Journal of Technology in Behavioral Science (2022) 7:130–140 https://doi.org/10.1007/s41347-021-00228-0 Perceptions of the Uses of Cell Phones and Their Impact on the Health of Early Adolescents in Barcelona: a Qualitative Study Marc Olivella‑Cirici1,2 · Esther Sánchez‑Ledesma1 · Xavier Continente1,3,4 · Catrina Clotas1 · Glòria Perez1,2,3,4 Received: 4 March 2021 / Revised: 30 August 2021 / Accepted: 7 October 2021 / Published online: 17 November 2021 © The Author(s) 2021 Abstract The use of cell phones and video games has transformed rapidly in adolescents, posing a challenge for the scientific com- munity. Using qualitative methodology and a socioconstructivist perspective, we identified perceptions and beliefs about the different uses of cell phones and video games and their relationship with the health and wellbeing of the adolescent population of Barcelona. From an analysis of discussion groups among early adolescents (n = 66 students aged 13–14 years, segmented by gender and socioeconomic level of the school neighborhood), information was obtained on (i) digital devices and their uses, (ii) the determinants of the uses of cell phones and video games, and (iii) the relationship between possible problem- atic uses and health and wellbeing. Responsible and problematic uses were identified. Problematic use was associated with compensation for social deficits and sometimes with dependency on the device. Differences were identified by gender (boys preferred video games and girls’ social networks). The adolescents were aware of the possible negative impacts on their health associated with problematic use of cell phones and video games and highlighted a lack of critical education in digital skills. Keywords Qualitative methods · Cell phone use · Behavior · Addictive · Adolescent · Mental health · Habits Introduction phone use is highly prevalent (approximately 50%) among youth in Barcelona (Santamariña-Rubio et al., 2017). A Digital and electronic devices have become an indispensable recent study confirmed that there are contextual and indi- part of everyday life for people around the world. Devices vidual factors such as impaired family relationships and poor with screens provide the population with fast and frequent mental health that are associated with problematic cell use, access to many sources of information, communication, and with a greater magnitude among girls (Olivella et al., 2020). entertainment (Anderson et al., 2016). This is especially The study of the problematic cell phone use is a major important for adolescents, given their intimate integration concern among public health professionals worldwide (Van in their habits and lifestyles (Bailin et al., 2014). This carries Velthoven et al., 2018). It has even been postulated as the both risks and benefits for the health and wellbeing of ado- most important socioaddiction of the twenty-first century lescents (Bailin et al., 2014). Some studies indicate that inap- (Shambare, 2012), although, currently, only pathological propriate use of these devices can encourage the appearance gambling or gambling disorder is recognized by the scien- of mental health problems such as anxiety, chronic stress, tific community (American Psychiatric Association (APA), and depression (Augner & Hacker, 2011). Problematic cell 2017). The absence of other similar disorders is explained by insufficient scientific evidence (American Psychiatric Association (APA), 2017). This entails the use of alterna- * Glòria Perez tive terms to “addiction” or “disorder” such as “problem- gperez@aspb.cat atic use” or “dependency” (Griffiths, 2014) or the creation 1 Barcelona Agency of Public Health, Barcelona, Spain of new terms to describe the dependence on cell phones 2 such as “nomophobia,” which is the fear of being out of cell Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain phone contact, also called “fear of missing out (FOMO)” 3 (Abdullah, 2017). The lack of uniformity in the definition Biomedical Research Institute Saint Pau, Barcelona, Spain carries a risk of pathologization and stigmatization of com- 4 CIBER of Epidemiology and Public Health (CIBERESP), mon behaviors and daily leisure activities in the adolescent Madrid, Spain 13 Journal of Technology in Behavioral Science (2022) 7:130–140 131 population (Abdullah, 2017). In addition, for individuals To select the four participating public schools, we con- outside the at-risk population, the behavior can provide ducted convenience sampling stratified by the socioeco- various benefits for both mental health and socialization nomic status (SES) of the neighborhood. Half of the schools (Kardefelt-Winther et al., 2017; Liu et al., 2015). were from advantaged SES and a half from disadvantaged Knowledge of excessive and repetitive behaviors is cur- SES, which are neighborhoods with a higher index of socio- rently restricted within the theoretical boundaries of sub- economic deprivation. The inclusion criteria of the groups stance addictions (Kardefelt-Winther et al., 2017), focus- were girls and boys in the 8th grade in the 2019–2020 aca- ing on individual effects and ignoring contextual factors demic years who were willing to participate and who signed (Anderson et al., 2016). For example, the academic and an informed consent document. Four schools from the city of socioeconomic context must be considered because many Barcelona participated. Participants were recruited through uses depend on academic and/or social demands (Panova & key informants from each educational center (coordinators Carbonell, 2018). At home, multiscreen environments and of the educational center and tutors). To achieve variety and the influence of socioeconomic conditions can aid family discursive diversity, gender was considered a segmentation reconciliations, but at the same time as they can become a variable within each school. The maximum possible hetero- source of conflict and concern (Michavila et al., 2018). Some geneity was prioritized within the discussion groups. studies have highlighted how the values of certain cultures are reflected and expressed in digital behavior (Khattab & Information Collection and Data Analysis Love, 2008). Thus, analysis of the social construct should include motivations and behaviors rather than solely focus- Eight discussion groups were held (two in each school, ing on the biological components of the addiction (Abdullah, one for boys and one for girls). In each group, interaction 2017; Panova & Carbonell, 2018). between participants was facilitated by a study volunteer to Quantitative studies to date do not identify causes of dis- explore a variety to topics. A total of 66 early adolescents ordered use of cell phones or video games (Fargues et al., (56.1% girls and 48.5% with disadvantaged SES) divided 2009) due to limitations related to the specific responses into groups of between 7 and 11 students participated in given to surveys (Scharkow, 2016). These findings highlight the discussion groups. The characteristics of the groups are the need to use a qualitative methodology that overcomes presented in Table 1. the limitations of the quantitative analyses carried out so far. The