CYBERPSYCHOLOGY, BEHAVIOR, AND SOCIAL NETWORKING

Volume 22, Number 11, 2019

ª Mary Ann Liebert, Inc.
DOI: 10.1089/cyber.2019.0325

Psychometric Properties and Demographic Correlates

of the Smartphone Addiction Scale-Short Version
Among Chinese Children and Adolescents in Hong Kong

Teris Cheung, RN, PhD,1 Regina L.T. Lee, RN, PhD,2 Andy C.Y. Tse, PhD,3 Chi Wai Do, PhD,4
Billy C.L. So, PhD,5 Grace P.Y. Szeto, PhD,6 and Paul H. Lee, PhD1
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Abstract

Nearly all children and teens in Hong Kong own a smartphone. There is currently no validated instrument that
measures whether they use their phone too much. This study tested the psychometric properties of a translated
Chinese version of the Smartphone Addiction Scale-Short Version (SAS-SV) and examined the demographic
correlates of smartphone addiction among Hong Kong children and adolescents. A total of 1,901 primary school
children and secondary school pupils were recruited from 15 Hong Kong schools. Furthermore, 1,797 primary
caregivers were asked to complete a self-administered questionnaire on their socioeconomic status and edu-
cational attainment. The study used exploratory factor analysis (EFA) to identify the factor structure of SAS-SV
for half the participants (n = 951), while confirmatory factor analysis (CFA) was used to assess the goodness-of-
fit of EFA models for the remaining half (n = 951). Spearman correlations were used to assess the convergent
validity of the SAS-SV, taking account of time spent by subjects on phones per day, the Smart Device Addic-
tion Screening Tool (SDAST), the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Scale of Per-
ceived Social Support (MSPSS), and the Center for Epidemiological Studies Depression Scale for Children
(CES-DC). EFA generated a three-factor model (with factors labeled ‘‘dependency,’’ the incidence of a ‘‘prob-
lem,’’ and ‘‘time spent’’). CFA confirmed this model yielded an acceptable goodness-of-fit (Comparative Fit
Index = 0.96, Tucker Lewis Index = 0.95, and root-mean-square error of approximation = 0.06). SAS-SV was
positively correlated with SDAST (q = 0.59), PSQI (q = 0.29), and CES-D (q = 0.35), and negatively correlated
with MSPSS (q = -0.10). A linear regression model showed that female adolescents, those with highly educated
caregivers and those who spent more time using smartphones on their holidays, had on average higher SAS-SV
scores, meaning they showed greater vulnerability to becoming addicted. The study found that SAS-SV is a
valid scale for estimating excessive smartphone use among Hong Kong children and adolescents.

Keywords: addictive behaviors, Chinese, information technology, mobile phones, validation

Introduction as high as 98 percent among young adolescents (99.2 percent

of boys and 98.4 percent of girls 15–19 years of age).3 By

C hildren and adolescents nowadays grow up sur-

rounded by smartphones.1 Hong Kong’s 2017 popula-
tion stood at 7.41 million2; and its number of smartphone
users in the same year was 5.53 million. It is estimated that 76
percent of male and 79.8 percent of female young children
(10–14 years of age) used smartphones, with this percentage
2021, 80.9 percent of the population in Hong Kong is ex-
pected to have a smartphone.4 The city has one of the highest
penetration rates of smartphones in the world.5
Compared to adults, adolescents may be more susceptible
to excessive smartphone use in that, they face an arguably
distinctive pressure to keep in touch with and be like their

1
School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong.
2
School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia.
3
Department of Health and Physical Education, Education University of Hong Kong, New Territories, Hong Kong.
4
School of Optometry, Hong Kong Polytechnic University, Kowloon, Hong Kong.
5
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong.
6
School of Medical and Health Sciences, Tung Wah College, Kowloon, Hong Kong.

