Recibido: December 2 th , 2017 Aceptado: March 15 th , 2018 Publicado: April 1 st , 2018
Introduction: Prevalence of Mobile phone dependence (nomophobia) in increasing all over the world, but its prevalence and related factors in Latin America are unknown so far. Recently, the role of nomophobia in aggression, antisocial personality and emotional disturbances in adolescents has been recognized. Material and
Methods: We included university students from Veracruz, Mexico. The Mobile Phone Problematic Use Scale (MPPUS) was applied: It is a Likert scale of 27 items. We used the 15th, 80th and 95th percentiles to establish four
categories: occasional, habitual, at risk and problematic users. The values obtained were compared with several sociodemographic variables. Statistical analysis was made by means of the Mann-Whitney U-test and one-way ANOVA.
Results: We included 541 students aged 18-25 years (median 20.5 years); the number of years using a mobile phone was greater than 5 in 73% (n = 395). The number of hours of use per day was at least 3 in 75.2% (n = 407). 16.5% can be considered as users at risk, and 4.1% as problematic users. We found a statistically significant association between the MPPUS value and the number of hours of use per day, as well as the number of years using a mobile phone (p <0.05).
Conclusion: The prevalence of mobile phone dependence is similar to that reported in other developing countries; the number of hours of use per day and the number of years using a cellphone could be considered as predictive factors in our population.
Keywords: cellphone, criminology, nomophobia, university students.
Introducción: la prevalencia de la dependencia del celular (nomofobia) aumenta en todo el mundo, pero se desconoce hasta ahora su prevalencia y factores relacionados en América Latina. Recientemente, se ha reconocido el papel de la nomofobia en la agresión, la personalidad antisocial y las perturbaciones emocionales en los adolescentes.
Metodología: se incluyeron estudiantes universitarios de Veracruz, México. Se aplicó la Escala de Uso Problemático de Teléfonos Móviles (MPPUS), que es una escala de Likert de 27 ítems. Se usaron los percentiles 15, 80 y 95 para establecer cuatro categorías: usuarios ocasionales, habituales, en riesgo y problemáticos. Los valores obtenidos se compararon con varias variables sociodemográficas. El análisis estadístico se realizó mediante la prueba U de Mann-Whitney y el ANOVA de una vía.
Resultados: se incluyeron 541 estudiantes entre 18 y 25 años de edad (mediana de 20,5 años); el número de años en que se usó el teléfono móvil fue mayor que 5 en el 73% (n = 395). El número de horas de uso por día fue de al menos 3 en 75,2% (n = 407). El 16,5% se puede considerar como usu arios en riesgo y el 4,1% como usuarios problemáticos. Se encontró una asociación estadísticamente significativa entre el valor de la MPPUS y el número de horas de uso por día, así como el número de años en que se usó el teléfono móvil (p < 0,05).
Conclusión: la prevalencia de la dependencia del teléfono móvil es similar a la informada en otros países en desarrollo; la cantidad de horas de uso por día y la cantidad de años en que se usó el celular podrían considerarse factores predictivos en nuestra población.
Palabras clave: celular, criminología, nomofobia, estudiantes universitarios.
Introdução: a prevalência da dependência do telefone celular (nomofobia) está aumentando em todo o mundo. Porém, na América Latina, este assunto e os fatores relacionados são desconhecidos até hoje. O papel da nomofobia na agressividade, a personalidade antissocial e as perturbações emocionais em adolescentes foi reconhecido recentemente.
Material e métodos: Incluíram-se estudantes universitários de Veracruz, México. Aplicou-se a MPPUS (Mobile Phone Problematic Use Scale, siglas em inglês): uma escala de Likert com 27 itens. Utilizaramse os percentis 15, 80 e 95 para estabelecer quatro categorias: usuários ocasionais, habituais, em risco e problemáticos. Compararam-se os valores obtidos com diversas variáveis sociodemográficas. Realizou-se a análise estatística por meio do teste U de Mann-Whitney e um ANOVA unidirecional.
Resultados: Incluíram-se 541 estudantes com idades entre 18 e 25 anos (média de 20,5 anos); o nú mero de anos usando um telefone celular foi maior que 5 em 73% (n=395). O número de horas de uso por dia foi de pelo menos 3 em 75,2% (n=407). 16,5% podem ser considerados usuários em risco, e 4,1% usuários problemáticos. Encontrou-se uma associação estatisticamente significante entre o valor da MPPUS e o número de horas de uso por dia, assim como o número de anos usando um telefone celular (p <0,05).
Conclusão: A prevalência de dependência do telefone celular é semelhante à relatada em outros países em desenvolvimento; o número de horas de uso por dia e o número de anos usando um telefone celular podem se considerar fatores preditivos na população.
