The Effect of Cell Phone Use in Adolescents on Sleep Qualıty: Central Anatolia Case

Abstract

Purpose: Poor sleep quality is closely related to lifestyle habits including the use of cell phones. This study is a cross-sectional study conducted to investigate the effects of characteristics of cell phone use in adolescent university students on sleep quality Methods: The study was conducted with randomly selected 1040 students who continue their undergraduate education at a state university. The data were collected using a survey designed by the researchers drawing on the literature and Pittsburgh Sleep Quality Index (PSQI). The data were analyzed through t test, variance analysis and multiple regression model. p<0.05 was set to define statistical significance. Results: Average duration of cell phone use was 6.6±2.4 years, and almost all the students in the study stated that they use their phones to keep in contact with their family and friends. The score students received from the PSQI was 7.52 ± 3.21 (Min: 0 - Max: 17), and 70.9% of the students had poor sleep quality. Multiple regression model showed the strongest correlates Sleep quality and between duration of talking on the cell phone at a time, talking on the phone while charging and the place where the cell phone. This model explained 7% of the variance in sleepy quality. Conclusions: The results of the study revealed that sleep quality of three fourth of the students is poor and characteristics of cell phone use has a negative effect on sleep quality. As these findings suggest, awareness of students must be raised with regard to over-use of cell phones so that possible negative effects can be minimized, and students must be encouraged to take part in educational, cultural, and sports activities, but this needs to be examined further.

Headnote

Abstract

Purpose: Poor sleep quality is closely related to lifestyle habits including the use of cell phones. This study is a cross-sectional study conducted to investigate the effects of characteristics of cell phone use in adolescent university students on sleep quality

Methods: The study was conducted with randomly selected 1040 students who continue their undergraduate education at a state university. The data were collected using a survey designed by the researchers drawing on the literature and Pittsburgh Sleep Quality Index (PSQI). The data were analyzed through t test, variance analysis and multiple regression model. p<0.05 was set to define statistical significance.

Results: Average duration of cell phone use was 6.6±2.4 years, and almost all the students in the study stated that they use their phones to keep in contact with their family and friends. The score students received from the PSQI was 7.52 ± 3.21 (Min: 0 - Max: 17), and 70.9% of the students had poor sleep quality. Multiple regression model showed the strongest correlates Sleep quality and between duration of talking on the cell phone at a time, talking on the phone while charging and the place where the cell phone. This model explained 7% of the variance in sleepy quality.

Conclusions: The results of the study revealed that sleep quality of three fourth of the students is poor and characteristics of cell phone use has a negative effect on sleep quality. As these findings suggest, awareness of students must be raised with regard to over-use of cell phones so that possible negative effects can be minimized, and students must be encouraged to take part in educational, cultural, and sports activities, but this needs to be examined further.

Key words: Sleep quality; Cell-Phone; Students, Adolescent Health, Multiple Regresyon

Introduction

Sleep is one of the fundamental requirements to meet the biological, psychological, social, and cultural needs of a person. Sleep is an important part of healthy life, and it is directly related with health and quality of life (Owens, 2014). Regular sleep duration and sleep quality enhance the physical and emotional well-being of the individual. Studies have revealed that insufficient and poor quality sleep affects cognitive functions, general health condition and well-being negatively (Munezawa, Kaneita et al., 2011). In adolescence, daily sleep requirement is between 8.5 and 9.3 hours, while it is higher in adults. During adolescence, when physical growth accelerates, sleep is the fundamental factor in improving physical and academic performance (Owens, 2014; Ergun, Duran, Gultekin & Yanar, 2017). Despite the increasing need for sleep, daily sleep duration decreases due to the factors specific to this period, which brings problems with it. Sleeping late at night and getting up late are sleep characteristics of this period. It has been noted in many recent studies that widespread use of cell phones has played an important role in the emergence of sleep related problems in adolescents (Munezawa, Kaneita et al., 2011; Tao, Wu et al., 2017; Li, Lepp & Barkley 2015; Durusoy, Hassoy et al., 2017; Leena, Tomi, Arja, 2005). Cell phones, which are the product of developing technology, have become a part of our everyday lives. The use of cell phones has gradually increased among students as they facilitate communication; they are portable, and they offer the opportunity to use the Internet and take photos (Kuyucu, 2017). Previously conducted studies revealed that thanks to these characteristics, 74.8% - 84.0% of adolescents in our country and in the world have been using cell phones (Munezawa, Kaneita et al., 2011; Tao, Wu et al., 2017; Li, Lepp & Barkley, 2015; Massimini & Peterson, 2009). Cell phones lead to health problems as well as facilitating communication and life. Cell phones, which are extremely useful and convenient when used correctly and appropriately, can have serious physiological and psychological negative effects when used unconsciously and excessively. Exposure to radio-frequency electromagnetic frequencies (EMF) has caused public and scientific discussions because of the negative effects of these frequencies on human health both during signal reception and transmission. Many studies have shown that cell phone overuse leads to lack of concentration, weakness, fatigue, increase in blood pressure, headache, eye problems and sleep disorders (Tao, Wu et al., 2017; Li, Lepp & Barkley, 2015; Kuyucu, 2017; White, Buboltz & Igou, 2010; Santini, Seigne et al.,2002). The current study was conducted to investigate the effects of cell phone use on the sleep quality of university students in a rural area in Central Anatolia.