714
 VALIDATION OF CHINESE SAS-SV
peers.6,7 Adolescents’ possible lack of self-control8 means
they are more likely to overuse smartphones than adults.9
Previous studies have shown that excessive smartphone use
can impair physical health (e.g., lead to vision loss and
musculoskeletal problems),10,11 while prompting mental
health problems (e.g., depression and anxiety),10,12,13 poor
interpersonal relations,14 maladjustments at school,14 and
delinquency.15
Definition and prevalence of excessive
smartphone use
The idea of overuse of smartphones is relatively new, with
only a few studies offering definitions of ‘‘excessive.’’6
While researchers have attempted to theorize smartphone
addiction, smartphone addiction does not feature as a psy-
chiatric diagnosis in the fifth edition of the Diagnostic and
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Statistical Manual Version, nor (yet) in any medical diag-
nosis mandating treatment. The term ‘‘addiction,’’16 then,
does not rest on a clinical diagnosis17 and remains contro-
versial, although it is hard to deny that smartphones are
objects to which some children and adolescents are overly
attached.18
Excessive smartphone use possesses similar character-
istics to gambling, game playing, and Internet addictions,
in being characterized by uncontrolled usage, neglect of
daily activities, and a restless pattern of attention. In this
sense, it is a behavioral addiction.19 Several factors un-
derlie smartphone addiction.20 Heavy users enjoy being on
their phones21 and become addicted in a way characteristic
of token-reward systems.22 Furthermore, some social media
apps encourage overuse,23 a correlation established by an
early study.23
In Asia, Internet addiction has emerged a serious behav-
ioral health problem.24 One study examines the prevalence
of ‘‘addicted’’-to-the-Internet behaviors in 5,366 adolescents
12–18 years of age in 6 Asian countries (China, Hong Kong,
Japan, South Korea, Malaysia, and the Philippines), using the
Asian Adolescent Risk Behavior Survey (AARBS),25 Inter-
net Addiction Test (IAT),26 and the Revised Chen Internet
Addiction Scale (CIAS-R).27 The overall prevalence of
smartphone ownership comes in at 62 percent, with South
Korea reporting 84 percent and China 41 percent. Hong
Kong has the highest number of adolescents reporting at least
daily Internet use (68 percent).
Gender differences in smartphone usage and addiction
Male and female users tend to use smartphones differ-
ently.28 Men and boys use smartphones to make calls,
sometimes for business connections,29 to play games, to edit
videos, and to read comics.30 Female users tend to use
camera applications to chat, access social networking sites,
listen to music, and make calls.30,31 Women and girls have
recourse to their smartphones to escape anxiety.21 Briefly,
men use phones to fetch information and play games, and
women to communicate.30,32 Recent anecdotal evidence
suggests gender differences in the incidence of smartphone
overuse.23,29,33,34 Female adolescents showed a greater risk
of dependency than males (31.9 percent and 29.3 percent,
respectively). Studies have also consistently reported higher
rates of excessive phone usage in girls.30,35,36
715
Excessive smartphone use among children
and adolescents in Hong Kong
There is little Hong Kong-based research on excessive
smartphone use, with most recent information derived from
studies of problematic Internet usage. For example, *4.5 to
16 percent of compulsive adolescent Internet users mainly
played games and accessed social networks online.37 Wang
et al. reported that 94 percent of 503 high school students
surveyed played video or Internet games, with 1 in 6 (15.6
percent) being addicted.20 The risk for gaming addiction was
significantly higher among boys (22.7 percent) than girls (8.7
percent), also disproportionately affecting poor students and
multiplayer gamers. Gaming addiction was associated with
average time spent gaming per week, cash outlay, perceived
family disharmony, and having close friends.20 In addition,
Fu et al. conducted a two-wave household survey on 208
adolescents between 15 and 19 years of age,37 identifying
patterns of Internet usage, symptoms of Internet addiction,
