Original Article

Nomophobia and Health Hazards: Smartphone Use and Addiction Among

University Students

Abstract Azra Daei,

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Background: Nomophobia, a state of socio‑psychological illness, refers to a fear of lack of access Hasan Ashrafi‑rizi1,
to mobile phone, which is thought to be a modern age disorder that causes negative health risks Mohammad Reza
and harmful psychological effects. This study aimed to determine the relationship between the
smartphone use and nomophobia disorder among university students. Methods: The study utilized Soleymani1
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a cross‑sectional method in which 320 students were selected via cluster sampling. Data collection Department of Medical Library
tools included a nomophobia and smartphones use questionnaires. Data were analyzed using SPSS and Information Sciences,
School of Management and
22 software in two sections: descriptive statistics and inferential statistics. Results: The incidence Medical Information Sciences,
rate of nomophobia among the students was moderate (3.1), and 73% of the students were moderate Isfahan University of Medical
smartphone users. Nomophobia had a significant relationship with gender, age group, and level of Sciences, Isfahan, Iran, 1Health
education; and the frequency of using smartphones had a significant relationship with age group Information Technology
and level of education. There was a positive correlation coefficient between nomophobia and the Research Center, Isfahan
frequency of using smartphones. The mobile phone use predicted nomophobia with a beta coefficient University of Medical Sciences,
of 0.402 (P < 0.05). Conclusions: Given the incidence rate of nomophobia disorder was moderate, Isfahan, Iran
it is necessary to make preventive decisions and plan educational programs in this regard for the
health of university students. Alternative actions are recommended for the treatment in low rate of
nomophobia, but drug therapy should be used in more advanced stages; therefore, it is suggested that
more attention to be paid to students’ free time and entertainments.

Keywords: Addiction, Iran, nomophobia, smartphone, students

Introduction researchers investigated multiple problems

due to using mobile phones (UMPs)
Mobile phones have undoubtedly made
including overuse of mobile phones and
one of the biggest changes in the field of
nomophobia.[4,8‑11] Nomophobia is defined
personal communications in the present
as a fear of lack of access to one’s mobile
era.[1‑4] Despite the advantages of new
phone, and is thought to be a disorder in
technologies in our lives, using these
the modern age.[5,7,12‑14] This term also refers
technologies may put one at the risk of
to mobile phone dependency or mobile
adverse effects such as excessive use of
phone addiction.[12] Nomophobia, a state of
mobile phones[5,6]; therefore, seemingly
socio‑psychological illness,[15] includes two
some people become so dependent on
phrases: “no mobile” and “phobia.” In their
their mobile phones which is the sign
study, King et al. considered nomophobia as
of behavioral addiction[5] and it can lead
a 21st‑century disorder resulting from new Address for correspondence:
to isolation and feeling of loneliness, Dr. Mohammad Reza Soleymani,
technologies. They defined nomophobia as
decreased interpersonal relationships, and Health Information Technology
a discomfort or anxiety when being out of Research Center, Isfahan
social interactions in them.[1,3] According to
mobile phone or computer contact.[16] Han University of Medical Sciences,
a survey conducted in the United Kingdom
et al. described nomophobia as anxiety due Isfahan, Iran.
in 2012, 66% of people were afraid of E‑mail: [email protected].
to separation from one’s smartphone.[17]
missing their mobile phones and being ac.ir
Recently, nomophobia has attracted some
without them. Studies in the United States
researchers’ attention in the field of mobile
showed that the fear of 66% of adults is
phones.[4,5,12,13,16,18‑28] Access this article online
recognized as nomophobia.[7]
According to reported documents, Website:
After the expanding use of information www.ijpvmjournal.net/www.ijpm.ir
smartphones are very popular among
and communications technologies (ICT), DOI:
young people, and students are 10.4103/ijpvm.IJPVM_184_19
considered pioneers in using them,[29] Quick Response Code:
This is an open access journal, and articles are and smartphones determine the way the
distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work How to cite this article: Daei A, Ashrafi‑rizi H,
non‑commercially, as long as appropriate credit is given and Soleymani MR. Nomophobia and health hazards:
the new creations are licensed under the identical terms. Smartphone use and addiction among university
For reprints contact: [email protected] students. Int J Prev Med 2019;10:202.