Methods

Participants: The research population is composed of the undergraduate students who were studying at Vocational School of Health, Faculty of Engineering, Faculty of Economy, and Faculty of Arts and Science in a university. The sample of the study, on the other hand, is comprised of 1040 students who were selected through randomly sampling and who gave their consent to participate in the study.

Measures: The data were collected using information from and the Pittsburgh Sleep Quality Index (PSQI).

Information From: The survey is composed of a total of 14 questions which were developed drawing on the literature (Munezawa, Kaneita et al., 2011; Santini, Seigne et al., 2002; Thomee, Harenstam & Hagberg, 2011; Saygılı, Çil Akıncı et al., 2011; Sahin, Ozdemir et al., 2013; Söderqvist, Carlberg, Hardell, 2013). Four questions aimed to collect socio-demographic information from the students, while ten questions were designed to identify the over-use of mobile cell-phone of students.

Pittsburgh Sleep Quality Index (PSQI): The index, which was developed by Buysse et al. (1989), has been used to determine the sleep quality of the students (Buysse, Reynolds & Monk 1989). PSQI is a self report scale consisting of 19 questions, which evaluate the sleep quality and sleep disorder in the past one month. It involves 24 questions, 19 of which are self-report questions and 5 of which are the questions to be answered by the spouse or roommate. 18 questions in the scale are scored. These questions are grouped under seven components, which are Subjective Sleep Quality, Sleep Latency, Sleep Duration, Habitual Sleep Efficiency, Sleep Disturbances, Use of Sleeping Medication, and Daytime Dysfunction. Each component is scored out of 0 to 3. The total score of the seven components gives the total score, which changes between 0 and 21. Sleep quality is evaluated as "good" if the total score is 5 and below. The Turkish reliability and validity study of the scale was conducted by Agargun et al., and internal consistency coefficient of the scale was found to be 0.80 (Agargun, Kara & Anlar,1996). The scale achieved a Cronbach's alpha of 0.83.

Data Analysis: The distribution of the data was evaluated by using skew analyses. Most data were normally distributed. Percentage distributions, t test and variance analysis (in independent groups), and multiple regression analysis were used in data analysis. p<0.05 was set to indicate statistical significance. In order to determine the extent to which the Pittsburgh Sleep Quality Index scores were affected, the effect of three variables which were found to be related to sleep quality and cell phone over-use of the students was evaluated through multiple regression analysis. Sleep quality as the dependent variable was analyzed by modeling it with the predictor variables, which are duration of talking on the phone at a time, talking on the phone while it is charging, and the place where the cell phone is kept while sleeping. The linear relationship between variables was evaluated by using collinearity statistics and there was perfect linear relationship between variables of the model. For all analyses, a p value 0.05 was used as the limit of statistical significance.

Ethical Approach: Before conducting the study, written permission was received from Bozok University, Faculty of Medicine, Clinical Research Ethics Committee and Bozok University Presidency, and written consent was obtained from the participants.

Results

This section summarizes the cell phone use of the students and the factors influencing sleep quality. Average age of the students who participated in the study was 21.1+1.8. 52.8% of the participants were male, and 38.8% of them were freshman students. All the students in the study had a cell phone. As far as the aims of students to use cell phones are concerned, it was found that all the students use their cell phones to communicate, while 57.45% use it to listen to music, 48.0% to take photographs, 41.4% to use the Internet, and 29.8% to watch videos. No relationship was found between the age and grade of the students, years of using a cell phone, and sleep quality. Average duration of cell phone use was 6.6±2.4 years, and 46.0% of the students talk on the cell phone 21 minutes or more at a time; 6.1% often talk on the cell phone while it is charging; 77.2% mainly talk on the phone at night; and 67.2% put their cell phone near the bed or under the pillow while sleeping. Only 12.4% of the students stated that cell phones may have a negative impact on health (Table 1).