Palavras-chave: telefone celular, criminologia, nomofobia, estudantes universitários.
Denis-Rodríguez E, Villegas-Domínguez JE, Denis-Rodríguez PB, Melo-Santiesteban G, BarradasAlarcón ME. Epidemiological behavior of mobile phone dependence: a criminological perspective. Colomb Forense , vol. 5, no. 1, pp. 3542, April 2018. doi: https://doi.org/10.16925/cf.v5i1.2362
For more than 20 years, there has been an expo nential increase in the number of people who own a cellphone, as well as the daily time of use, and the number of functions and tasks that can be per formed . Since then, concerns have arisen about the addictive potential of prolonged or repeated use of cellphones. This can be related to the paradoxical duality of the use of new technologies, in which in the short term they involve more bene fits than inconveniences, but in the long term, they can cause the emergence of addictive or impulsive behaviors .
This has led to the emergence of a new research area focusing on the possible mobile phone depen dence, named more simply as nomophobia (Nomobile-phone phobia) . It has been suggested that mobile phone dependence could be related to various psychological and sociodemographic fac tors, such as early age, self-negative conceptions of life, low self-esteem, poor perception of personal efficacy, and impulsiveness , behaviors that can be observed in other addictive phenomena. In fact, it has been suggested that mobile phone depen dence should be included among the addictive disorders of DSM-V, since it is only mentioned as a subtype of addiction to gambling as a behavioral phenomenon [5,6].
Mobile telephone dependence must be consti tuted by the following characteristics: 1) conscious and problematic use of the cellphone, with genera tion of family conflicts, and loss of interest in daily activities ; 2) preference for cellphone use over other physical, mental, social, work or family activities, often accompanied by sleep disturbances ; 3) psychological manifestations associated with excessive cellphone use, such as abstinence, tolerance, poor self-control or irritability ; and 4) perception of anxiety and loneliness when the cell phone cannot be used, or when there is no imme diate response to a sent message .
Mobile phone dependence, with all the afore mentioned manifestations, must in turn be studied in relation to the pattern of individual use, which has been modified over the years. Currently, six specific patterns are identified: 1) use of social net works during the day; 2) general Internet browsing; 3) nighttime use of various social networks; 4) online shopping; 5) use of mobile phone for entertainment purposes; and 6) mobile phone video gaming.
Several physical and psychological alterations associated with nomophobia have been described . Among the physical alterations are cervi cal muscle stiffness and pain, ocular alterations (blurred vision, conjunctival hyperemia), alterations in reproductive capacity, Quervain tenosy novitis, and even the development of brain tumors . It has also been related to different psycho pathological entities, among which are tactile or visual and alterations in mood and behavior. In a study conducted in 256 individuals, aged 18 to 40 years, an increase in the tendency to impulsive behavior was observed ; in a study conducted in 1236 individuals with mobile phone dependence, the degree of anxiety measured by the Zung scale was greater than in a control group with a risk of 10.1% . Alterations have been observed in the volume of gray matter in the right upper fron tal gyrus and talamus, as well as less integrity of the white matter in the hippocampus, structures closely related to the limbic system . The depen dence on mobile phones has also been related, through epidemiological studies, to sleep distur bances, aggression, tendency to depression, and greater exposure to cyberbullying [15,16].
The aforementioned effects have given rise to the study of the real prevalence of nomopho bia in the general population, and in particularly susceptible sectors. One of the aspects that has greatly hindered the determination of this param eter is the use of multiple measurement systems; in some cases, these are surveys based on semi-struc tured interviews, and in other cases they are scales validated in certain populations . There is no universally validated scale, but some of them have useful psychometric characteristics. Among them we have the Cellular Phone Dependence Questionnaire (CPDQ), the Mobile Phone Problem Use Scale (MPPUS), the Mobile Phone Usage Scale (MPUS), the Test of Mobile Phone Dependence (TMDbrief), and about 15 other scales . Most of them are Likert-type scales with variable number of items that measure dependence on the mobile phone or certain specific parameters, such as the use of social networks, texting or free browsing on the Internet. In this study we will use the MPPUS, which is a 27-item Likert-type scale; it has been validated and compared with the Addiction Scale of the Multiphasic Personality Inventory (MMPI2-RF), with a Cronbach alpha of 0.90 for all its sub scales .