© 2019 International Journal of Preventive Medicine | Published by Wolters Kluwer - Medknow 1

 Daei, et al.: Nomophobia and health hazards

young generation and students communicate. The lives of this end, a questionnaire for measuring the frequency
many students have changed under the influence of this of UMPs, derived from a study by King et al.,[19] was
phenomenon[26] because of its negative health risks and used (the developers of this questionnaire are from among
harmful psychological effects. Students as an important those active in nomophobia and mobile phone addiction).
and vulnerable population in the society, on the one hand, After being translated into Persian, the validity of
and as an active and dynamic population, on the other this questionnaire was re‑examined by 4 specialists in
hand, need special attention. In addition, given a limited psychology and information science. The reliability of this
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number of studies have so far been conducted on students questionnaire was measured by 30 individuals who had
with regard to nomophobia in Iran, it seems essential to not participated in the main study. The total Cronbach’s
conduct studies for measuring the intensity of nomophobia alpha coefficient for this tool was 0.83, which showed
to plan and take appropriate measures inside the country the appropriate validity of the questionnaire. Finally,
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by taking into account the expansion of ICTs, especially 20 questions were determined to measure the frequency of
among the young population and students as the pioneers UMPs, which are scored based on No or Yes scale from
of using smartphones. Accordingly, the aim of this study 0 to1. The total score is calculated by summing up the
is to investigate the relationship between the frequency of answers given to the questions, and it shows “low” UMPs
UMPs and nomophobia disorder among students at Isfahan for scores from 0 to 7, “moderate” for scores 7.01 to 14,
University of Medical Sciences. and “high” for scores 14.01 to 20.
Methods The inclusion criteria for the study were having a mobile
phone and willingness to participate in the study. The
The present survey was conducted by using a
exclusion criterion was lack of time to participate in the study
cross‑sectional study. The population in this study consisted
or non‑use of mobile phones. The respondents were free to
of all students in Isfahan University of Medical Sciences in
participate in the study and verbal consent was obtained. Also,
2017, out of whom 384 students were selected as a sample
there was no need to enter their personal information in the
using the Krejcie‑Morgan table and a cluster sampling
questionnaire. Data were analyzed using SPSS 22 software,
method. The response rate was 83.3% (320 subjects). Data
descriptive statistics (the mean and standard deviation), and
collection tools included two questionnaires: a nomophobia
inferential statistics (a Pearson correlation test, a t‑test, and
questionnaire and a questionnaire for measuring the
an analysis of variance (ANOVA)).
frequency of UMPs. The former was derived from the
Nomophobia Questionnaire (NMP‑Q) developed by Results
Yildirim and Correia[23] in 2015, which was translated into
Persian by Sayyah et al., and whose psychometrics were Students participating in the study, based on their gender,
evaluated.[3] The questionnaire consists of four sub‑scales consisted of 188 women (59%) and 132 men (41%). 82.5%
and 20 items, which are scored based on a 5‑point Likert of the students were in the age group under 25 years. As for
scale from 1 “completely disagree” to 5 “completely the distribution of subjects based on their levels of education,
agree.” The total score is calculated by summing up the 49% were studying in an undergraduate program (the highest
answers given to the questions, and shows mild, moderate, percentage), and 11% were studying in a professional
and/or severe nomophobia. In the original questionnaire,[23] doctorate program or completing their residency (the lowest
the Cronbach’s alpha coefficients for the entire scale percentage). As for the rate of participation in the study,
and the said sub‑scales were calculated equal to 0.945, among the nine schools at Isfahan University of Medical
0.939, 0.874, 0.827, and 0.814, and in the Persianized Sciences, two highest participation rates belonged to the
questionnaire,[3] they were 0.81 for the entire questionnaire, School of Medicine with a participation rate of 31% and
and 0.81, 0.79, 0.82, and 0.83 for the rest of the factors, the School of Nursing with a participation rate of 18%,
indicating proper validity for conducting the study. and the lowest participation rate belonged to the School of
Modern Technologies with a participation rate of 1%.
For UMPs questionnaire, efforts were made to use a valid
and simple questionnaire on mobile phone uses,[16,19,20,30‑32] Table 1 shows the incidence rate of nomophobia among
which does not take much of participants’ time. To students. As can be seen, dimension IV is lower than

Table 1: Incidence rate of nomophobia among students at Isfahan University of Medical Sciences
Benchmark=3
Dimensions of Nomophobia Mean Standard deviation t P
Dimension I: Not being able to communicate 3.1 0.93 1.83 0.068
Dimension II: Losing connectedness 3.2 0.86 1.4 0.000
Dimension III: Not being able to access information 3.1 0.79 3.15 0.002
Dimension IV: Giving up convenience 2.85 0.86 −3.12 0.002
Nomophobia 3.1 0.72 1.79 0.074