groups were held for approximately one hour and This study aimed to identify and describe knowledge were moderated by the same facilitator (MO) together with of the different uses of cell phones and video games and a non-participating observer, who differed among groups. to explore possible determinants in early adolescents The discussion guide (see Appendix 1) was semi-structured aged 13–14 years and segmented by gender. The relation- and open to incorporating new topics that might arise from ship between perceptions of the problematic use of cell group discussions. All groups were audio-recorded for later phones and video games and health and wellbeing was also literal transcription. The transcripts were completed with a analyzed. contextualization of the conversations (spaces, relationships between the participants and beliefs related to the ideas, ste- reotypes and prejudices of the interactions). Subsequently, we performed a thematic analysis of the content of the dis- Methods course of the discussion groups. The category generation Design, Sampling, and Recruitment Strategy Table 1  Description of the sample We conducted a qualitative explanatory study from a socio- Group Gender Socioeconomic status of the Participants constructionist perspective (Dew, 2007). Explanations on school neighborhood the uses of cell phones and video games are social and were 1 Male Disadvantaged 7 collectively generated by holding discussion groups as a 2 Female Disadvantaged 9 technique for information collection. The discourse of the 3 Male Advantaged 8 study groups generated a construct with multiple meanings 4 Female Advantaged 11 and realities, which was interpreted by considering the con- 5 Female Disadvantaged 9 text and an interpretive generative theory based on the inter- 6 Male Disadvantaged 7 nal meaning of language (Berenguera et al., 2014). We also 7 Female Advantaged 8 analyzed the social meanings that may or may not question 8 Male Advantaged 7 the dominant culture and the social conventions assumed Total 66 by adolescents. 13 Vol.:(0123456789) 132 Journal of Technology in Behavioral Science (2022) 7:130–140 process was mostly inductive. Three people from the work- applications, connected to the Internet and designed for ing group (MO, GP, ES) carried out the triangulation of the social interaction. Instagram, TikTok, WhatsApp, Twitter, results and the content analysis. This study was approved by and YouTube were identified as social networks that perform the Research Ethics Committee with medicines from the Parc an important social function, placing users in a social hier- de Salut MAR, code no. 2020/9410). archy (e.g., “People believe that your Instagram accounts defines who you are. For example, if you have 150 followers, then they’ll call you a loser, but if you have 1000 or 2000 Results then you are popular” boy, disadvantaged SES). Through social networks, adolescents can express themselves, make Three thematic categories were obtained from the adoles- their experiences public, meet other people, learn, or even cents’ discourse: (i) digital devices and their uses, (ii) the get a job. Participants believed that digital devices were an determinants of cell phone and video game uses, and (iii) indispensable part of their lives, especially among some of problematic cell phone and video game use, health, and the girls from disadvantaged SES neighborhoods. The use wellbeing. The main results, obtained from the adolescents’ of devices for different purposes was a normalized behavior perceptions and beliefs, are presented in Table 2. The results and formed a greater or lesser part of participants’ daily and discussion of the additional topic “addressing problem- lives. atic cell phone and video game use” are shown in Appendix 2. There Are Good and Bad Uses of Digital Devices That Differ by Gender Topic 1: Digital Devices and Their Uses All adolescents agreed that cell phone and video game use Digital Devices Are Part of the Daily Lives of Early differed by gender, reflecting real-life roles, although they Adolescents hoped that, one day, this phenomenon would be reversed. Most girls reported that they tended to use social media to Participants highlighted the communicative, educational, interact with other people and gossip. They stated that they and entertainment uses of digital devices, through different wanted to have control, a return from their investment in Table 2  Main results of the perceptions and beliefs of adolescents about cell phone and video game use, distributed by topic Topic 1: digital devices and their uses Cell phones are mainly used for communication, education, and entertainment Social networks are applications that can rank users in a social hierarchy Cell phones and video game use is ubiquitous in adolescent life and is even indispensable for some girls from disadvantaged backgrounds Use differs by gender: boys tend to play video games and girls tend to use social networks Problematic use can be due to excessive viewing or misuse of the device's content Responsible use is feasible with good management of viewing hours and considered use of the device Topic 2: the determinants of cell phone and video game uses Individual determinants such as an affective deficit or poor mental health can explain the use of cell phones or video games for social and emo- tional compensation Boredom and poor free time management can lead to cell phone and video game use Idols or “influencers” encourage social and gender pressure and create false expectations regarding cell phone and video game use Family socialization and educational factors at school may be related to future problematic use Large companies have economic interests and use intrinsic mechanisms of the devices that promote cell phone and video game use Topic 3: problematic use of cell phones and video games, health, and well-being Cell phone and video game use can have a (negative) impact on the health and well-being of the young population Conflicts created by problematic use are frequent and may be encouraged by the virtual barrier Adolescents can change their habits with a tendency to give up domestic, social, academic, and sports activities Problematic use can lead to changes in personality and mood, which can affect adolescents’ mental health or lead to highly serious situations such as cyberbullying Trying to follow “influencers” can affect the self-esteem of the adolescent population, favor the appearance of eating disorders, promote self- harm, and even lead to suicide attempts Blindness, headache and/or back pain, problems due to a sedentary lifestyle, or accidents may be due to problematic use There can be a feeling of compulsive dependence on cell phones and video games, similar to use of addictive substances 13 Journal of Technology in Behavioral Science (2022) 7:130–140 133 virtual activity or a reward, and were concerned about what for an affective deficit or low levels of emotional wellbeing, was said about them on the networks (e.g., “You have to by providing social or emotional contact. spend hours being connected to collect the “fruits” of what In some cases, screen use was an attempt to avoid reality