand the relationship between ESS and accessibility, we parsed the population into those who felt that they needed to be accessible around the clock (7.4%) and those who did not (92.6%). The most accessible group, as compared to the less accessible group, had a numerically though not statistically significantly higher texting rate (50 vs. 20 per day; p = 0.07, Mann–Whitney U test), but were awakened more at night by the phone (27% vs. 4%, weekly or daily; p <; 0.05, χ2 test), and stayed awake later than desired more often (40% vs. 17%, weekly or daily; p <; 0.05, χ2 test). We did a similar analysis, parsing the population into those who had attempted but failed to reduce their use of their mobile phone (17%) with those who had not (83%). Those who had attempted to reduce their mobile phone use had a higher texting rate (60 vs. 20 per day; p <; 0.01, Mann–Whitney U test) and stayed awake later than desired more often (53% vs. 11%, weekly or daily; p <; 0.01, χ2 test), but were not awakened more at night by the phone (12% vs. 5%, weekly or daily; p = 0.26, χ2 test).

Discussion

Given previous research on the topic, our a priori hypothesis was that teenagers who use their phone more often at night are likely to be more prone to daytime sleepiness. We did not, however, observe this simple relationship in this sample of U.S. teens. We did find that being female, perceived need to be accessible by mobile phone, and having tried but failed to reduce mobile phone usage were all predictive of daytime sleepiness, with the latter two likely being moderated by increased use of the phone at night. Previous work has shown that being female was associated with higher ESS scores [11]. It may be that adolescent females score higher on the ESS without being objectively sleepier, though this remains to be tested. Our analyses revealed that staying up late to use the mobile phone and being awakened by the mobile phone may be involved in the relationship between increased ESS scores and perceived need to be accessible by mobile phone and a past attempt to decrease mobile phone use. These analyses reveal some of the complexity of assessing daytime sleepiness, which is undoubtedly multifactorial. If the sheer number of text messages being sent per day is directly associated daytime sleepiness, it is likely with a small effect size. Our work, of course, is not without its limitations. Data were collected from a sample of convenience at a single, public high school in California. Only 10% of students responded to the survey and this may have introduced some response bias to the data. The data collected were cross-sectional; a longitudinal collection would have enabled a more precise analysis of moderators and mediators as well as a more accurate interpretation of causal relationships. Also, we did not objectively record the number of texts, so there may be a certain degree of bias or uncertainty associated with self-report of number of texts and calls. Several variables that might influence sleepiness both directly and indirectly through mobile phone use (e.g., socioeconomic status, comorbid sleep disorders, medication use) were not assessed. Future studies on the impact of mobile phone use on sleep and sleepiness should take into account the multifactorial and temporal nature of these behaviors.

Conclusions

The endemic sleepiness found in adolescents is multifactorial with both intrinsic and extrinsic factors. Mobile phone use has been assumed to be one source of increased daytime sleepiness in adolescents. Our analyses revealed that use or perceived need of use of the mobile phone during normal sleeping hours may contribute to daytime sleepiness. As overall number of text messages did not significantly contribute to daytime sleepiness, it is possible that a temporal rearrangement of phone use (e.g., limiting phone use during prescribed sleeping hours) might help in alleviating some degree of daytime sleepiness.

Abbreviations

ESS: Epworth sleepiness scale; SD: Standard deviation; ANOVA: Analysis of variance.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

JMZ and NN designed the study, analyzed the data, and drafted the manuscript. Both authors have read and approved the final manuscript.

Acknowledgements

The authors wish to thank the students of Mountain View High School (Mountain View, California) for participating in this study.

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Articles from BMC Public Health are provided here courtesy of BioMed Central

Introduction and background

Wireless communication has emerged as one of the fastest diffusing mediums on the planet,fueling an emergent “mobile youth culture” that speaks as much with thumbs as it does with tongues. At one of our focus groups a teen boy gushed, “I have unlimited texts . . . which is like the greatest invention of mankind.” His enthusiasm was hardly unique. Cell phone use and, in particular, the rise of texting has become a central part of teens’ lives. They are using their phones to stay in touch with friends and parents. They are using them to share stories and photos. They are using them to entertain themselves when they are bored. They are using them to micro-coordinate their schedules and face-to-face gatherings. And some are using their phones to go online to browse, to participate in social networks, and check their emails. This is the sunny side of the story. Teens are also using mobile phones to cheat on tests and to skirt rules at school and with their parents. Some are using their phones to send sexts, others are sleeping with buzzing phones under their pillows, and some are using their phones to place calls and text while driving.