It was revealed that the students who participated in the study received a score of 7.52±3.21 (Min:0-Max:17) from the Pittsburgh Sleep Quality Index and that 70.9% of the students have poor sleep quality (Table 2).

It was found that students who talk on the cell phone 21 minutes or more at a time have significantly higher total sleep quality index scores in habitual sleep efficiency (p=0.042), daytime dysfunction (p<0.001), and total sleep quality index scores (p=0.013). It was revealed that sleep latency scores of the students who answer the phone directly holding it close to their ears are high and statistically significant (p=0.013). Sleep latency (p=0.005), habitual sleep efficiency (p=0.002), sleep disturbance (p<0.001), use of sleeping medication (p=0.015), daytime dysfunction (p=0.002), and total sleep quality index scores (p=0.007) of the students who use their cell phone while it is charging were found to be significantly higher. Subjective sleep quality (p=0.007), sleep latency (p=0.001), habitual sleep efficiency (p=0.008), sleep disturbance (p<0.001), daytime dysfunction (p=0.015) and total sleep quality index (p<0.001) scores of the students who generally put their cell phone near the bed or under the pillow while sleeping were found to be significantly higher (Table 3).

Multiple regression was conducted to examine the contribution of significant duration of talking on the cell phone at a time, talking on the phone while charging and the place where the cell phone is kept while sleeping . The model was significant and explained 7% of the variance in sleep quality (Table 4). In this model, factors that remained strongly associated with sleep quality were high outcome and efficacy. The linear relationship between variables in each model was evaluated by using the collinearity statistics. In these analyses, it is desired to have Variance Inflation Factor (VIF) to be lower than 10 and the tolerance value to be higher than 0.2. The VIF values for the model were; between 1.040 and 1.096. The tolerance values for the between 0.91 and 0.96. The B values for the model 0.88, .20 and 0.71; respectively (Table 4).

Discussion

This study focuses on the relationship between the sleep quality of the university students and of cell phone over-use. It revealed that sleep quality of the students is poor, and over-use of mobile cell-phone reduce sleep quality. Emerging health risks associated with cell phone use are related to high toxic emissions from cell phones and exposure to electromagnetic frequencies (EMF) (Velmurugan, 2016; Velmurugan, 2017). Cell phone ownership is increasing among adolescents. It was revealed that 74.3% of the adolescents in Turkey use cell phones (Turkey Profile of Adolescent Research, 2013). According to a study conducted in Japan, the rate of cell of use of adolescents varies between 74.8% and 84.0% (Munezawa, Kaneita et al., 2011). In the current study, all the adolescents who are defined as the EMF exposure risk group owned a mobile phone. In addition to keeping in contact with their families and friends, all the adolescents in the study used their cell phones to listen to music, take photographs, and use the Internet, respectively. Other studies in the literature also found that adolescents use their cell phones for the same purposes (Durusoy, Hassoy et al., 2017). The years of cell phone use was found to be 6.60±2.40 years, indicating that the participants started to use a cell phone at a very early age. Moreover, duration of daily cell phone use was found to be 76.67±73.79 minutes, which may pose health risks in the future as well. The studies in the literature argue that as the duration of cell phone use and talking time on the cell phone increase, people are overly exposed to EMF within radio-frequency range, which leads to depression, sadness, temper, headache, anxiety, forgetfulness, tinnitus, and decrease in sleep quality (Durusoy, Hassoy et al., 2017; Thomee, Harenstam & Hagberg, 2011; Velmurugan, 2017; Acharya, Acharya & Waghrey, 2013). In our study, when we asked the adolescents what effects they observed in themselves with the increase in cell phone use, more than half of them stated that they have experienced fatigue, while half of them said they have experienced such problems as headache, temper, forgetfulness and lack of attention. Aghav argues that these symptoms are detected due to the negative effects of electromagnetic frequencies which emerge as a result of the intensity of cell phone frequency (Aghav, 2014).

In their studies conducted on human subjects, Lowden et al. found that being exposed to EMF radiating from cell phones prior to and during sleep decreases REM (rapid eye movement) sleep (Lowden, Akerstedt & Ingie, 2011). Another study by Huber et al. revealed that exposure to EMF at night affects melatonin rhythm and brain activity, particularly the activity of the pineal gland, which leads to a change in cerebral blood flow and cerebral electrical activity, and consequently impairs sleep quality (Hubber, Treyer & Borbelly, 2002). The current study revealed that about 75 percent of the adolescents have poor sleep quality. In studies conducted with adolescents in various countries, developmental characteristics and uncontrolled use of cell phones have been shown to reduce sleep quality (Munezawa, Kaneita et al., 2011; Tao, Wu et al., 2017; Li, Lepp & Barkley 2015; Durusoy, Hassoy et al., 2017; Mohammadbeigi & Absari, 2016; Oz, Arslantaş, et al., 2015; Bruni, Sette, et al., 2015; Demirci, Akgonul & Akpinar, 2015).