suicidal ideation, psychiatric symptoms, and psychosocial
conditions on the basis of self-reports. The prevalence rate
for having five or more symptoms of Internet addiction was
estimated at 6.7 percent (95% CI 3.3–10.2). The prevalence
rate of adolescent Internet addiction was 6.7 percent (8.4
percent for males and 4.5 percent for females). No statisti-
cally significant age or gender differences were obtained.
Other studies have indicated a preponderance of adolescent
boys addicted to the Internet.38
As an indication of discrepancies between studies’ find-
ings, the Internet addiction rate reported by Fu et al. was
markedly lower than previously reported in Hong Kong.
Using the same instrument and cutoff point (five symptoms),
Leung39 determined 38 percent of 699 Internet users 16–24
years of age were addicted, with a bias toward females.
Another study38 judged 20 percent of a convenience sample
of 6,024 secondary school students addicted. Differences
in estimated prevalence rates may arise from the non-
standardized instruments used in studies. Differences in re-
spondents’ demographic profiles and in data collection
and sampling methods could also account for variations in
findings.
To our knowledge, no study has been conducted on the
psychometric properties and demographic correlates of the
Smartphone Addiction Scale-Short Version (SAS-SV) in
Hong Kong. As the number of smartphone users grows in
China, this study may shed light on the scale of smartphone
overuse and offer directions to policymakers wishing to stem
minors’ dependency on smartphones.
Methods
Participants
The study used convenience sampling and a traditional
paper-and-pencil survey. Fifteen primary and secondary
schools with existing research links to the authors (in the
Kwai Tsing, Tsuen Wan, Kwun Tong, and Yau Tsim Mong
districts of Hong Kong) joined the study. The study sought
the participation of students in Primary 3–5 (third-to-sixth
grade in the American education system) and Secondary 1–3
(seventh-to-ninth) who could read Chinese and were between
7 and 17 years of age. This tapped a total of 2,466 subjects
from 15 schools (response rate: 60 percent). We excluded
 716
students with known sleeping disorders (e.g., sleep apnea and
sleepwalking), with physical or mental problems preventing
them from independently performing daily living activities,
and with missing data in the SAS-SV (n = 188). The resulting
sample consisted of 1,901 participants. The primary parental
caregiver of each participant was also invited to complete a
self-administered questionnaire about their family’s socio-
economic status. One thousand seven hundred ninety-seven
(94.5 percent) returned the questionnaire. As all participants
were younger than 18 years, written parental consent was
obtained before subjects’ participation.
Measures
Excessive smartphone use. We used the SAS-SV orig-
inally developed by Kwon et al.40 in South Korea. The study
relied on Brislin’s model of translation41 involving three
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phases and four steps. The final step involved the principal
investigator comparing a professionally back-translated
version of the Chinese SAS-SV (routed through Korean)
with the original for linguistic congruence and cultural sen-
sitivity. The SAS-SV consisted of 10 symptoms of excessive
smartphone use.40 Six experts selected 10 items of this short
version from the original 33-item SAS.40 Each item was
scored on a six-point Likert scale. The Cronbach’s alpha in
our sample was 0.86.
Smartphone usage. Information on smart device usage
for the time participants spent on smartphones was collected
with a modified questionnaire used in Hong Kong for mea-
suring electronic console-game usage. The time spent on
smartphones was categorized into school days and holidays.
Smart device addiction. The Smart Device Addiction
Screening Tool (SDAST) is a scale consisting of eight
symptoms of smart device addiction coded as yes/no re-
sponses. This tool was adapted from the Young’s IAT26,42
and validated by our team (content validity index = 0.87 and
test–retest reliability = 0.69). The Cronbach’s alpha in our
sample was 0.75.
Sleeping quality. The Pittsburgh Sleep Quality Index