While a small number of children get a cell phone in elementary school, the real tipping point for ownership is in middle school. About six in ten (66%) of all children in our sample had a cell phone before they turned 14. Slightly less than 75% of all high school students had a cell phone.

This report particularly highlights the rapid rise of text messaging in recent months. Some 72% of all US teens are now text message users, up from 51% in 2006. Among them, the typical texter sends and receives 50 texts a day, or 1500 per month. By way of comparison a Korean, Danish or a Norwegian teen might send 15 – 20 a day and receives as many. Changes in subscription packages have encouraged widespread texting among US teens and has made them into world class texters. As a result, teens in America have integrated texting into their everyday routines. It is a way to keep in touch with peers even while they are engaged in other social activities. Often this is done discreetly and with little fuss. In other cases, it interrupts in-person encounters or can cause dangerous situations.

To understand the role that cell phones play in teens’ lives, the Pew Research Center’s Internet & American Life Project and Michigan’s Department of Communication Studies conducted a survey and focus groups in the latter part of 2009. The phone survey was conducted on landline and cell phones and included 800 youth ages 12-17 and one of their parents. It was administered from June 26-September 24, 2009. The overall survey has a margin of error of 4 percentage points; the portion dealing with teen cell owners involved 625 teens in the sample and has a margin of error of 4 percentage points; the portion dealing with teen texters involved 552 teens in the sample and has a margin of error of 5 percentage points.

A brief history of the mobile phone as a technology

The idea for cellular telephony originated in the US. The first cellular call and the first call from a hand held cellular device also were placed in the US.

The cell phone merges the landline telephony system with wireless communication. The landline telephone was first patented in 1876. Mobile radio systems have been used since the early 1900’s in the form of ship to shore radio, and were installed in some police cars in Detroit starting in 1921. The blending of landline telephone and radio communication came after the Second World War. The first commercially available “mobile radiophone service” that allowed calls from fixed to mobile telephones was offered in St. Louis in 1946. By 1964 there were 1.5 million mobile phone users in the US. This was a non-cellular system that made relatively inefficient use of the radio bandwidth. In addition, the telephones were large, energy intensive car-mounted devices. According to communications scholar Thomas Farley, the headlights of a car would noticeably dim when the user was transmitting a call.

In the drive to produce a more efficient mobile telephone system, researchers W. Rae Young and Douglas Ring of Bell Labs developed the idea of cellular telephony, in which geographical areas are divided into a mesh of cells, each with its own cell tower. This allowed a far more efficient use of the radio spectrum and the “cell” phones needed less power to send and receive a signal. The first installation was in 1969 on the Amtrak Metroliner that traveled between New York City and Washington. Four years later Martin Cooper of Motorola made the first cellular call from a prototype handheld cell phone.

Regulation around mobile phones

After the inauguration of mobile phone service in the US, a regulatory environment that allowed multiple mobile-calling standards stifled mobile communication development and expansion in the US for several years. Indeed, the growth of the GSM standard in Europe and the rise of DoCoMo in Japan meant that the dramatic developments in the cell phone industry were taking place abroad. In the US, small license areas for mobile phone companies meant that users were constantly roaming outside their core area. A user in Denver would have to pay roaming charges if he or she made or received a call in Ft. Collins, Colorado Springs or Vail. To the degree that texting was available, users could only text to users in their home network.

In the late 1980’s industry consolidation eliminated the small local areas and by the turn of the millennium, interoperability between operators became standard, and the cost of calling plans and the price of handsets fell. Rather than being a yuppie accessory, the cell phone became widely-used by everyone from the captains of industry and finance to the people who shined their shoes and walked their dogs.

As cell phones have become more available, they are increasingly owned and used by children and teens. Further, as handsets become more loaded with capabilities ranging from video recording and sharing, to music playing and internet access, teens and young adults have an ever-increasing repertoire of use. Indeed, we are moving into an era when mobile devices are not just for talking and texting, but can also access the internet and all it has to offer. This connectivity with others and with content has directed the regulator’s lens onto mobile safety practices. It has also prompted the beginning of a cultural conversation about how to ensure that parents have the tools to regulate their child’s mobile use, should they choose to. Understanding how youth use mobile phones is vital to creating effective policy based on the reality of how the technology is used. It is also important to understand how telecommunications company policies and pricing affect how teens and parents use their phones.