MMPUS is the most widely used scale for the measurement of mobile phone dependence: it has been validated in different populations around the world, reaching Cronbach‘s alphas above 0.90, as in a sample of 600 university students in Tehran, Iran . In a recent study, its reliability and inter nal consistency were analyzed in a sample of 1126 individuals aged 16-65 years, allowing the estab lishment of four categories of mobile phone use: casual use, regular use, people at risk, and prob lematic use, with predictive factors such as age, sex, educational level, and time of daily use 1. This test has also been used in a population of 902 university students in Turkey , 1132 students aged 12-18 in Spain, and several countries in Latin America , in 412 Swiss teenagers , in 1529 adolescents aged 11-18 years in England using the Spanish version , in 468 university students in China  in 456 adolescents from several European coun tries, with a Cronbach‘s alpha of 0.85 and Kendall‘s Tau of 0.80  and a multinational population of patients from southern Europe, South America, Mesoamerica, India and Pakistan, without finding differences between regions in terms of the psy chometric analysis of the reliability of this test . Finally, MMPUS was also used in a sample of 100 university students in Wyoming, United States; a relationship between the high leves of nomophobia and family history of alcoholism was found, which is a fact that has not yet been studied .
Determining the frequency of nomophobia must include specific factors such as addiction, dependence, problematic use, excessive use, or risky behavior. In each of these criteria, the obtained per centile ranges are difficult to compare given that the samples, instruments and methodology used are not always the same. Practically, all the studies so far have been carried out on young people, with an age range of 11 to 32 years, although the majority have been 18 to 25 years old; the size of the sample has been equally variable, including studies with small samples of 34 individuals up to multicenter studies with samples close to 2000 individuals. Due to the variability of the measurement methodol ogy used, the values of prevalence in the world are highly variable. In a study conducted in 2311 Asian students, the prevalence of nomophobia was 23.3%, and these individual risk factors were found: school year, being an only child, monthly income, and aca demic performance . In a study conducted in 1126 individuals aged 16-65 years, the prevalence of nomophobia measured by the MPPUS test was 20.5 . In a review of the literature, its authors report prevalences ranging from 5.35% to 32% in Spain, from 3.1 to 18.8% in Japan, from 4.1 to 33% in South Korea, from 28.7% in the Netherlands, and 33% in Tunisia . In a study of 2775 young adults from different parts of Europe, the high est numbers of nomophobia cases were found in northern (Finland and England) and southern Europe (Spain and Italy), although individually, the countries with higher values (greater than 30%) were Belgium, England, and France . In India, a prevalence of 31.33% was found in a sample of 415 students, finding predictive factors such as sex, type of family, type of telephone used, average time of daily use, and total years of mobile phone use . There is also high prevalence of nomophobia in special groups, such as medical oncologists , and university students during clases .
It is somewhat surprising that no methodologically well-defined studies have been conducted on prevalence and predictive factors in most Latin American countries, including Mexico. For this reason, we decided to use the most widely used nomophobia measurement scale in the world in a population of university students in Veracruz, Mexico.
The sample consisted of 548 university students from various faculties of the University of Veracruz: Dentistry, Psychology, Public Accounting, Communications and Histopathologist Technician. The University of Veracruz is a public univer sity located in the port of Veracruz, Mexico, with a population of 3 million, with medium low and medium high economic levels on average. All the students who participated had a smartphone-type cellphone: they used it for various activities on the Internet, with a large predominance of Facebook, WhatsApp and Instagram social networks. All the participants agreed to participate in the study with prior informed consent, approved by the Bioethics Committee of the Institute of Forensic Medicine of the University of Veracruz. All participants anonymously answered the MPPUS (Mobile Phone Problematic Use Scale) in their classrooms during the period of January to April 2017; MPPUS was applied by a team of experienced researchers in the handling of this psychometric instrument. It took an average of 10 minutes to answer the MPPUS; the researchers were present during the entire applica tion of the instrument, solving any doubts about the correct answering procedure. After excluding seven incompletely answered tests, the final sam ple consisted of 541 students.
MPPUS is a Likert-type psychometric test, with 5 possible answers, consisting of 27 items that determine various manifestations of mobile phone dependence: feelings of isolation, family or work/ academic problems, impairment of daily life, etc. The students had to answer each item by choosing only one of five possible options: Strongly Agree, Agree, Neutral, Disagree, and Strongly Disagree; this gives us a score that goes from 27 to 135. According to the methodology followed by pre vious studies [19, 21, 34] we divided students in 4 categories: casual users, regular or habitual users, users at risk, and problematic users, considering the 15th, 80th and 95th percentiles as cut-off values. The statistical analysis was performed by means of the Mann Whitney U test, and one-way ANOVA.