(PSQI) is a 19-item scale that measures the sleeping quality
within seven domains: subjective sleep quality, latency, du-
ration, habitual efficiency, disturbances, use of medication,
and daytime dysfunction.43 Each item is scored on a three-
point scale, except for the items reporting bedtime and time
awake. The Cronbach’s alpha of the seven subscores in our
sample was 0.58.
Social support. The Multidimensional Scale of Per-
ceived Social Support (MSPSS) is a 12-item scale subjec-
tively assessing whether subjects, and their friends and
family, perceive they are adequately socially supported.44
We used a shortened version of three items, with one item
taken from each dimension (family, friends, and significant
others) in line with factor analysis of available multi-country
data (n = 20,752, ages 8–17, data upon request). The total of
these 3 items strongly correlated with total scores for the
original 12 items (q = 0.92, p < 0.001). The Cronbach’s alpha
in our sample came in at 0.74.
CHEUNG ET AL.
Depressive symptoms. The Center for Epidemiological
Studies Depression Scale for Children (CES-DC)45 used by
the study consists of 20 items recording depressive symp-
toms. A cutoff score of 15 suggests depression in children
and adolescents.46 The Cronbach’s alpha in our sample was
0.86.
Statistical analysis
Frequencies (percentages) and means (SDs) were used to
describe the demographic characteristics of the participants
and the 10 items of the scale. Pearson correlations examined
SAS-SVs interitem correlations. We randomly divided our
dataset into two equally sized groups. The first half of the
data (n = 951) was subjected to exploratory factor analysis
(EFA), while the second half (n = 950) was fed to confir-
matory factor analysis (CFA). The study identified the
structure of one-factor, two-factor, and three-factor models
using maximum likelihood EFA with oblique rotation,
without assuming any number of factors for the SAS-SV.
The Kaiser-Meyer-Olkin test for sampling adequacy was
0.89, indicating an adequate sample for EFA. The result of
Bartlett’s test (v2 = 3,201, p < 0.001) supported variable
sphericity. CFA was used to assess the goodness-of-fit of the
one-factor, two-factor, and three-factor EFA-derived mod-
els, with only absolute path loadings of 0.3 or above modeled
in CFA. A Comparative Fit Index (CFI) of >0.95, Tucker
Lewis Index (TLI) of >0.95, root-mean-square error of ap-
proximation (RMSEA) of <0.08, composite reliability (CR)
of >0.7, and average variance extracted of >0.5 indicate that
the model presents a good fit. Spearman correlations assessed
the convergent validity of the SAS-SV, noting the time spent
on smartphones per day (divided into school days and holi-
days), SDAST, PSQI, MSPSS, and CES-D. We expected that
the SAS-SV would be positively associated with SDAST,
PSQI, and CES-D, and negatively associated with MSPSS.
A linear regression model was used to identify the demo-
graphic correlates of SAS-SV using the complete dataset. All
analyses were performed using SPSS 23, and CFA per-
formed using the R package OpenMx.47
Results
The cohort’s sociodemographic characteristics (n = 1,901;
Table 1) were gender balanced, with more than 85 percent of
participants’ caregivers completing at least secondary edu-
cation. Approximately 11.4 percent had tertiary education or
above. On school days, participants spend an average of
1 hour and 50 minutes (SD 1 hour 49 minutes) on smart-
phones. On holidays, they spend 3 hours and 49 minutes (SD
2 hours and 43 minutes) on phones. Of the 1,797 caregivers,
1,271 (70.7 percent) were mothers and 430 (23.9 percent)
were fathers.
Means (SD) and Pearson correlations of the 10 items in the
SAS-SV are shown in Table 2. The most and least prob-
lematic symptoms of excessive smartphone use were ‘‘4.
Could not live without my smartphone’’ (mean: 3.39) and
‘‘5. Feel worried without my smartphone’’ (mean: 2.41),
respectively. Correlations ranged between 0.22 and 0.62
(in all cases, p < 0.001), with a mean correlation of 0.38.
EFA results are given in Table 3. The one-factor, two-
factor, and three-factor models explained 43.7 percent, 55.6
percent, and 64.1 percent of the total variance, respectively.
 VALIDATION OF CHINESE SAS-SV 717

