INTRODUCTION
Smartphone ownership and usage have rapidly increased worldwide. The percentage of American adults who own smartphones rapidly increased from 35% in May 2011 to 45% in May 2013 and 77% in 2017 [1,2].
In Korea, smartphone usage was about 53.4% in 2012, 68.4% in 2013, 76.1% in 2014, and 88.7% in 2016 [3]. In 2019, a national survey of Koreans, the prevalence of Problematic smartphone use (PSU) for all ages was 20.2%. Especially in children and adolescents, the prevalence of PSU is 22.9% and 30.2%, respectively [4]. Exposing infants and toddlers to smartphones also is increasing rapidly, and the age of initial exposure to mobile devices is getting younger [5]. In the United States, most children start using mobile media devices before they are one year old, and they use the devices daily by age two [6]. In Korea, about 31.3% of toddlers start using smartphones before they are 24 months old [5], interactive and mobile media devices such as smartphones and tablets have been on the rise during recent years [7]. Some studies have reported negative influences of children’s usage of mobile devices. Adolescents who excessively used smartphones had poor cognitive emotional regulation strategies [8], and they experienced depression, anxiety, and daily dysfunctions related to excessive smartphone usage [9]. Particularly among children, excessive screen time might cause socio-emotional developmental delays and/or behavioral problems at age two [10]. Moreover, excessive screen time during early childhood has been associated with cognitive development, such as language delays [11]. Consequently, as awareness that excessive smartphone usage has increased, many countries have developed guidelines on the appropriate smartphone usage for children and adolescents [12,13]. Some previous studies found that the age at first internet usage powerfully predicted adolescent internet addiction [14,15]. Smartphones are a main tool for accessing the internet, and, therefore, the younger the smartphone exposure, the higher the risk of internet addiction. Consequently, children’s age at first internet usage is an important factor to their risk of smartphone addiction and related mental health problems. Children’s screen time is influenced by many factors. It tends to directly relate to family environment, such as parental factors (addictions, depression, parenting style) [15,16]. We investigated whether a mother’s smartphone addiction was associated with the smartphone usage of her young children.
METHODS
Participants
This study analyzed data derived from the Kids Cohort for Understanding Internet Addiction Risk factors in Early Childhood (K-CURE) study. This prospective cohort study was conducted in Korea to investigate the effects of internet usage on children and adolescents. Our study used the first wave data of the K-CURE study [17]. The data were collected between December 1, 2015, and June 30, 2016, on the mothers of 400 children aged two through five years old recruited from three cities (Suwon, Goyang, and Seongnam). To find out how mothers affect their younger children, this study was conducted using first wave data. Subsequently, the parents of 352 children (88% of those consents) provided sufficient data to be included in our study. The purpose and methods of the study were full explained to all of the parents and they all provided informed written consent before they participated.
Variables
Mother’s smartphone usage
The Adult Smartphone Addiction Self-assessment Scale (S-scale) is the Self-assessment Scale developed by National Information Society Agency [18]. The S-Scale consists of 15 items with a four-point Likert scale ranging from 1 (not at all) to 4 (always). It is composed of the following four categories: daily life disturbance (5 items), virtual world orientation (2 items), withdrawal (4 items), and tolerance (4 items). The mothers were sorted into two groups (high risk and low risk) using their S-Scale scores. In this study, we assumed that mothers whose S-Scale scores over 39 (about upper 10% of the entire data) as a high risk group.
Child’s media usage
The parents reported the types of smart devices their children used, including smartphones. They reported usage regarding the following six types devices: smartphone, television, desktop or laptop computer, tablet computer, video game console (e.g., Microsoft Xbox), and portable gaming devices (e.g., Nintendo DS). The parents reported their children’s frequency and average amount of time spent using smart devices during the past month. The responses were identified as weekday or weekend and categorized by type of device. To analyze the children’s age at first smartphone usage, the parents’ estimated age when they first used a smartphone was used.
Parental behaviors
The parents reported the methods used to and extent to which they controlled their children’s smartphone usage. Mother’s psychological characteristics were measured using the Parenting Stress Index Short Form (PSI-SF) [19], Beck Depression Inventory II (BDI), and Beck Anxiety Inventory (BAI). Beck Depression Inventory II (BDI) is composed of 21 items [20]. Each question inquires the participant’s psychological and physical symptoms and changes in mood in the past two weeks, each questions are scored on a 4-point scale (from 0 to 3). The validity and reliability of BDI in Korean population was established [21]. Beck Anxiety Inventory (BAI) is composed of 21 items with a four-point Likert scale ranging from 1 (Not at all) to 4 (always) [22]. Parenting Stress Index Short Form (PSI-SF) is composed of 36 items with a Likert-type answer format of five options. It is developed for evaluate the level of stress and negative feelings a person experiences regarding his or her role as a parent [23]. Mothers with high PSI-SF scores (>80) were classified as seriously stressed, those with high BDI scores (>22) were classified as depressed based on a previous study on the Korean population [24], and those with high BAI scores (>22) were classified as anxious based on a previous study’s findings [25].
Statistical analysis
First, we assessed socio-demographic differences by comparing the high-risk group to the low-risk group of mothers using chi-squared for contingency tests. Second, we used Fisher’s Exact Test to test the relationships between smartphone addiction (high risk vs. low risk) and the psychological variables. Third, a binomial logistic regression analysis was performed with the dichotomous indicator of mothers’ smartphone addition and other mental health issues as predictors and the children’s total smartphone usage and age at the first smartphone usage as binary dependent variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed on the covariates. All of the statistical analyses were performed in SPSS version 21.0 (IBM Corp., Armonk, NY, USA).