The study included 548 university students from 18 to 25 years old (average age 20.5 years), of whom 258 were men (47.69%) and 283 were women (52.31%); all students were asked anonymously about their age, gender, the number of daily cellphone use hours (less than 1 hour a day, 1 to 3 hours a day, 3 to 6 hours a day and more than 6 hours a day), and the number of years of having a mobile phone (less than 1 year, from 1 to 5 years and more than 5 years). 98.2% of the sample (n = 531) had finished high school, 75.2% (n = 410) used the mobile phone at least 3 hours a day, and 73% ( n = 395) had at least 5 years of having a mobile phone (Table 1).
|N||% of total|
|Level of education concluded||High school|
Bachelor ́s degree
|Number of years of having a mobile phone||Less than 1 year|
1 to 5 yearsMore than 5 years
|Number of hours per day using a mobile phone||Less than 1 hour|
1 to 3 hours3 to 6 hours
More than 6 hours
Once the students were divided into the four categories (casual users, regular or habitual users, users at risk, and problematic users), with the 15th, 80th and 95th percentiles as cut-off points, we observed that the average score in the MMPUS was 73.6 (on a scale that goes from 27 to 135). As it can be seen in Table 2, most of the sample (64.1%, n = 347) can be considered regular users, but if we sum the users at risk and the problematic users, we can consider that there is a mobile phone dependency of 20.6% in our sample (n = 111).
|Use of mobile phone||Ocassional|
We performed a comparative analysis between the sociodemographic variables, and the categories of use of the mobile phone; among the occasional users, 68.7% were female (versus 45.8% in regular users, 64% in users at risk and 45.5% in problematic users), 96.4% had completed high school (versus 98.6% in regular users, 97.8% in users at risk and 100% in problematic users), 65.1% had more than 5 years of cellphone use (versus 72.3% in reg ular users, 83.1% in users at risk and 72.7% in problematic users), and 48.2% used the cellphone at least 3 hours a day (versus 73.8% of regular users and 100% of users at risk and of problematic users).
As it can be seen in Table 3, when making the comparative analysis between the estimates obtained from the MPPUS scale and the socio demographic variables, by means of the Mann Whitney U test and one-way ANOVA, there is a statistically significant difference in the variables related to number of hours of daily use and the number of years of having a mobile phone (p<0.05), but no difference was found in relation to sex, age, or educational level.
The use of the mobile phone is an increasing social phenomenon: various physical and psycho pathological alterations have been implicated. It is extremely important to accurately measure the
prevalence of excessive and addictive use of the mobile phone in the general population and in par ticularly susceptible groups, such as adolescents or university students.
The measurement of the prevalence of nomophobia has been difficult since there are sev eral psychometric scales, without reaching a point of agreement on a universally accepted scale. Due to its psychometric properties and reliability, the MPPUS scale is the most widely used in the world, although its distribution is not yet univer sal. However, we decided to use it, in order to make a comparative study between the prevalence of nomophobia in Mexico and that reported in other parts of the world using the same psychometric test.
In the sample studied, the prevalence of nomophobia was 20.6%, bringing together at-risk and problematic users. This is relatively similar to that reported in other parts of the world, including Europe, Asia, and the United States. As far as we know, this is the first study conducted in Mexican university students. It is striking that the figures obtained in the MPPUS are higher and statistically significant in those individuals with more than 3 hours of daily use of the mobile phone, and more than 5 years of having a mobile phone, parame ters that we can consider of predictive value in our population. We did not find differences in terms of age, sex, and educational level. Some other socio demographic variables were not assessed, such as the history of substance abuse or other addictive
|Average score of MPPUS||Standard deviation||P value|
|Educational level||High school||73.7||19.4||Ns*|
|Bachelor ́s degree||65.8||22.6|
|Number of years of having a mobile phone||< 1 year||68.4||19.8||P < 0.05|
|> 5 years||75.1||19.4|
|Number of hours per day using a mobile phone||< 1 hour||48.7||7.4||P < 0.05|
|1 to 3 hours||59.5||11.3|
|3 to 6 hours||67.6||13.6|
|> 6 hours||91.8||16.6|
phenomena, the consumption of psychotropic medications, the presence of personal or family history of psychopathologies or family violence, as well as the place of origin of the students, factors that could be considered in future studies to deter mine the qualitative characteristics of the phenom enon of nomophobia in our population.
It is evident that similar studies should be car ried out in other parts of the country and in other Latin American countries, preferably using the same methodology or elaborating a scale of their own that complies with standards of validity, and statistical reliability. This will allow us to observe that the phenomenon of mobile phone dependence is a public health problem, with epidemic nature and pandemic tendency, which can lead to a propor tionally progressive increase in various pathologies related to nomophobia, such as certain physical ill nesses and some psychopathological alterations like depression, suicidal ideation, aggressiveness, antisocial behavior, and impulsivity, among others.
Mobile phone dependence is a challenge for public health policies developed in our country, and in areas with similar sociocultural characteristics. This type of studies is a wake-up call to our legislative authorities, to control, at least in part, the disproportionate and apparently exponential growth of a technological phenomenon that seems to have no serious repercussions, but it is evident that it can become just the tip of an iceberg that would expose us to a future problem of large scale.