Table 1. Demographic Characteristics of the Participants (n = 1,901)

Variable Category Frequency Percentage
Gender Male 950 50.0
Female 950 50.0
Missing 1
Caregiver’s education level Have not received any formal education 21 1.2
Primary 211 12.0
Secondary 1,325 75.4
Tertiary or above 200 11.4
Missing 144
Monthly household income (HK dollar) <10,000 254 14.7
10,000–19,999 702 40.5
20,000–29,999 404 23.3
30,000–39,999 189 10.9
40,000–49,999 88 5.1
50,000+ 96 5.5
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Missing 168

Variable Range Mean SD

Age 7–17 11.1 2.1

Minutes spent on smartphone per day (school day) 0–600 109.6 109.1
Minutes spent on smartphone per day (holiday) 0–600 218.5 162.7
SAS-SV 10–60 28.9 10.3
SAS-SV, Smartphone Addiction Scale-Short Version.

Table 2. Means and Pearson Correlations in the 10 Items of the Smartphone

Addiction Scale-Short Version (n = 1,901)
Item-total
Item 2 3 4 5 6 7 8 9 10 Mean (SD) correlation
1. Missing planned work due to 0.52 0.37 0.31 0.38 0.37 0.34 0.26 0.40 0.31 2.83 (1.45) 0.53
smartphone use
2. Having a hard time concentrating 0.45 0.32 0.43 0.38 0.35 0.26 0.38 0.30 2.60 (1.50) 0.56
in class while doing assignments or
while working due to smartphone
use
3. Feeling pain in the wrists or at the 0.22 0.33 0.32 0.26 0.22 0.31 0.31 2.56 (1.51) 0.45
back of the neck while using a
smartphone
4. Won’t be able to stand not having a 0.53 0.48 0.56 0.37 0.41 0.30 3.39 (1.65) 0.58
smartphone
5. Feeling impatient and fretful when 0.62 0.52 0.39 0.41 0.33 2.41 (1.40) 0.66
I am not holding my smartphone
6. Having my smartphone in my mind 0.56 0.36 0.46 0.34 2.70 (1.49) 0.65
even when I am not using it
7. I will never give up using my 0.47 0.46 0.33 3.07 (1.56) 0.65
smartphone even when my daily
life is already greatly affected by it
8. Constantly checking my 0.38 0.26 2.88 (1.66) 0.49
smartphone so as not to miss
conversations between other
people on Twitter or Facebook
9. Using my smartphone longer than I 0.47 3.19 (1.58) 0.62
had intended
10. The people around me tell me that I 3.26 (1.72) 0.48
use my smartphone too much
All Pearson correlations were significant at 0.1 percent level.
 Table 3. Exploratory Factor Analysis of Smartphone Addiction Scale-Short Version (n = 951)
One factor Two factor Three factor
Factor 1: Factor 1: Factor 2: Factor 1: Factor 2: Factor 3:
Item Addiction Dependence Problems Dependence Problems Time spent
1. Missing planned work due to smartphone 0.52 0.04 0.64 0.02 0.63 -0.05
use
2. Having a hard time concentrating in class 0.56 -0.003 0.76 0.01 0.81 0.04
while doing assignments or while
working due to smartphone use
3. Feeling pain in the wrists or at the back 0.45 0.004 0.60 -0.02 0.58 -0.05
of the neck while using a smartphone
4. Won’t be able to stand not having a 0.65 0.75 -0.08 0.69 -0.05 -0.04
smartphone
5. Feeling impatient and fretful when I am 0.76 0.65 0.12 0.80 0.15 0.17
not holding my smartphone
6. Having my smartphone in my mind even 0.74 0.69 0.05 0.72 0.06 0.01
when I am not using it
7. I will never give up using my smartphone 0.72 0.81 -0.09 0.74 -0.06 -0.07
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even when my daily life is already

greatly affected by it
8. Constantly checking my smartphone so 0.53 0.56 -0.03 0.45 -0.02 -0.16
as not to miss conversations between
other people on Twitter or Facebook
9. Using my smartphone longer than I had 0.63 0.44 0.18 0.03 0.08 -0.85
intended
10. The people around me tell me that I use 0.49 0.35 0.18 0.17 0.14 -0.31
my smartphone too much
Total variance explained, percentage 43.7 55.6 64.1