2 International Journal of Preventive Medicine 2019, 10: 202

 Daei, et al.: Nomophobia and health hazards

the moderate level, and the rest of the dimensions are dimension “not being able to access information.”[24] A study
at a moderate level. Ultimately, the incidence rate of by Anshari et al. showed that 46% of participants suffered
nomophobia is generally at a moderate level. from some kind of nomophobia disorder[8] and another showed
Table 2 shows the frequency of UMPs among students that the prevalence of nomophobia was on the rise among
at Isfahan University of Medical Sciences. Most students students of medicine in India.[4] Some studies showed higher
were moderate mobile phone users. prevalence of nomophobia. The study conducted by Sharma
et al. on Indian medical students showed that nearly 75%
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Table 3 is allocated to the relationship between the incidence of the participating students had nomophobia disorder, and
rate of nomophobia and demographic variables. As can be 83% of them had experienced panic attacks when they were
seen, the results of the t‑test, correlation test, and ANOVA not able to access mobile phones.[34] In another study, Askari
showed that nomophobia had a significant relationship with stated that 73% of the subjects slept with their cellphones. He
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gender, age group, and level of education (P < 0.05), and also added that 53% of the subjects experienced anxiety when
that the frequency of UMPs had a significant relationship their phone battery was dead, their phone credit finished, or
with age group and level of education (P < 0.05), but no the mobile network was out of reach, and that 68% of the
significant relationships were found in other cases. subjects felt the vibration or ringtone of their phone before
Table 4 shows the correlation coefficient between receiving the call.[28]
nomophobia and the frequency of UMPs. As can be Our study showed that the frequency of UMPs was at a
seen, there is a positive correlation coefficient between moderate level, which is consistent with the findings of a
nomophobia and the frequency of UMPs (0.402). study by Koo and Park that showed 88.7% of the young
Based on the data in Table 5, the frequency of UMPs people were regular mobile phone users.[30] The study by
predicts the level of nomophobia with a beta coefficient of Singh, et al. indicated that 76% of the respondents checked
0.402 and at a significance level of 0.05. their mobile phones constantly and made greater use of
them.[4] In the present era, due to the rise of smartphones
Discussion with advanced technologies, similar to a computer,
The aim of this study was to determine the relationship multitasking support, and easy to communicate with
between the frequency of UMPs and nomophobia disorder others,[8] we are witnessing an increasing use of mobile
among students at Isfahan University of Medical Sciences. The phones in all individuals; and this tool has become an
incidence rate of nomophobia among students, in this study, important part of individuals’ everyday lives.[5]
is generally at a moderate level, which indicates an increase This study made it clear that there was a statistically
in the prevalence of nomophobia disorder among young significant relationship between nomophobia disorder
people. In confirmation of the findings of the present study, and gender, and that its prevalence was higher in men
a study by Pavithra et al. on medical students showed 39.5% than in women. It seems that men see mobile phones as
of the students had nomophobia, and 27% were at the risk of a very powerful technology that increases their level of
developing it.[33] Moreover, the results of the study by Yildirim independence. Men often accept mobile technologies sooner
et al. showed that 42.6% of the young people had nomophobia than women, and use all of their functions, whereas women
disorder, and that their greatest fear was connected with the
mostly use mobile phones for communication. The results of
this study are consistent with those of a study by Majidaei
Table 2: Frequency of UMPs et al.,[35] Emelin et al.,[32] Yaseminejad et al.,[31] and Yildirim
Frequency of use Number Percentage et al.[24] Psychological studies show that 70% of women and
Low (scores from 0-7) 63 19.7 61% of men are afraid of being without a mobile phone.[28]
Moderate (from 7.01-14) 235 73.4 Study of Arpaci et al. showed significant gender differences
High (from 14.01-20) 22 6.9 in nomophobia, where women scored significantly higher
Total 320 100 than men.[25] In contrast, studies by Zamani et al.,[36] Adawi

Table 3: Incidence rate of nomophobia and frequency of UMPs based on demographic variables
Variables Nomophobia The frequency of UMPs
Gender t Significance level t Significance level
−3.74 0.000 −0.154 0.878
Age Correlation coefficient Significance level Correlation coefficient Significance level
−0.286 0.000 −0.116 0.038
School (faculty) F Significance level F Significance level
1.291 0.247 1.565 0.135
Level of education F Significance level F Significance level
12.386 0.000 4.531 0.004

