A cross-sectional investigation conducted among school-going adolescents in the coastal district of Karaikal, Puducherry, has revealed that more than one-quarter of surveyed students meet the screening criteria for smartphone addiction, with clear statistical links connecting excessive digital engagement to psychological morbidity and disrupted sleep schedules. The research, carried out between September 2025 and February 2026 across secondary school classes, documented an overall smartphone addiction prevalence of 28.5 percent alongside a 26.0 percent prevalence of psychological morbidity among 645 participating students. Using standardized screening instruments and multivariable logistic regression modeling, the investigative team demonstrated that prolonged bedtime screen exposure, elevated weekend handset utilization, and underlying psychological distress independently multiplied the odds of behavioral addiction, whereas securing at least six hours of nocturnal sleep provided a measurable protective buffer against compulsive usage patterns.

The study provides critical empirical insight into an under-researched demographic transition occurring across semi-urban and rural enclaves within the Union Territory of Puducherry in southern India. While digital technology penetration has expanded rapidly across India to encompass more than 700 million users nationwide, the scientific literature addressing behavioral dependence has historically focused on metropolitan centers and university undergraduate cohorts. In contrast, coastal districts like Karaikal present a distinct sociocultural setting where widespread access to affordable handheld devices and high-speed mobile networks has arrived far faster than community digital literacy initiatives or institutional parental mediation strategies. This rapid influx of personal connectivity into traditional community environments has substantially altered adolescent recreation, daily communication, and study habits, exposing middle and secondary school students to intensive digital environments during formative neurodevelopmental stages.

To capture an accurate epidemiological snapshot of this vulnerable demographic, the investigators implemented a multistage cluster sampling design across Karaikal’s eight administrative educational zones. The theoretical sample size requirement was determined a priori to be at least 629 participants, assuming an anticipated regional prevalence of 23 percent, an absolute precision margin of 5 percent, a 95 percent confidence interval, a design effect correction factor of two, and a anticipated 10 percent non-response rate. After randomly selecting one administrative educational cluster, the researchers drew three schools stratified by public and private institutional management from the official administrative master directory. Within the selected institutions, all students enrolled in the sixth through tenth grades were invited to take part, culminating in a fully consented study sample of 645 participants who secured both written student assent and formal parental authorization under Institutional Scientific and Ethics Committee protocol approval.

The enrolled adolescent cohort presented a mean chronological age of 12.6 years with a standard deviation of 1.2 years, displaying a demographic distribution that was 62 percent female, 59 percent resident in urban or semi-urban neighborhoods, and 62.8 percent enrolled in private academic institutions, while 64.3 percent lived in nuclear family households. Behavioral dependency was formally assessed using the ten-item Smartphone Addiction Scale Short Version, which rates habitual phone engagement on a six-point Likert continuum yielding aggregate scores between 10 and 60 points, applying gender-stratified cut-off thresholds of 31 points or higher for males and 33 points or higher for females. Concurrently, psychiatric symptoms and emotional distress were screened through the validated twelve-item General Health Questionnaire, allowing the investigative team to measure qualitative and quantitative distributions of psychological morbidity within standard statistical software packages using both bimodal and Likert evaluation formats.

Detailed examination of hardware possession and accessibility highlighted that direct personal ownership is not a necessary precondition for heavy daily utilization among adolescents. Although only 28.8 percent of surveyed students owned an individual mobile phone, fully 83.6 percent reported consistent daily access to handheld devices through family members or peers, leaving only 16.4 percent entirely without regular device access. Participants recorded a median device usage history of three years with an interquartile range of two to four years, alongside a median daily engagement of one hour. Usage was heavily concentrated during non-school hours, with 45.6 percent of students reporting peak device involvement during the evening and 45.7 percent engaging predominantly at night, compared to only 9.9 percent during morning hours. Furthermore, 51.6 percent engaged with screens immediately before sleeping, spending a median duration of 50 minutes in bed on their devices. Internet connectivity was overwhelmingly mobile, with 80.3 percent relying exclusively on mobile cellular data and consuming an average of 1.5 gigabytes daily at an average reported expenditure of 302 Indian rupees per day.

Adolescents cited diverse behavioral motivations for handling their devices, with recreational gaming emerging as the most frequent driver at 32.2 percent, closely followed by alleviation of boredom at 30.7 percent and academic learning pursuits at 26.2 percent. Interpersonal communication accounted for 16.7 percent of primary usage, while hedonic pleasure, emotional stress reduction, and unreflective habit accounted for 9.3 percent, 8.4 percent, and 6.0 percent, respectively. Application tracking mirrored these motivations: mobile gaming applications represented the most frequently opened category at 28.5 percent, followed by video platforms at 19.8 percent, educational tools at 18.4 percent, WhatsApp messaging at 16.4 percent, music applications at 14.9 percent, and photo-centric software at 11.9 percent. Crucially, participants recognized negative physical and cognitive repercussions stemming from screen habits, identifying a superficial approach to learning tasks and mental distraction each at 13.0 percent, ocular discomfort at 11.0 percent, academic disinterest at 6.7 percent, sleep disturbances at 6.5 percent, emotional mood modification at 4.8 percent, daytime somnolence at 4.2 percent, and social isolation and musculoskeletal aches each at 3.4 percent.