Table 4. Confirmatory Factor Analysis of Smartphone Addiction Scale-Short Version (n = 950)

One factor Two factor Three factor
Factor 1: Factor 1: Factor 2: Factor 1: Factor 2: Factor 3:
Addiction Dependence Problems Dependence Problems Time spent
Missing planned work due to smartphone use 0.59 0.68 0.70
Having a hard time concentrating in class while 0.59 0.71 0.72
doing assignments or while working due to
smartphone use
Feeling pain in the wrists or at the back of the 0.48 0.57 0.56
neck while using a smartphone
Won’t be able to stand not having a smartphone 0.66 0.68 0.69
Feeling impatient and fretful when I am not 0.73 0.74 0.75
holding my smartphone
Having my smartphone in my mind even when I 0.74 0.75 0.75
am not using it
I will never give up using my smartphone even 0.72 0.74 0.75
when my daily life is already greatly affected
by it
Constantly checking my smartphone so as not to 0.55 0.56 0.56
miss conversations between other people on
Twitter or Facebook
Using my smartphone longer than I had 0.66 0.64 0.79
intended
The people around me tell me that I use my 0.52 0.54 0.61
smartphone too much

v2 377 247 153

p <0.001 <0.001 <0.001
CFI 0.90 0.94 0.96
TLI 0.87 0.91 0.95
RMSEA 0.10 0.08 0.06
CR 0.87 0.89 0.90
AVE 0.40 0.44 0.48
AVE, average variance extracted; CFI, Comparative Fit Index; CR, composite reliability; RMSEA, root-mean-square error of
approximation; TLI, Tucker Lewis Index.
718
 VALIDATION OF CHINESE SAS-SV 719
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FIG. 1. Path diagram of the three-factor model.

In the two-factor model, items 4–10 fell into Factor 1 (De-
pendency) and items 1–3 into Factor 2 (Problems). In the
three-factor model, items 4–8 fell into Factor 1, items 1–3
into Factor 2, and items 9 and 10 into Factor 3 (Time spent).
Table 4 gives CFA results. The one-factor and two-factor
models yielded a poor fit, while the three-factor model fit
well (CFI >0.95, TLI >0.95, RMSEA <0.08, and CR >0.7).
Figure 1 gives the path diagram for the three-factor model.
Following EFA and CFA results, three subscale scores
were obtained by summing item scores grouped under the
same factor in the three-factor model. Factor 1, Factor 2, and
Factor 3 had Cronbach’s alphas of 0.71, 0.82, and 0.63, re-
spectively. Table 5 shows the convergent validity of the
SAS-SV and its three subscales. As expected, SAS-SV was
positively associated with SDAST, PSQI, and CES-D, and
negatively with MSPSS. Notably, the correlations between
SAS-SV and MSPSS had small effect sizes, from -0.06
( p = 0.009) to -0.11 ( p < 0.001).
Table 6 presents a linear regression model for the SAS-
SV. Female participants, participants with highly educated
caregivers, and participants spending more time on their
smartphones on holidays were positively associated with
smartphone addiction in terms of the SAS-SV.
Discussion
Surprisingly, the SAS-SV one-factor model identified in
the original validation study40 fit our results badly, because
the within-item correlations of our sample were weaker than
those in the validation exercise. In particular, the item-total
correlations in our sample ranged from 0.48 to 0.66, while
earlier results ranged from 0.57 to 0.74.40 This measure of