Previous research on cell phones and teens

This report tries to expand a tradition of cell phone research that extends into the early 1990s, and work on landline telephony as far back as the 1970s. The first studies to examine the social consequences of the mobile phone came in the early 1990s when researchers examined its impact on residential markets. One of the earliest papers on cell phones examined it through the lens of gender; in 1993, Lana Rakow and Vija Navarro wrote about the cell phone and what they called “remote mothering.” Starting in the mid 1990s in Europe there was the beginning of more extended scholarship on cellular communication, and by 2000 work was being done in the US that evolved from a small number of articles to edited books and eventually to both popular and more scholarly books on mobile communication.

Several themes have been central in these analyses. One is the use of cell phones in the “micro-coordination” of daily interaction. As the name implies, this line of research examines how the cell phone allows for a more nuanced form of coordination. Instead of having to agree on a time and place beforehand, individuals can negotiate the location and the timing of meetings as a situation clarifies itself. Micro-coordination can be used to organize get-togethers and it can be used to sort out the logistics of daily life (e.g. sending reminders to one another or exchanging information on the fly). Extending this concept further, the cell phone can be used to coordinate so called “flash mobs” as well as different kinds of protests.

While micro-coordination describes an instrumental type of interaction, another line of research has examined how the cell phone can be used for expressive interaction. Since the device provides us direct access to one another, it allows us to maintain ongoing interaction with family and friends. This, in turn provides the basis for the enhancement of social cohesion. In this vein, some researchers have examined how the cell phone affects our sense of safety and security. The cell phone can be used to summon help when accidents have happened and they can be seen as a type of insurance in case something bad occurs. Others have examined how teens, as well as others, see the mobile phone as a form of self-expression. Having a cell phone is a status symbol and having a particularly sought after model can enhance our standing among peers.

Finally, focusing directly on teens, there has been considerable research on the role of the cell phone as part of the emancipation process. Up to this point, however, there has been little quantitative analysis of teens in the US on this topic. Indeed this is one of the main questions considered in this report. Before the cell phone, there were often discussions in the home as to whether a teen could have a landline extension in her room. Teens’ push to have their own landline phone underscored their drive to control contact with their peers. The rise of the cell phone has changed the dimensions of this discussion. The cell phone has provided teens with their own communication channel. This access can be used to plan and to organize daily life and it can be used to exchange jokes and endearments. It can also be used to plan mischief of varying caliber, and it can be used to exchange photos that are – literally – the picture of innocence or of depravity.

The organization of the report

This report is the fruit of a collaboration between the University of Michigan and the Pew Research Center’s Internet & American Life Project in an attempt to broadly capture the current state of mobile phone ownership and use among American youth and their families today. From June through September 2009, the Pew Internet Project fielded a random digit-dial telephone survey among a nationally representative sample of 800 teens ages 12-17 and one of their parents or a guardian (the teen and their parent/guardian were interviewed independently). In addition to the telephone survey, the University of Michigan fielded 9 focus groups among teens ages 12-18 in four cities in June and October of 2009. The focus groups queried teens more deeply about attitudes toward and practices around their mobile phone.

The study has been guided by a desire to measure the state of affairs around mobile phones and youth in the US – how many, how much, how often, with whom? – and to better understand how mobile phones fit into and enhance (or detract from) friendships and family relationships.

The report is organized into five chapters. The first chapter covers many of the basic measurements around mobile phones, the demographic variations around their use, and different models of phone ownership. This chapter also explores the economics of teens’ phone use, including payments, and calling and texting plan structures.

The second chapter of the report looks in depth at text messaging and voice calling, and compares the two modes of communication. It then places both of those activities in the broader context of teens’ overall communications practices as well as in the context of all the activities that teens can and do engage in on their mobile phone handsets, such as listening to music, sending email, looking up websites online and taking and sharing photos and videos.

The third chapter examines parents’ and teens’ attitudes towards their cell phones, and the ways the devices enhance and disrupt their lives. It details how families and teens feel about safety and the phone, and the ways in which the phone has become a social and entertainment hub. This chapter also explores how the phone has become an electronic tether between parents and children, and teens and friends, one so potent that teens frequently sleep with their phone under their pillows.

Chapter four examines the ways in which parents and schools regulate and monitor teens’ mobile phone use and how those actions may relate to teen cell phone-related behaviors.

The fifth chapter looks at teens, cell phones and “adverse behaviors.” It recaps some of our previous research on sexting and distracted driving, and presents new research on harassment through the mobile phone, as well as teens’ experiences with spam and the sending of regrettable text messages.

The last section of the report details the full set of methods that we used to conduct the research that undergirds this report.

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