The multiple regression model explained 7% of the variance that talking on the cell phone 21 minutes or more at a time, putting the cell phone near the bed or under the pillow while sleeping, and talking on the cell phone while it is charging are more influential as the main determinants of the decrease in sleep quality, respectively. In their studies, Mohammadbeigi et al. found that cell phone addiction reduces sleep quality 4.5 times more (Mohammadbeigi & Absari, 2016). Oz et al., (2015) revealed that putting the cell phone near the bed while sleeping reduces sleep quality. When the over-use of mobile cell-phone which affect sleep quality are concerned, Lowden and Huber found that talking on the phone for a long time at a time, putting the cell phone near the bed, and talking on the cell phone while it is charging mean that cell phone is held close to the head for a long time and thus, brain may be affected by the EMF (Lowden, Akerstedt & Ingie, 2011; Hubber, Treyer & Borbelly, 2002). Furthermore, it was maintained that holding the cell phone close to the same ear for more than 510 minutes poses some health risks. With the temperature increase in this part of the brain, structural changes may occur in the cells, which may lead to headache, temper, sleep deprivation, lack of attention, and structural changes in cells. Thus, it is advisable not to hold cell phone close to the same ear for more than 5-10 minutes. Furthermore, calling or talking on the cell phone while it is charging was found to be another factor affecting sleep quality negatively. Talking on the phone while it is charging means being exposed to both radio frequencies and EMF (Tao, Wu et al., 2017; Durusoy, Hassoy et al., 2017). The current study further revealed that students who mainly talk on the phone while it is charging have significantly higher sleep latency, habitual sleep efficiency, sleep disturbances, use of sleep medication, daytime dysfunction and total sleep quality index scores compared to those who do not.

The students who participated in the study stated that they mostly use their cell phone after 10 pm. It was further found that sleep latency scores of the students who used their cell phone mostly at night were higher compared to those who did not. Various studies reached similar results (Tao, Wu et al., 2017; Durusoy, Hassoy et al., 2017; Thomee, Harenstam & Hagberg, 2011; Oz, Arslantaş et al., 2015). Those who are engaged with their cell phones all night choose to sleep during the day, and thus, they exhibit symptoms like stress, anxiety, depression, fatigue, headache and temper more due to the disturbed balance between melatonin and serotonin [Tao, Wu et al., 2017; Bruni, Sette, et al., 2015; Demirci, Akgonul & Akpinar 2015).

This study has some limitations while revealing new findings. It is recommended that the number of participants be increased in future studies with a multi-center design involving culturaleconomic differences and different of cell phone over-use.

The current study revealed that the incorrect and excessive use of cell phones leads to headache, forgetfulness, fatigue and temper in adolescent university students by reducing sleep quality. If these symptoms in adolescents continue, they may lead to obesity and risk of chronic diseases like heart disease and diabetes at older age. Thus, preventive measures must be taken and education must be given to adolescents in order to ensure correct use of cell phones during the adolescence period.

Acknowledgments: All authors have no substantial direct or indirect commercial financial incentive associated with publishing the article, and that the manuscript or portions thereof are not under consideration by another journal and have not been previously published. They are deeply grateful to participants for their cooperation.

References

References

Acharya, J.P, Acharya, I, Waghrey, D. (2013). A study on some of the common health effects of cell-phones amongst college students. J Commun Health Educ, 3(4), 1-4.

Aghav, S.D. (2014). Study of radiation exposure due to mobile towers and mobile phones. Indian Streams Res J, 3(12), 1-6.

Agargun, M.Y, Kara, H, Anlar, O. (1996). The validity and reliability of the Pittsburgh sleep quality index. Turk Psychiatry Journal , 7, 107-11.

Bruni O, Sette S, Fontanesi L, Baiocco R, Laghi F, Baumgartner E> (2015) Technology use and sleep quality in preadolescence and adolescence. Journal of clinical sleep medicine: 11(12): 1433-1441.

Buysse, D.J, Reynolds, C.F, Monk, T.H. (1989). The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res, 28, 193-213.

Demirci K, Akgonul M, Akpinar A. Relationship of smartphone use severity with sleep quality, depression, and anxiety in university students. Journal of Behavioral Addictions, 2015, 4(2): 8592.