Table 5. Convergent Validity (Spearman Correlation) of Smartphone

Addiction Scale-Short Version and Its Subscales
SAS-SV SAS-SV SAS-SV
SAS-SV Factor 1: Factor 2: Factor 3:
Variable total score Dependence Problems Time spent
SAS-SV Factor 1: Dependence 0.76
SAS-SV Factor 2: Problems 0.90 0.51
SAS-SV Factor 3: Time spent 0.76 0.49 0.55
Time spent on smartphone per day (school day) 0.25 0.13 0.27 0.20
Time spent on smartphone per day (holiday) 0.32 0.16 0.35 0.23
Smart Device Addiction Screening Tool (n = 1,876) 0.59 0.40 0.55 0.49
Pittsburgh Sleep Quality Index (n = 1,708) 0.29 0.23 0.28 0.19
Multidimensional Scale of Perceived Social Support -0.10 -0.11 -0.09 -0.06 ( p = 0.009)
(n = 1,878)
Center for Epidemiological Study–Depression Children 0.35 0.33 0.30 0.22
(n = 1,768)
All Spearman correlations (except the one labeled above) were significant at 0.1 percent level.
 720 CHEUNG ET AL.

Table 6. Regression on Smartphone Addiction Scale-Short Version (n = 1,901)

Variable b (95% CI) p
Gender
Male Ref.
Female -1.66 (-2.63 to -0.69) 0.001
Caregiver’s education level
Have not received any formal education Ref.
Primary -4.97 (-9.87 to -0.07) 0.047
Secondary -5.74 (-10.50 to -0.98) 0.02
Tertiary or above -6.83 (-11.82 to -1.84) 0.007
Monthly household income (HK dollar)
<10,000 Ref.
10,000–19,999 -0.97 (-2.45 to 0.51) 0.20
20,000–29,999 -0.42 (-2.05 to 1.22) 0.62
30,000–39,999 -0.91 (-2.88 to 1.06) 0.37
40,000–49,999 0.01 (-2.47 to 2.48) 0.996
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50,000+ -0.57 (-3.14 to 2.00) 0.66

Age 0.01 (-0.25 to 0.27) 0.94
Minute spent on smartphone per day (school day) 0.005 (-0.002 to 0.01) 0.15
Minute spent on smartphone per day (holiday) 0.016 (0.012 to 0.021) <0.001