International Journal of Preventive Medicine 2019, 10: 202 3

 Daei, et al.: Nomophobia and health hazards

et al.,[2] and Pavithra et al.[33] showed no relationship study by Emelin et al. showed that the frequency of UMPs
between nomophobia disorder and gender. was not a predictor of mental dependence,[32] and that the
frequency of UMPs could not have a significant relationship
The present study showed that nomophobia and the
with mobile phone dependence.
frequency of UMPs had a statistically significant
relationship with age. Between inconsistent studies, Limitations
the study conducted by Yildirim et al.[24] and
One of the limitations of this study is that it is conducted
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Argumosa‑Villar et al.,[5] which showed that age did not

only on the students of one university. Therefore, caution is
have any effects on individuals’ nomophobic behaviors
needed in generalizing the findings to other individuals and
is noteworthy. Study carried out by Emelin et al. found
students. Other limitations were its cross‑sectional nature
a correlation between age and excessive use of mobile
and using a correlational method to show the relationship
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phones.[32] Farooqui and Gothankar believe that the age

between variables. Hence, it is necessary to conduct
which can be most affected by nomophobia is between
longitudinal studies to achieve greater clarity for the
20 and 24 years[7] because young people employ new
relationship shown between the variables. Psychological
technologies and tools faster than other people.[5,28] Using
variables, which can affect the frequency of UMPs and
smartphones has in some way become a dominant and
nomophobia, can be used in future studies.
defining feature and a symbol for the status of young
generation.[5] Hanley believes addiction to mobile Conclusions
technologies can turn into a widespread social problem
in the society.[28] Mobile phones have become a full‑time This study showed that the incidence rate of nomophobia and
tool that meets the basic needs of young people for the frequency of UMPs are at a moderate level among the
socialization through communication. This dependency students, and at the same time, they have a positive correlation
on tool prevents young people from following some basic with each other. It seems that this disorder is becoming
issues such as development and promotion of health.[28] prevalent among young people. Given this disorder plays a
decisive role in the health of individuals, it is necessary to
Findings showed no significant relationship between make preventive decisions and plan educational programs in
nomophobia and frequency of UMPs and the faculty this regard for university students, which could be done in the
variable and no certain study was found in relation to these form of workshops and holding some consultation sessions
findings. Seemingly, this disorder has affected all students on media literacy to discuss this topic. Alternative actions
from any academic discipline. This study showed that like sports and social programs are recommended for the
nomophobia and the frequency of UMPs had a statistically treatment in low rate of nomophobia, but drug therapy should
significant relationship with the level of education, which is be used in more advanced stages. Hence, it is suggested that
not consistent with the study conducted by Pavithra et al.[33] more attention to be paid to students’ free time, especially
This study found that there was a positive correlation should focus on the students living in dormitories because
coefficient between nomophobia and the frequency of UMPs, being away from their families and lack of recreational and
and that the frequency of UMPs predicted nomophobia; entertainment facilities can push them towards UMPs. It
therefore, higher frequency of UMPs increased the rate is also suggested that students use time management as a
of nomophobia. The study by Pavithra et al. showed that solution to reduce the risks of this disorder.
nomophobia scores were higher in students who used their
Declaration of patient consent
smartphones more than 3 h a day.[33] Adawi et al. showed
that nomophobia was connected with the number of hours The authors certify that they have obtained all appropriate
spent on mobile phones.[2] In contrast, the findings of the participant consent forms. In the form, the participants
have given their consent for their images and other clinical
information to be reported in the journal. The participants
Table 4: Correlation coefficient between nomophobia understand that their names and initials will not be
and frequency of UMPs published and due efforts will be made to conceal their
Frequency of UMPs identity, but anonymity cannot be guaranteed.
Nomophobia
Correlation coefficient 0.402 Acknowledgments
Significance level 0.000 We thank students of Isfahan University of Medical
Number 320 Sciences for their contributions.

Table 5: Beta coefficient in predicting nomophobia based on frequency of UMPs

Predictive variable Benchmark Non‑standard coefficients Standard coefficients t Significance
variable B Standard error Beta level
Frequency of UMPs Nomophobia 1.717 0.219 0.402 7.836 0.000

4 International Journal of Preventive Medicine 2019, 10: 202

 Daei, et al.: Nomophobia and health hazards

Financial support and sponsorship 18. Bragazzi NL, Del Puente G. A proposal for including nomophobia
in the new DSM‑V. Psychol Res Behav Manag 2014;7:155‑60.
Nil. 19. King AL, Valenca AM, Silva AC, Sancassiani F, Machado S,
Conflicts of interest Nardi AE. “Nomophobia”: impact of cell phone use interfering
with symptoms and emotions of individuals with panic disorder
There are no conflicts of interest. compared with a control group. Clin Pract Epidemiol Ment
Health 2014;10:28‑35.
Received: 22 May 19 Accepted: 17 Sep 19 20. King ALS, Valença AM, Silva ACO, Baczynski T, Carvalho MR,
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Published: 28 Nov 19 Nardi AE. Nomophobia: Dependency on virtual environments or

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