you are posting” girl, advantaged SES). Girls reported that and its associated problems. In others, it was to fulfill a need they were more glued than boys on applications such as for contact with others or entertainment and fun. Screen use TikTok and Instagram, although some believed that their was often prompted by boredom, and participants were use of digital devices was more varied than that of boys. aware of their difficulty in managing their free time, in which Many girls stated that they sought to increase their social cell phones and video games were usually their preferred acceptance and popularity through networks and also used option. They also believed that altering their routines could them to flirt and follow fashions. Boys, in contrast, spent be the first step in developing problematic use: hours in front of screens playing video games, which they “I admit it, that in summer, since I have no obligations, believed were designed for them because they claimed to I change my schedule and during the day I sleep, I’m be more competitive than girls. Some participants from dis- like an owl, during the day I sleep and at night I play” advantaged backgrounds stated that boys and girl naturally (boy, disadvantaged SES). had different priorities and points of view. Finally, for many girls, carrying a cell phone increased their safety when they Influencers Create False Expectations Among Early were not at home. Adolescents Adolescents believed that problematic use of cell phones and video games took two main forms: (i) excessive viewing According to adolescents, an idol is a person who may be of series and social networks for entertainment or abusive known—such as their own friends—or not—such as famous use of video games, which were closely related to boredom people, YouTubers, or “influencers”—who affect their pref- “addiction,” and (ii) the misuse of the content of the device, erences, making them want to be more popular, famous, or for example, playing aggressive or highly competitive video earn money (e.g., “I think there are idols who can be famous, games. Some participants believed that gossiping and watch- friends or whoever. People tend to be equal to them and want ing movies or pornography were examples of problematic to do the same to be able to say they have done it and this uses, as well as using social media to feign and “pose” ends with a bad habit or addiction” boy, advantaged SES). (e.g., “People use networks as a fake life, just to pretend to Influencers were mostly female figures in social networks be something that they are not” girl, disadvantaged SES). and male figures in video games, perpetuating different use Another example was violating the privacy of third parties or by gender and a social norm that was difficult for partici- offending people with sensitive content that could provoke pants to question. They believed that there was social pres- confrontation or controversy. sure to be permanently connected to their peers (e.g., “If I Adolescents also believed that cell phones and video now meet someone and that person has their cell phone on games could be used responsibly, with good screen time them, I’ll also use it. It’s like a pressure to be constantly management. As examples of good uses, they mentioned viewing the screen” girl, advantaged SES). Some partici- storing memories and experiences, doing homework and pants from a more advantaged background recognized that studying, looking for information, listening to songs to the effect of this social pressure differed by gender, socially learn languages, engaging in stress control, making money, promoting those people whose uses were expected according improving personal skills, interacting socially, and enjoying to their gender. communicating with relatives who lived abroad, especially among adolescents from disadvantaged environments. Education and the Family Environment as Determining “Using it well means not being like this all day [staring Factors in Device Use at the cell phone]. But only using it occasionally and doing things that seem useful” (girl, advantaged SES). Participants believed that educational factors, such as family socialization, were related to problematic use of cell phones Topic 2: Determinants of Mobile Phone and Video and video games (e.g., “If we see that our parents are very Game Uses addicted, we’ll see that this is normal and when we grow up we’ll normalize this. Therefore, we’ll be very addicted Boredom, Social Compensation, and Avoidance of Reality too” boy, advantaged SES). In addition, participants from Through Screens an advantaged environment believed that this led to differ- ences in use by gender, with families having a responsibility Adolescents believed that problematic use can be determined to bring up their offspring in an inclusive way. They also by various individual factors. Screen use could compensate believed that easy access at home and the use of cell phones 13 134 Journal of Technology in Behavioral Science (2022) 7:130–140 and video games use in childhood encouraged the develop- and he or she already knows what you do on Fridays ment of future problematic use: (…)” (girl, advantaged SES). “If I’m a child and I see my father fixing something Problematic Use Can Impact Habits and Interfere with a hammer, later I’ll like it more. If I’m a girl and with Academic Life I see my mother or my sister putting on makeup, then I’ll do the same. As you get older, you copy what the Many adolescents associated problematic use with a change grown-ups do” (boy, advantaged SES). in their routine and a loss of time control, a tendency to forget personal care, loss of autonomy, or discontinuation of Structural Factors Behind Cell Phone and Video Game Use domestic and care work. Some used cell phones and video in Early Adolescents games to the detriment of other activities, thus encouraging social isolation, loss of quality of personal relationships, a Some adolescents from a more advantaged environment sedentary lifestyle, and lack of sleep: were aware of the existence of companies behind the screens, promoting their use despite knowing about problematic “There’s no time to stop, you can stay there a whole behaviors. The pressure of fashion and the lack of informa- night without sleep and the next day be like a zombie” tion on how to engage in responsible use were explained by (boy, disadvantaged SES). interests and economic factors (e.g., “The people who sell In the academic environment, participants reported that, the devices don’t say how to use them properly because they because cell phone use requires almost no effort, in the want us to be more and more absorbed” boy, advantaged academic setting, their ability to reason and concentration, SES). According to these adolescents, the devices contain among other skills and abilities, was limited, leading to aca- intrinsic devices to provoke dependent behaviors, rewarding demic failure and dropping out. the most loyal users with a better virtual and social position. Possible Disturbances in Emotional Wellbeing Related Topic 3: Problematic Use of Cell Phones and Video to Problematic Use Games, Health, and Wellbeing