divergence led to our conducting a study of the psychometric
properties of our Chinese Hong Kong sample.
Study results suggest some participants have developed a
maladaptive dependency on, and obsessive-compulsive use
of, smartphones. Participants exhibited marked symptoms of
addiction such as loss of control and negative emotions
without a smartphone to hand. Our findings confirm previous
research.48 In this study, most of our participants seemed to
suffer from core symptoms of excessive smartphone use,
including (a) conflict: they used their phone, rather than
studying or working; (b) reinstatement: they were unable to
restrict their usage voluntarily; (c) behavioral salience: users’
behaviors were dominated by their smartphones; and (d)
withdrawal: they were unhappily separated from their phones—
all striking findings matching earlier observations.42,49,50
Gender differences and addiction factors in excessive
smartphone use
We found femininity in our cohort significantly associated
with smartphone overuse. Girls particularly became more
addicted to phones than boys in conditions of stress.35 This
may be because girls used phones for intrinsic, not instru-
mental, reasons.51 Adolescent girls used phones to regulate
mood21—a motivation also found in a problematic degree of
Internet use.52,53
Excessive smartphone use, sleep quality,
and depression
Previous studies suggest that excessive smartphone use is
closely associated with sleep disturbance.24,54–56 Adolescents
are recommended 9 hours’ sleep a night.57 However, this study
cohort had an average sleep duration of 8.5 hours. Participants
spent 2 hours on average on smartphones during weekdays,
increasing to 4 hours on days off. Long hours of smartphone
usage may shorten and worsen sleep, leading to daytime
sleepiness.1,24 Poor sleep may negatively impact young peo-
ple’s alertness, cognitive functioning, and mood,58,59 weaken-
ing young people’s immune systems and inducing headaches,
distractibility, and vulnerability to depression.1,60–63 Separately
from sleep disturbance, excessive smartphone use may also
contribute to depression through effects on self-perceived
mental health,12,64–66 for instance, by forcing unflattering
comparisons between users and apparently happier social me-
dia counterparts.1,67,68 Smartphone overuse may further in-
crease the risk of victimization through cyberbullying.69,70
Excessive smartphone use and educational attainment
among family caregivers
This study finds that caregivers’ educational attainment is
connected to excessive smartphone use in adolescents. This
finding of a positive association matches that of a recent
study71; other work has found parents’ educational attain-
ment significantly predicts children’s problematic smart-
phone use.72,73 The association could obtain because parents
are busy with their jobs and neglect children, or because they
push them to study, meaning adolescents are on their phone
both accessing educational apps and taking refuge with
friends from education.
Excessive smartphone use and social support
Excessive smartphone use, for the study, is negatively
correlated with MSPSS. In other words, subjects who per-
ceive themselves as having less social support are more de-
pendent on their phones. Adolescents, especially girls, may
perceive networks as a medium to increase their social
presence,74 social capital, and perceived social support from
family75 and friends.76 In using phones as platforms for so-
cial connections, some adolescents could go too far and turn
to networks to appease insecurities.77
Limitations of the study
The fact that the study’s findings emerged from cross-
sectional data means that causality (between smartphone
overuse and risk factors) cannot be established. The use of
self-report questionnaires is also subject to underestima-
tion or overestimation of participants’ smartphone usage.
 VALIDATION OF CHINESE SAS-SV
Children filling in questionnaires in their teachers’ presence
may distort reports in accordance with a social desirability
bias.
Implications of the study
Smartphones are convenient and offer an array of services,
leading to their growing adoption in Asia. It is important,
given the risks of ‘‘addiction,’’ to raise awareness of the
hazards of excessive smartphone use. Our results suggested
that an individual may be addicted to her smartphone usage if
she (or he) uses a phone for entertainment, to stave off
feelings of depression or inadequacy, and to avoid peer
disapproval. In preventing addiction, it is vital to take gender
differences into account in crafting pre-emptive programs.
Our results indicate that female adolescents are more vul-
nerable to smartphone overuse, suggesting a need to develop
Downloaded by STOCKHOLMS UNIVERSITET from www.liebertpub.com at 11/10/19. For personal use only.
gender-specific interventions aimed to get girls away from
their phones.
Conclusion
The SAS-SV is a valid scale for measuring excessive
smartphone use among children and adolescents. From a
public health perspective, it is important to educate adoles-
cents on the risks of overusing smartphones. There is a need
for further research on adolescents’ behaviors in using
smartphones excessively, and in these behaviors’ drivers and
consequences.
Acknowledgments
The authors would like to thank Miss Ki Chu (Hong Kong
Polytechnic University) for data collection and data man-
agement of this study.
Compliance with Ethical Standards
Informed consent was obtained from all individual par-
ticipants and their main caregivers included in the study.
This study was approved by the Human Subjects Ethics
Review Committee of the Hong Kong Polytechnic Uni-
versity (Reference No. HSEARS20151121001).
Author Disclosure Statement
No competing financial interests exist.
Funding Information
The Food and Health Bureau of the Hong Kong Special
Administrative Region, China, provided financial support in
the form of a grant from the Health and Medical Research
Fund (Ref 13144041). The sponsor had no role in designing
or conducting this research.
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Address correspondence to:
Dr. Paul H. Lee
School of Nursing
Hong Kong Polytechnic University
GH527
Hung Hom
Kowloon
Hong Kong
E-mail: paul.h.lee@polyu.edu.hk