RESULTS
Demographic and smartphone usage characteristics
Table 1 describes the demographic characteristics of the sample of mothers. There were no significant differences between the high-risk group and low-risk group regarding age, gender of main caregiver, parental educational level, or monthly household income. The main caregivers were the parents in both groups (95.7% and 93.7% for the high-risk and low-risk groups, respectively). Most of the fathers were employed (100% in the high-risk group and 98.3% in the low-risk group), and most of mothers were homemakers. However, there was a significant difference regarding mother’s employment (p< 0.05). In the high-risk group, the percentage of unemployed mother was higher than in the low-risk group (80.9% vs. 61.1%, respectively).
Similarly, parental opinion and the extent to which they controlled the children’s smartphone usage were not significantly different between the two groups of mothers. Most of the mothers (98.6% and 100% in the low-risk and high-risk groups, respectively) responded that using smartphones is not helpful to their children. About one-half of the parents controlled their children’s smartphone usage (51.5% of the high-risk group and 59.0% of the low-risk group).
Psychological differences between the high-risk and the low-risk groups
Table 2 presents the differences between the high-risk group and the low-risk group in BDI, BAI, and PSI-SF scores, which were statistically significant (p<0.05). In the high-risk group, the percentage of depressed mother was higher than in the low-risk group (34.0% vs. 12.5%, respectively). In the high-risk group, the percentage of mothers with highs PSI-SF scores was higher than in the low-risk group (68.1% vs. 38.2%, respectively).
Relationship between mother’s smartphone addiction and child’s smartphone usage
Table 3 shows the results of logistic regression on predicting factors for children’s smartphone use. As predictors, the mother’s smartphone addiction, the mother’s employment status, which showed a significant difference by group, and mental health related indicators were included in the logistic regression analysis. The mother’s smartphone addiction was found to have a significant impact in predicting the child’s first exposure age to smartphones (adj. OR=0.418, p=0.021), however, other predictors did not affect both the child’s smart use time and the first exposure age.
DISCUSSION
Results of the Fisher’s Exact Test indicated statistically significant differences between the groups on the BDI, BAI, and PSI-SF which is consistent with previous studies’ findings about psychological factors and internet addiction [26]. Previous studies have reported that problematic internet usage was comorbid with other psychiatric disorders; for example, one study found that about 7.0% of adults with excessive internet usage had a comorbid dysthymic disorder [27]. Social anxiety disorder has been associated with problematic internet usage [28], and excessive internet usage was found to degrade interpersonal relationships [29]. Therefore, smartphone usage also might be comorbid with psychiatric disorders, such as depression and anxiety. A further complication is that high levels of depression, anxiety, and stress might increase smartphone usage among mothers because depressed mothers might try to escape their psychological problems by distracting themselves with their smartphones.
This study investigated the association between a mother’s smartphone addiction and her children’s smartphone usage. According to the logistic regression analysis, children whose mothers were in our high-risk group began using smartphones younger than those whose mothers were in our low-risk group. Previous studies suggested that early exposure to the internet might increase the risk of internet addiction [14,30,31]. There are several possible explanations for these findings. First, children of high-risk mothers would likely have more opportunities than other children to be exposed to smartphones. As found in previous studies, the environment at home has a great impact, especially for preschool children [32]. These children might start using smartphones at younger ages than they otherwise would be inclined to do so. Second, high-risk mothers might be relatively lax about regulating their children’s usage. A previous study found that parents who spent two hours or less per day watching television and using a computer were less likely than parents who used those devices more often to allow their children more than two hours per day of screen time [33]. Further, parents’ smartphone addiction was directly related to the extent of their control of their children’s smartphone usage [34]. Third, maternal depression might be associated with early smartphone usage. A previous study reported that depression and anxiety were related to smartphone addiction [35]. Because maternal depression might negatively influence parenting quality, depressed mothers might have problems forming the stable relationships with their children that are needed for successful control of their children’s behaviors, including their smartphone usage. Depressed, low-energy mothers also might use smartphones as a parenting tool to soothe their children. Thus, maternal depression and smartphone addiction might function together to influence children’s early smartphone usage.
We expected the children’s total smartphone usage time would be higher in the high-risk than in the low-risk group. However, the relationship was not significant. Several previous studies found that parents’ smartphone addiction was related to their adolescents’ smartphone overuse [36]. Our finding might have diverged from this result because the children in our study were two to five years old, did not own personal smartphones, and needed their parents’ or another older person’s cooperation to use a smartphone. Our results might reflect the differences between toddlers and adolescents regarding freedom and autonomy. We suspect that a study that followed children throughout their childhoods would find significant changes in smartphone usage time as they grow from toddlers into adolescents.
This study has some limitations to consider when interpreting its findings. First, children’s smartphone usage was measured by parental reports. Therefore, it might not be accurate for two reasons: many mothers cannot constantly check their children’s daily logs, which could result in inaccurate reporting of smartphone usage, and the mothers almost universally believed that smartphones are not helpful to their children (98–100%) and underreporting might be the result of social desirability bias. Second, the ISDS3 was intended as a brief screening tool rather than a diagnostic tool, and it might not accurately measure problematic smartphone usage. Finally, this study was cross-sectional, so we were unable to interpret the results from the perspective of causality.
Smartphone addiction negatively influences children’s emotional, cognitive, and social development. Because children are deeply and widely influenced by their families, parenting styles, and caregivers, it is important to understand the relationship between a mother’s smartphone addiction and her children’s smartphone usage. Educating parents and evidence-based policy interventions are needed to regulate children’s smartphone usage within a safe and healthy range. This study revealed that a mother’s smartphone addiction was related to her children’s early smartphone usage. Further study might explore the diverse effects of early smartphone usage on children’s health, wellbeing, and behaviors.