Some adolescents believed that problematic use could lead Early Adolescents Have Strong Awareness of the Possible to changes in personality and mood, provoking anger, sad- Negative Impact of Problematic Use ness, or frustration when something does not go according to plan, as well as stress and anxiety. Likewise, bad expe- In general, participants were self-critical, recognizing that riences, such as public humiliation or finding little social their behavior was sometimes negatively changed in the acceptance in the networks, could negatively impact mental absence of cell phones and video games. In addition, they health. stated that seeing aggressive content could lead them to Participants believed that social networks could also develop more aggressive and competitive behaviors with the affect self-esteem in adolescents seeking to be equal to influ- people around them, creating conflicts, sometimes highly encers or to follow implicit beauty ideals, encouraging the frequent, and that could be related to a false sense of protec- appearance of eating disorders, especially among girls. In tion, accentuated by the virtual barrier. The causes of con- the most serious cases, it could lead to self-harm and suicide flicts could be diverse: sending compromised photographs attempts. to third parties, losing a video game, misunderstandings through chats, or the expression of different opinions on the “People say ‘oh, what a pretty girl!’ and I’m not like network. The participants believed that it was easier to reach that … anorexics are because they see a lot of people agreements in person than virtually and that these conflicts who are pretty and delicate [on social networks] and could harm family relationships and friendships. they want to be like that, they stop eating, they feel bad Not knowing who was behind the screen provoked inse- and self-harm and things like that, by wanting to be curities and participants believed that it encouraged a loss what they’re not” (girl, disadvantaged SES). of privacy, scams, identity theft, and false rumors, which In addition, participants linked problematic use with could lead to cyberbullying situations and even cases of health problems such as blindness and even epilepsy. They pedophilia: also believed that screen use could lead to headaches and/ “You post a photo in the school and a person who fol- or back pain and problems due to a sedentary lifestyle. In lows you and who has made a false account already addition, they pointed out that the distraction of cell phones knows where you study … you post a photo in the park and video games could lead to accidents. Some participants 13 Journal of Technology in Behavioral Science (2022) 7:130–140 135 believed that the waves emitted by the devices were harmful influencers, social pressure—which differed by gender- to health. family socialization and economic interests, also influ- enced cell phone and video game uses. The participants Dependence on Devices and Similarities and Differences were aware of the impact of problematic use on their with Other Addictions health and wellbeing. They reported that it could change their behavior and habits, encourage conflicts, affect their Another concern of study participants, especially girls, was self-esteem and mental health, and harm their academic the feeling of dependence on some content on cell phones performance and relationships with the environment, and video games that could cause obsessive and compulsive among other effects. They even compared compulsive use and resulted from deficient time management (e.g., “I dependence on some screen content with use of addictive swear that I have a problem, because there are times when substances. I’m with my cell phone and I get bored with it. And I don’t care, I keep using it!” girl, advantaged SES). In some cases, the adolescents used the concept of “addiction” to define a Integration of the Cell phone and Video Games Use problematic relationship with social networks, video games, in Adolescent Life and online shopping or gambling. These participants admit- ted that their cell phone was their main source of fun and Male participants reported that they played more video that they often did not realize they had a problem until they games and watched more videos while girls more fre- had a bad experience. quently used social networks to interact with their peer Some adolescents identified certain similarities between group or share experiences. Previous qualitative (Godsell substance addiction and problematic cell phone and video & White, 2019) and quantitative (Lee & Kim, 2018) stud- game use, but also differences. For example, they believed ies identified the different use of cell phones and video that drugs were more difficult to give up and that they served games by gender as a reflection of the psychophysiologi- no useful purpose, unlike electronic devices, which they cal, psychological, and social development demands of believed to have good uses as well as bad. Another differ- each gender (Punamäki et al., 2007). ence was in education because, unlike substance addition, The adolescents in this study believed that responsible problematic uses of cell phones and video games were not use of the cell phone and video games was feasible as addressed in class, which led to ignorance about their effects they could be useful for many aspects of their lives. Most on health and wellbeing. Finally, at a structural level, drug- girls reported that moderate use of social networks to com- taking is penalized with laws and regulations, but cell phone municate with their friends was harmless and could even and video game use is encouraged, highly accessible and provide benefits. In this regard, there is currently no evi- socially acceptable: dence showing that moderate Internet use is detrimental to the adolescent brain (Mills, 2014). Some boys stated that “Cell phones and video games are more legalized than video games could provide advantages. Evidence suggests drugs. And you can order or buy a cell phone but you that playing action video games produces a small improve- cannot legally buy drugs” (boy, advantaged SES). ment in neuropsychological performance (Bisoglio et al., 2014; Powers et al., 2013). Generalizations about video games are often not helpful because cooperative multi- Discussion player games are becoming more common, and research suggests that these types of games may favor socially ben- The results of this study allowed us to identify in greater eficial behaviors (Granic et al., 2014). This benefit was depth the uses of cell phones and video games and their also detected by some of our participants. Thus, the type determinants. The relationship between problematic use of content viewed and mode of play is important for the and the health and wellbeing of early adolescents in an potential for emotional and behavioral influence of video urban setting was also described. The boys and girls par- games (Bell et al., 2015). ticipating in the study stated that cell phones and video However, adolescents believed that there were two main games were becoming an increasingly important part types of problematic use: (i) overuse and (ii) misuse of of their daily lives. Their uses could be responsible and device content, such as playing aggressive or highly com- appropriate, with various benefits, but could also become petitive games. There is evidence of a small and transitory problematic. According to the participants, problematic increase in aggressive thoughts and behaviors when viewing use of cell phones and video games was related to psy- certain video games (Anderson et al., 2010), although there chosocial factors such as social deficits or low levels of is still debate about the quality of the evidence supporting emotional wellbeing. Other factors, such as the effect of this claim (Elson & Ferguson, 2014). 