Durusoy, R, Hassoy, H, Ozkurt, A, Karaaba AO. (2017). Mobile phone use, school electromagnetic field levels and related symptoms: a crosssectional survey among 2150 high school students in İzmir. Environmental Health, 16(1), 51-65.

Ergun, S, Duran, S, Gultekin, M, Yanar, S. (2017). Evaluation of the factors which affect the sleep habit and quality of health college students. TJFMPC,11(3),186-193.

Hubber, R, Treyer, V, Borbelly, A.A. (2002). Electromagnetic fields such as those from mobile phones alter regional cerebral blood flow and sleep & waking EEG. J Sleep Res, 11, 289-295.

Kuyucu, M. (2017). Use of smart phone and problematic of smart phone addiction ın young people: "smart phone (colic)" university youth. Global Media Journal TR Edition, 7(14), 328-359.

Leena, K, Tomi, L, Arja, R.R. (2005). Intensity of mobile phone use and health compromising behaviours-how is information and communication technology connected to health-related lifestyle in adolescent? J Adolescent, 28, 35-47.

Li, J, Lepp, A, Barkley, J.E. (2015). Locus of control and cell phone use: Implications for sleep quality, academic performance, and subjective well-being. Computers in Human Behavior, 52, 450-457.

Lowden, A, Akerstedt, T, Ingie, M. (2011). Sleep after MP exposure in subjects with MP related symptoms M. Bioelctromagnatics, 32(1), 4-14.

Massimini, M, Peterson, M. (2009). Information and communication technology:Affects on U.S. college students. Cyberpsychology:Research on Cyberspadce, 3(1),1-15.

Mohammadbeigi, A, Absari, R, Valizadeh, F, Saadati M, Sharifimoghadam S, Ahmadi A, Mokhtari M, Ansari H. (2016). Sleep quality in medical students; the impact of over-use of mobile cellphone and social networks. J Res Health Sci, 16(1), 46-50.

Munezawa, T, Kaneita, Y, Osaki, Y, Kanda H, Minowa M, Suzuki K, Higuchi S, Mori J, Yamamoto R, Ohida T. (2011). The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescent: A Nationwide cross-sectional survey. Sleep, 34(8), 1013-1020.

Owens, J. (2014). Adolescent sleep working group, and committee on adolescence. insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics,134(3),921932.

Oz F, Arslantaş D, Buğrul N, Koyuncu T, Unsal A. (2015). Evaluation of problematic use of mobile phones and quality of sleep among high school students. Journal of Human Sciences;12(1):226235.

Santini, R, Seigne, M, Bonhomme-Faivre, L, Bouffet S, Defrasne E, Sage M._ (2002). Symptoms experienced by users of digital cellular phones: a study of a french engineering school. Electromagnetic Biology and Medicine, 21, 81-88.

Saygili, S, Cil, Akiınci, A, Arikan, H, (2011). Sleeping quality and fatigue among university students. Electronic Journal of Vocational Colleges, 88-94.

Sahin, S, Ozdemir, K, Unsal, A, Temiz N. . (2013). Evaluation of mobile phone addiction level and sleep quality in university students. Pak J Med Sci. 29(4):913-8. PMCID:

Soderqvist, F, Carlberg, M, Hardell, L. (2008). Use of wireless telephones and selfreported health symptoms: a population-based study among Swedish adolescents aged 15-19 years. Environ Health, 7, 18-28.

Tao, S, Wu, X, Zhang, Y, Zhang, S, Tong S, Tao F. (2017). Effects of sleep quality on the association between problematic mobile phone use and mental health symptoms in Chinese college students. International Journal of Environmental Research And Public Health, 14(2), 185-195.

Thomee, S, Harenstam, A, Hagberg, M. (2011). Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adultsa a cohort study. BMC Public Health, 11(66), 2-11.

Turkey Profile of Adolescent Research (2013). Ankara, T.C. Ministry of Family and Social Policies Publications of Family and Community Services, 2013.

Velmurugan, M.S. (2017). Sustainable perspectives on energy consumption, EMRF, environment, health and accident risks associated with the use of mobile phones. Renewable and Sustainable Energy Reviews, 67, 192-206.

Velmurugan, M.S. (2016). Environmental and health aspects of mobile phone production and use: Suggestions for innovation and policy. Environmental Innovation and Societal Transitions, 21, 69-79.

White, A, Buboltz, W, Igou, F. (2010). Mobile phone use and sleep quality and Length in college students. International Journal of Humanities and Social Science, 1(18), 51-58.