Initial univariate logistic regression testing uncovered several demographic, behavioral, and schedule-related variables that correlated significantly with elevated odds of addiction. Being enrolled in senior secondary grades, specifically the eighth standard or higher, and possessing personal ownership of a smartphone initially demonstrated notable statistical significance. Behavioral patterns including exceeding one hour of daily screen exposure, any routine smartphone engagement around bedtime, prolonged pre-sleep viewing lasting an hour or longer, and intensive weekend usage similarly showed strong raw associations with addiction risk. The unadjusted analyses also identified a clear positive relationship between psychological morbidity scores and behavioral addiction, whereas securing adequate nocturnal sleep of six or more hours per night emerged as a significant protective factor. Conversely, baseline variables including student chronological age, rural versus semi-urban residential locality, institutional school governance classification, and nuclear versus joint household structures showed no statistically significant univariate influence.

When the researchers incorporated all statistically significant factors into a multivariable logistic regression model to adjust for confounding interactions, the timing and context of screen exposure proved far more influential than nominal ownership or total daily duration. Adolescents who actively engaged with their smartphones for one hour or more directly before bedtime exhibited more than double the adjusted odds of smartphone addiction compared to those using devices for less than an hour prior to sleep, demonstrating an adjusted odds ratio of 2.233 with a 95 percent confidence interval of 1.325 to 3.761. Similarly, extending screen time to two hours or more during weekends nearly doubled the risk of smartphone addiction, yielding an adjusted odds ratio of 1.939 with a 95 percent confidence interval of 1.297 to 2.897. Conversely, sleeping at least six hours nightly remained an independent protective determinant, cutting the odds of addiction by more than half with an adjusted odds ratio of 0.456, while broader variables such as higher academic grade, personal device ownership, and total daily duration of one hour or more lost their independent predictive significance after full multivariable adjustment.

The multivariable regression confirmed a strong independent association between smartphone addiction and psychological morbidity, with affected students exhibiting an adjusted odds ratio of 1.829 within a 95 percent confidence interval of 1.223 to 2.736. This finding corroborates clinical hypotheses surrounding digital escapism, wherein adolescents facing academic pressures or psychosocial tension turn to virtual spaces as an avoidant coping strategy, only to experience intensified psychological distress through social comparison, cyber victimization, and chronic social displacement. Alongside this mental health link, the investigation identified an unexpected finding: regular participation in outdoor activities was independently associated with an elevated risk of smartphone addiction, displaying an adjusted odds ratio of 1.619 within a 95 percent confidence interval of 1.060 to 2.472. While prior adolescent literature typically characterizes physical activity as protective against behavioral dependencies, the authors noted that contemporary youth outdoor recreation in semi-urban India increasingly integrates mobile photography, live video streaming, social media check-ins, fitness tracking, and location-based gaming, thereby embedding digital connectivity directly into outdoor physical settings.

Interpreting these findings requires recognizing the structural parameters and methodological boundaries of the Karaikal survey. Because the study utilized an observational, cross-sectional design, the observed statistical associations cannot confirm temporal order or establish direct causal mechanisms between smartphone addiction, psychological morbidity, and recreational outdoor habits. Furthermore, data gathering relied on self-administered questionnaires, introducing the potential for recall inaccuracy and social desirability biases when adolescents reported their daily screen durations, bedtime habits, and subjective psychological symptoms. Nevertheless, the documentation that 28.5 percent of students in this coastal district experience behavioral addiction highlights an urgent public health priority. The authors conclude that regional health authorities and educational leaders must design targeted school counseling initiatives, integrate digital well-being into standard health curricula, encourage parental boundaries on late-night device access, and support prospective longitudinal research to isolate causal pathways across rapidly modernizing adolescent populations.

Subject of Research: Smartphone addiction determinants and psychological morbidity among school-going adolescents in Puducherry

Article Title: Determinants of smartphone addiction and its association with psychological morbidity among school-going adolescents in Karaikal, Puducherry, India: a cross-sectional study

Article References: Ramachandran, N., Chellamuthu, L., Kandasamy, V., Murugesan, K., Uthirapathy, U., Kanagalingam, S., & Krishnakumar, Y. (2026). Determinants of smartphone addiction and its association with psychological morbidity among school-going adolescents in Karaikal, Puducherry, India: a cross-sectional study. Discover Public Health, 23(1), Article 1795. https://doi.org/10.1186/s12982-026-02880-4

Image Credits: AI Generated

DOI: 10.1186/s12982-026-02880-4

Keywords: smartphone addiction, adolescent health, psychological morbidity, Karaikal, Puducherry, cross-sectional study, bedtime screen time, sleep hygiene, multivariable logistic regression, SAS-SV, GHQ-12, digital escapism, outdoor activities, school health, mobile data usage, screen time determinants