13 136 Journal of Technology in Behavioral Science (2022) 7:130–140 Social Determinants of Problematic Use of Cell and girls participating in this study also identified overinfor- Phones and Video Games mation and the use of notifications as an intrinsic attraction strategy by devices. This combination of factors causes a The adolescents in this study believed that the roots of prob- synergistic amplification stimulating cortisol release, which lematic use may lie in a social compensation mechanism due generates stress in the user and triggers a “self-medication” to an intense need to interact with their peers. Greenfield response to interact with the device (Kaess et al., 2017). The (2018) states that we are programmed for social connec- consequent dopamine release has been shown to be stronger tion, and when deprived of it, we tend to consume a drug or with anticipation of the reward caused by notifications than behavior that “medicates” this need. Previous studies have with the reward itself after consulting the device (Bibbey proposed that social isolation is strongly associated with the et al., 2015). appearance of behavioral disorders, with virtual communi- cation being a “pseudo-connection” with the environment Some Cell Phone and Video Games Uses Can Impact (Alexander, 2012). This was echoed by some participants in Early Adolescents’ Health and Wellbeing this study since, despite spending many hours connected to the Internet, they reported that the communication experi- Study participants reported a high degree of awareness of ence was worse than in face-to-face relationships. The use the risks of problematic use to their health and wellbeing. of smartphones for games and social networks has been Opinions varied about what best defined problematic use: (i) described as a risk factor for problematic use; in contrast, the number of hours of viewing digital content or (ii) the way maintaining strong friendships, both in the face-to-face and devices were used. The evidence shows that both factors— virtual environments, can be a protective factor (Fischer- both intensity and modality of device use—can influence Grote et al., 2019). the causal pathways leading to mental health problems In this study, adolescents highlighted the figure of idols in university students (Višnjić et al., 2018). In this study, or “influencers,” users of social networks who become role some girls from advantaged backgrounds questioned the models (Ratwatte & Mattacola, 2019). These figures gained link between the amount of time the adolescent population the trust and friendship of their followers by designing spends in front of screens and impairment of their general visual content focused on an ideal body shape with specific wellbeing. One study has correlated screen viewing with the communication and advertising techniques (Pilgrim & health of the user (Twenge et al., 2020a, b) while, in contrast, Bohnet-Joschko, 2019). Thus, adolescents identify with another has questioned the link (Orben & Przybylski, 2019). the roles and ideals shown on social networks, and their For the participating boys and girls, the screen acted as needs are modulated, creating a relationship of dependency a barrier that allowed them to develop an alter-ego state, between influencers and their followers (Pilgrim & Bohnet- enabling them to dare to express themselves and experience Joschko, 2019). various functions. This may be due to the anonymity per- The adolescents in this study believed that the develop- ceived by the user (Greenfield, 2018) and, in part, to less ment of problematic use often depended on the character- access to the functions of the orbitofrontal area of the brain istics of each person. In this regard, the risk of problem- where the inhibitory circuits are located, producing a disin- atic use seems to be increased by low self-esteem and poor hibiting effect in the user (Griffiths et al., 2016). self-control and to be reduced by academic motivation and Adolescents in this study identified various changes in success at school (Fischer-Grote et al., 2019). In this study, their daily habits due to problematic use: time distortion, in adolescents believed that the family and educational envi- which use for entertainment hindered their ability to manage ronment significantly influenced their cell phone and video time, and produced lifestyle changes and behavior deficits game use, with observable differences by gender and access. (Greenfield, 2018). One of the consequences reported by Ease of access to devices has been shown to activate the the study participants was a sedentary lifestyle. Low levels mesolimbic brain pathways that promote compulsive use of physical activity associated with passive cell phone and impulses (Griffiths et al., 2016). video game use have been linked to obesity and diabetes Adolescents from a more advantaged environment were (Saunders et al., 2014), as well as to elevated cortisol levels, aware of the economic interests behind screens. In their hypertension, deep vein thrombosis, and electrolyte imbal- opinion, companies sought to gain their permanent atten- ances (Bibbey et al., 2015; Reed et al., 2015). tion by promoting social reward mechanisms to the most Study participants reported that their sleeping habits loyal users. This could create a compulsive need for valida- were negatively affected, which they associated with greater tion, especially on social media and video games. This use is fatigue during waking time. Previous studies have reported associated with an excessive release of dopamine in the mes- that cell phone and video game use before going to bed was olimbic system, causing disinhibition in the user and, conse- associated with shorter sleep duration and lower quality quently, more compulsive use (Brand et al., 2014). The boys (Continente et al., 2016; Thomée, 2018). This alteration 13 Journal of Technology in Behavioral Science (2022) 7:130–140 137 has been associated with perceived poor health (Punamäki in frequent problematic cell phone use (Olivella et al., 2020; et al., 2007) and with problematic cell phone use (Olivella Santamariña-Rubio et al., 2017). In this study, we detected et al., 2020). A common obstacle to sleeping is distractions broad expansion of the problem, which was becoming highly from screens. Godsell and White (2019) reported that some normalized in groups from disadvantaged environments. girls had an anxious dependence on cell phones at night and Unlike substance addictions, there is little consensus on that families played a key role in creating rules to ensure how to measure a possible addiction to cell phones or video healthy sleep. It has also been shown that a strong predictor games and the specific threshold to be used in the assess- of high-stress levels is keeping the cell phone less than 1 m ment of hypothetical patients (Andreassen, 2015), since the away during sleep (Višnjić et al., 2018). ubiquitous use of devices in the lives of adolescents could Other consequences reported in this study that have been produce numerous false positives (Maraz et al., 2015). described in previous studies (Greenfield, 2018) were intol- Additionally, problematic use is accepted within adolescent erance to boredom, stress due to constant alertness, social digital culture and society in general, which could further isolation, and attention deficits. exacerbate denial of a potential disorder. Cell phones and Participants believed that academic impairment could video games are seen as a vital social and personal acces- also occur if cell phones and video games were not used sory and can be personified as a digital member of the family properly. One study has reported that, when people know (Greenfield, 2018). they can access information through search engines, they are less likely to remember the content (Sparrow et al., 2011). Strengths and Limitations For video games, it has been reported that impaired school performance can be explained by displacement of after- To our knowledge, this is one of the first studies that addresses school activities with academic value (Weis & Cerankosky, cell phone and video game use in early adolescents from a 2010). Problematic use can also impact motivation, reward, socioconstructionist approach in Barcelona and Spain. Unlike memory, and various aspects of psychological functioning other studies, a pathologizing view of common behaviors in (Greenfield, 2018). adolescents has been avoided. This has allowed the collection The dependence on influencers that, in turn, affected and interpretation of the concerns, needs, beliefs, and adolescents’ beliefs and expectations led them to identify perceptions of early adolescents, from different backgrounds, in diet and exercise as factors that needed to be controlled for relation to cell phone and video game use from a comprehensive bodily perfection. They reported that these figures had the approach, including the conceptualization of this phenomenon ability to change their habits and even their expectations and its determinants and description of the impact of problematic and their view of themselves. The concept “Fitspiration” has use on their health and wellbeing. In addition, the groups were been used to describe problematic behaviors that negatively segmented by gender and the SES of the neighborhood where impact the health and wellbeing of people who follow “fit- the school was located. Another strength is that the performance ness” and beauty models (Raggatt et al., 2018). Optimiz- and observation of the discussions were carried out by young ing appearance is seen as the key to happiness (Pilgrim & people, which may have facilitated the emergence of discourse Bohnet-Joschko, 2019). According to the adolescents in this due to the generational proximity. In addition, focusing the study, this leads to eating disorders and other mental health discussion on adolescents in the 8th grade (13 and 14 years old) problems and, in extreme cases, to suicide, a finding also provided us with valuable information to design preventive reported in a previous study (Twenge et al., 2020a, b). interventions on the responsible use of cell phones and video Most of the participating boys and girls believed in the games that were designed with young people in mind. existence of behavioral addiction to cell phones and video This study also has some limitations. The breadth of the games. The existence of addiction has been reported in topics addressed during the groups and the still imprecise some studies (Griffiths et al., 2016) but questioned in others conceptualization of the phenomenon prevented us from (Zendle & Bowden-Jones, 2019), and there have been pro- dealing in depth with some critical issues, such as cyber- posals to move away from the concept of addiction for the bullying and other uses that could lead to problems such as study of this phenomenon (Panova & Carbonell, 2018). To shopping and betting online or viewing pornography. These date, the WHO and the American Psychological Association issues should be addressed in more detail in future stud- (APA) do not accept the inclusion of this addiction (World ies. However, each discussion group had some freedom and Health Organization, 2020; American Psychiatric Associa- flexibility to focus their discourse on the topics that seemed tion (APA), 2017). most relevant to participants. Another limitation is that the The discourse of the girls in this study showed more prob- facilitator was a man, which may have represented a barrier lematic use than that of the boys, which is consistent with in the groups of girls regarding the expression of certain the evidence (Fischer-Grote et al., 2019). In Barcelona, 3.2% discussion topics. However, this fact could have also boosted of boys and 4.7% of girls in the 8th grade reported engaging group discussions in the group of boys. 13 138 Journal of Technology in Behavioral Science (2022) 7:130–140 Conclusions Funding Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Cell phone and video game use is a normalized and ubiquitous behavior in the daily lives of early adolescents. It has been Declarations described how responsible use has its benefits. Nevertheless, Conflict of Interest The authors declare no competing interests. there are also problematic uses, which differ by gender: boys are more likely to abuse video games and videos while girls more Open Access This article is licensed under a Creative Commons Attri- frequently have problems associated with social networks. The bution 4.0 International License, which permits use, sharing, adapta- opinions collected in this study could help determine the border tion, distribution and reproduction in any medium or format, as long between normal behavior and a possible behavioral disorder. as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes Various factors such as low levels of emotional wellbeing, the were made. The images or other third party material in this article are influence of idols, social pressure—which differs by gender, included in the article's Creative Commons licence, unless indicated family socialization, and the economic interests of large otherwise in a credit line to the material. If material is not included in companies—are related to the problematic use of cell phone and the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will video games. These factors can alter the behavior and habits of need to obtain permission directly from the copyright holder. To view a early adolescents and even cause conflicts that affect their self- copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. esteem and life prospects. Early adolescents are highly aware of the impact of problematic use on their relationships and their academic performance, as well as on their health and wellbeing. The results of this study show the importance of taking into References account the youth perspective in the design and application of health policies and interventions that are more in line with Abdullah, M. (2017). Smartphone addiction: Critical issues. Global the perceptions of early adolescents and are less influenced by Journal Of Addiction & Rehabilitation Medicine, 4(5). https://​ doi.​org/​10.​19080/​gjarm.​2017.​04.​555646 institutional paternalism. Thus, future interventions should take Alexander, B. (2012). Addiction: The urgent need for a paradigm shift. as a starting point the needs and beliefs of cell phone and video Substance Use & Misuse, 47(13–14), 1475–1482. https://​doi.​org/​ game users. 10.​3109/​10826​084.​2012.​705681 American Psychiatric Association (APA). (2017). Diagnostic and sta- tistical manual of mental disorders (5th ed.). Washington DC. Anderson, C., Shibuya, A., Ihori, N., Swing, E., Bushman, B., & Ethical Considerations Sakamoto, A., et al. (2010). Violent video game effects on aggression, empathy, and prosocial behavior in Eastern and To guarantee the confidentiality of the informants of the Western countries: A meta-analytic review. Psychological discussion groups, in this study, the databases were anonymized Bulletin, 136(2), 151–173. https://​doi.​org/​10.​1037/​a0018​251 Anderson, E., Steen, E., & Stavropoulos, V. (2016). Internet use and based on the Organic Law on Protection of Personal Data (LO problematic internet use: A systematic review of longitudinal 3/2018). To participate in the discussion groups, the families of research trends in adolescence and emergent adulthood. Interna- the participating boys and girls signed an informed consent form tional Journal of Adolescence and Youth, 22(4), 430–454. https://​ in which the study was reported, and explicit consent was given doi.​org/​10.​1080/​02673​843.​2016.​12277​16 Andreassen, C. (2015). Online social network site addiction: A compre- for the authorization of the audio recording and its transcription. hensive review. Current Addiction Reports, 2(2), 175–184. https://​ Participation in the discussion groups was completely voluntary, doi.​org/​10.​1007/​s40429-​015-​0056-9 and the participants could leave the session at any time. The Augner, C., & Hacker, G. (2011). Associations between problematic narrative data obtained has only been processed for the purpose mobile phone use and psychological parameters in young adults. International Journal of Public Health, 57(2), 437–441. https://​ of the study objectives. This study was approved by the Research doi.​org/​10.​1007/​s00038-​011-​0234-z Ethics Committee with medicines from the Parc de Salut MAR Bailin, A., Milanaik, R., & Adesman, A. (2014). Health implications of new (code no. 2020/9410). age technologies for adolescents. Current Opinion in Pediatrics, 26(5), 605–619. https://​doi.​org/​10.​1097/​mop.​00000​00000​000140 Supplementary Information The online version contains supplemen- Bell, V., Bishop, D., & Przybylski, A. (2015). The debate over digital tary material available at https://d​ oi.o​ rg/1​ 0.1​ 007/s​ 41347-0​ 21-0​ 0228-0. technology and young people. BMJ, h3064. https://​doi.​org/​10.​ 1136/​bmj.​h3064 Berenguera, A., Fernández de Sanmamed, M. J., Pons, M., Pujol, E., Acknowledgements This study was made possible due to the involve- Rodríguez, D., & Saura, S. (2014) Escuchar, observar y comprender. ment of the working group on youth health, cell phones, and video Recuperando la narrativa en las Ciencias de la Salud. Aportaciones games of the Barcelona Public Health Agency and the work carried de la investigación cualitativa. Barcelona: Institut Universitari out by the nurses Andrea Bastida, Neus Ferrer, and the participating d’Investigació en Atenció Primària Jordi Gol (IDIAP J. Gol). educational centers. The authors also wish to thank Sara Permanyer, Bibbey, A., Phillips, A., Ginty, A., & Carroll, D. (2015). Problematic Alba Nieto, Montse Zayas, and Ferran Martínez for their participa- Internet use, excessive alcohol consumption, their comorbidity tion as observers of the discussion groups and to Gail Craigie for the and cardiovascular and cortisol reactions to acute psychological English revision. 13 Journal of Technology in Behavioral Science (2022) 7:130–140 139 stress in a student population. Journal of Behavioral Addictions, Journal of Sports Medicine, 50(20), 1252–1258. https://​doi.​org/​ 4(2), 44–52. https://​doi.​org/​10.​1556/​2006.4.​2015 10.​1136/​bjspo​rts-​2015-​095084 Bisoglio, J., Michaels, T. I., Mervis, J. E., & Ashinoff, B. K. (2014) Maraz, A., Király, O., & Demetrovics, Z. (2015). Commentary on: Cognitive enhancement through action video game training: Great Are we overpathologizing everyday life? A tenable blueprint for expectations require greater evidence. Frontiers in Psychology, 5. behavioral addiction research. Journal of Behavioral Addictions, https://​doi.​org/​10.​3389/​fpsyg.​2014.​00136 4(3), 151–154. https://​doi.​org/​10.​1556/​2006.4.​2015.​026 Brand, M., Young, K. S., & Laier, C. (2014) Prefrontal control and Michavila, N., Abad, M. J., & García, P. (2018). El impacto de las internet addiction: A theoretical model and review of neuropsy- pantallas en la vida familiar. Empantallados. GAD3. chological and neuroimaging findings. Frontiers in Human Neu- Mills, K. (2014). Effects of Internet use on the adolescent brain: roscience, 8. https://​doi.​org/​10.​3389/​fnhum.​2014.​00375 Despite popular claims, experimental evidence remains scarce. Continente, X., Pérez, A., Espelt, A., & López, M. J. (2016). Media Trends in Cognitive Sciences, 18(8), 385–387. https://​doi.​org/​10.​ devices, family relationships and sleep patterns among adoles- 1016/j.​tics.​2014.​04.​011 cents in an urban area. Sleep Medicine, 32, 28–35. https://​doi.o​ rg/​ Olivella, M., Continente, X., Bartroli, M., Serral, G., & Pérez, G. 10.​1016/j.​sleep.​2016.​04.​006 (2020). The problematic use of the mobile: A cross-sectional Dew, K. (2007). A health researcher’s guide to qualitative methodolo- analysis of the individual profile and associated factors. Interna- gies. Australian and New Zealand Journal of Public Health, 31(5), tional Journal Of Urban Health, (Submitted). 433–437. https://​doi.​org/​10.​1111/j.​1753-​6405.​2007.​00114.x Orben, A., & Przybylski, A. (2019). Screens, teens, and psycho- Elson, M., & Ferguson, C. (2014). Twenty-five years of research on logical well-being: Evidence from three time-use-diary studies. violence in digital games and aggression. European Psychologist, Psychological Science, 30(5), 682–696. https://​doi.​org/​10.​1177/​ 19(1), 33–46. https://​doi.​org/​10.​1027/​1016-​9040/​a0001​47 09567​97619​830329 Fargues, M., Chamarro Lusar, A., Graner Jordania, C., & Carbonell Panova, T., & Carbonell, X. (2018). Is smartphone addiction really Sánchez, X. (2009). Validación de dos escalas breves para evaluar an addiction? Journal of Behavioral Addictions, 7(2), 252–259. la adicción a Internet y el abuso del móvil. Psicothema, 21(3), https://​doi.​org/​10.​1556/​2006.7.​2018.​49 480–485. Pilgrim, K., & Bohnet-Joschko, S. (2019). Selling health and hap- Fischer-Grote, L., Kothgassner, O., & Felnhofer, A. (2019). Risk fac- piness how influencers communicate on Instagram about diet- tors for problematic smartphone use in children and adolescents: ing and exercise: Mixed methods research. BMC Public Health, A review of existing literature. Neuropsychiatrie, 33(4), 179–190. 19(1). https://​doi.​org/​10.​1186/​s12889-​019-​7387-8 https://​doi.​org/​10.​1007/​s40211-​019-​00319-8 Powers, K., Brooks, P., Aldrich, N., Palladino, M., & Alfieri, L. (2013). Godsell, S., & White, J. (2019). Adolescent perceptions of sleep and Effects of video-game play on information processing: A meta- influences on sleep behaviour: A qualitative study. Journal of analytic investigation. Psychonomic Bulletin & Review, 20(6), Adolescence, 73, 18–25. https://​doi.​org/​10.​1016/j.​adole​scence.​ 1055–1079. https://​doi.​org/​10.​3758/​s13423-​013-​0418-z 2019.​03.​010 Punamäki, R., Wallenius, M., Nygård, C., Saarni, L., & Rimpelä, A. Granic, I., Lobel, A., & Engels, R. (2014). The benefits of playing (2007). Use of information and communication technology (ICT) video games. American Psychologist, 69(1), 66–78. https://​doi.​ and perceived health in adolescence: The role of sleeping habits org/​10.​1037/​a0034​857 and waking-time tiredness. Journal of Adolescence, 30(4), 569– Greenfield, D. (2018). Treatment considerations in Internet and video 585. https://​doi.​org/​10.​1016/j.​adole​scence.​2006.​07.​004 game addiction. Child and Adolescent Psychiatric Clinics of Raggatt, M., Wright, C., Carrotte, E., Jenkinson, R., Mulgrew, K., North America, 27(2), 327–344. https://​doi.​org/​10.​1016/j.​chc.​ Prichard, I., & Lim, M. (2018). “I aspire to look and feel healthy 2017.​11.​007 like the posts convey”: Engagement with fitness inspiration on Griffiths, M. (2014). Internet addiction disorder and Internet gam- social media and perceptions of its influence on health and well- ing disorder are not the same. Journal Of Addiction Research being. BMC Public Health, 18(1). https:// ​ d oi.​ o rg/​ 1 0. ​ 1 186/​ & Therapy, 05(04). https://​doi.​org/​10.​4172/​2155-​6105.​1000e​124 s12889-​018-​5930-7 Griffiths, M., Kuss, D., Billieux, J., & Pontes, H. (2016). The evolution Ratwatte, P., & Mattacola, E. (2019). An exploration of fitspiration of Internet addiction: A global perspective. Addictive Behaviors, content on YouTube and its impacts on consumers. Journal of 53, 193–195. https://​doi.​org/​10.​1016/j.​addbeh.​2015.​11.​001 Health Psychology. https://​doi.​org/​10.​1177/​13591​05319​854168 Kaess, M., Parzer, P., Mehl, L., Weil, L., Strittmatter, E., Resch, F., & Reed, P., Vile, R., Osborne, L., Romano, M., & Truzoli, R. (2015). Koenig, J. (2017). Stress vulnerability in male youth with Inter- Problematic Internet usage and immune function. PLoS One, net gaming disorder. Psychoneuroendocrinology, 77, 244–251. 10(8), e0134538. https://​doi.​org/​10.​1371/​journ​al.​pone.​01345​38 https://​doi.​org/​10.​1016/j.​psyne​uen.​2017.​01.​008 Santamariña-Rubio, E., Serral-Cano, G., & Ariza, C. (2017) Collabo- Kardefelt-Winther, D., Heeren, A., Schimmenti, A., van Rooij, A., rating Group. La salut i els seus determinants en l’alumnat ado- Maurage, P., Carras, M., et al. (2017). How can we conceptual- lescent de Barcelona. Enquesta FRESC 2016. Agència de Salut ize behavioural addiction without pathologizing common behav- Pública de Barcelona. iours? Addiction, 112(10), 1709–1715. https://​doi.​org/​10.​1111/​ Saunders, T., Chaput, J., & Tremblay, M. (2014). Sedentary behaviour add.​13763 as an emerging risk factor for cardiometabolic diseases in children Khattab, I., & Love, S. (2008). Mobile phone use across cultures. Inter- and youth. Canadian Journal of Diabetes, 38(1), 53–61. https://​ national Journal of Technology and Human Interaction, 4(2), doi.​org/​10.​1016/j.​jcjd.​2013.​08.​266 35–51. https://​doi.​org/​10.​4018/​jthi.​20080​40103 Scharkow, M. (2016). The accuracy of self-reported Internet use—A Lee, E., & Kim, H. (2018). Gender differences in smartphone addic- validation study using client log data. Communication Methods tion behaviors associated with parent–child bonding, parent–child and Measures, 10(1), 13–27. https://​doi.​org/​10.​1080/​19312​458.​ communication, and parental mediation among Korean elemen- 2015.​11184​46 tary school students. Journal of Addictions Nursing, 29(4), 244– Shambare, R. (2012). Are mobile phones the 21st century addic- 254. https://​doi.​org/​10.​1097/​jan.​00000​00000​000254 tion?. African Journal Of Business Management, 6(2). https://​ Liu, M., Wu, L., & Yao, S. (2015). Dose–response association of screen doi.​org/​10.​5897/​ajbm11.​1940 time-based sedentary behaviour in children and adolescents and Sparrow, B., Liu, J., & Wegner, D. (2011). Google effects on memory: depression: A meta-analysis of observational studies. British Cognitive consequences of having information at our fingertips. 13 140 Journal of Technology in Behavioral Science (2022) 7:130–140 Science, 333(6043), 776–778. https://​doi.​org/​10.​1126/​scien​ce.​ manner of mobile phone use and depression, anxiety, and stress 12077​45 in university students. International Journal of Environmental Thomée, S. (2018). Mobile phone use and mental health. A review of Research and Public Health, 15(4), 697. https://​doi.​org/​10.​3390/​ the research that takes a psychological perspective on exposure. ijerp​h1504​0697 International Journal Of Environmental Research And Public Weis, R., & Cerankosky, B. (2010). Effects of video-game owner- Health, 15(12), 2692. https://​doi.​org/​10.​3390/​ijerp​h1512​2692 ship on young boys’ academic and behavioral functioning. Twenge, J. M., Blake, A. B., Haidt, J., & Campbell, W. K. (2020a) Psychological Science, 21(4), 463–470. https://​d oi.​o rg/​1 0.​ Commentary: Screens, teens, and psychological well-being: Evi- 1177/​09567​97610​362670 dence from three time-use-diary studies. Frontiers in Psychology World Health Organization (WHO). (2020). Addictive behaviours. 11. https://​doi.​org/​10.​3389/​fpsyg.​2020.​00181 Retrieved 16 July 2020, from https://​www.​who.​int/​health-​topics/​ Twenge, J., Joiner, T., Rogers, M., & Martin, G. (2020b). Considering addic​tive-​behav​iours. all of the data on digital-media use and depressive symptoms: Zendle, D., & Bowden-Jones, H. (2019). Is excessive use of social Response to Ophir, Lipshits-Braziler, and Rosenberg (2020). media an addiction?. BMJ, l2171. https://​doi.​org/​10.​1136/​bmj.​ Clinical Psychological Science, 8(2), 379–383. https://​doi.​org/​ l2171 10.​1177/​21677​02619​898179 Van Velthoven, M., Powell, J., & Powell, G. (2018). Problematic Publisher's Note Springer Nature remains neutral with regard to smartphone use: Digital approaches to an emerging public health jurisdictional claims in published maps and institutional affiliations. problem. Digital Health, 4, 205520761875916. https://d​ oi.o​ rg/1​ 0.​ 1177/​20552​07618​759167 Višnjić, A., Veličković, V., Sokolović, D., Stanković, M., Mijatović, K., & Stojanović, M., et al. (2018). Relationship between the 13