Preplanned Studies: Association Between Family Upbringing Environment and Mobile Phone Dependence Syndrome in Middle School Students — Guangzhou City, Guangdong Province, China, 2023

Introduction: With the widespread adoption of smartphones, Mobile Phone Dependence Syndrome (MPDS) has emerged as a significant public health concern. However, the relationship between family upbringing environment and MPDS among middle school students remains unclear.

Methods: The study employed a multi-stage cluster random sampling method to conduct questionnaire and scale assessments among 1,928 students from eight middle schools in Guangzhou during April and May 2023. Propensity score matching was performed to control for confounding variables, including sex, grade, boarding status, and place of residence. used Multivariate logistic regression models were used to examine the associations between parental educational attainment, parenting styles, care levels, family economic conditions, and middle school students’ MPDS.

Results: After adjusting for covariates, this study revealed that middle school students whose fathers had educational attainment levels of junior high school [odds ratio (OR)=0.39, 95% confidence interval (95% CI): 0.17–0.90], senior high school, junior college, technical secondary school, or vocational university (OR=0.28, 95% CI: 0.12–0.67), or a bachelor’s degree and above (OR=0.34, 95% CI: 0.12–0.92) demonstrated significantly lower odds of MPDS compared to those whose fathers had only an elementary school education or below. Additionally, students whose fathers employed an authoritarian parenting style (OR=1.98, 95% CI: 1.22–3.21) showed significantly higher odds of MPDS compared to those whose fathers embraced a democratic parenting approach.

Conclusion: Promoting democratic parenting styles among fathers and enhancing fathers’ educational levels may be beneficial in reducing adolescents’ MPDS risk. This study provides valuable insights for developing scientifically informed strategies aimed at promoting adolescents’ physical and mental well-being.

In recent years, the rapid advancement of China’s industrial and information technology infrastructure has led to widespread smartphone adoption. However, excessive smartphone use, termed MPDS, can result in subjective distress, psychological symptoms, health complications, and social disruptions. Research indicates that more than 25% of Chinese adolescents experience smartphone addiction (1). The emergence of excessive smartphone use during adolescence correlates significantly with increased risks of depression, anxiety, loneliness, and sleep disorders. Therefore, addressing excessive smartphone use among teenagers represents a critical public health priority.

Adolescent MPDS is influenced by individual, school, and family factors, with the family upbringing environment playing a particularly crucial role. The family upbringing environment is shaped by parental educational attainment and the quality of care they provide. Building upon Baumrind’s foundational parenting style theory, Maccoby and Martin further categorized parenting styles into four distinct types — democratic, authoritarian, indulgent, and spoiling — based on the dimensions of demandingness and responsiveness (2). Within China’s sociocultural context, traditional Chinese parenting has been characterized by strict parental authority and child obedience. However, as China has experienced significant social and economic transformation during the past four decades, Chinese parents have become more educated and enjoy improved living standards, leading many to adopt more democratic parenting styles. This study aims to examine the association between family upbringing environment and MPDS occurrence among middle school students in Guangzhou City, thereby providing evidence-based strategies and measures for promoting adolescent physical and mental health development.

Data were collected from 1,928 students across 8 middle schools in Liwan and Nansha districts of Guangzhou City, Guangdong Province, China, between April and May 2023. Participants were selected using a multistage cluster random sampling method. Liwan District and Nansha District were selected to represent the central urban area and rural administrative region, respectively. 1 key middle school, 1 key high school, 1 ordinary middle school, and 1 ordinary high school were selected from each district (if there is no distinction, then randomly select). 1 ordinary class and 1 key class were selected from grades 7 to 12 from each district (if there is no distinction, then randomly select). All students in the selected classes were included in the investigation.

Based on an existing study (3), the prevalence of MPDS among middle school students was estimated at 15.0%. The α value was set at 0.05, while the d value was set at 0.15 p. To account for the multistage cluster sampling design, we increased this estimate by 50%. Assuming a 90% response rate, the final minimum required sample size was 1,613 students.

$$ n=\frac{\mathrm{Z}_{\alpha}^2p\left(1-\mathrm{\mathit{p}}\right)}{d^2} $$

Participants were excluded if any of the following conditions occurred: 1) the middle school student MPDS scale was not completed, or contained 1 or more missing questions (n=14); 2) the questionnaire contained logical errors (n=31). Finally, 1,883 eligible participants were included in the final analysis.

The Mobile Phone Dependence Scale, developed by Wang Xiaohui (4), was employed to assess MPDS severity among middle school students. Scores exceeding 48 indicated MPDS. Parental parenting styles were categorized into four types: authoritarian, democratic, indulgent, and spoiling. The questionnaire provided explicit definitions for each parenting style, and students identified the approaches adopted by their respective parents. Due to the absence of self-reported household income data in the questionnaire, we used students’ boarding status and monthly allowance as substitute variables to reflect their family economic status. A monthly allowance of less than 500 Chinese Yuan (CNY) for boarding students indicates low family economic status. A monthly allowance between 500 and 1,500 CNY for boarding students, or between 500 and 1,000 CNY for non-boarding students, is classified as average family economic status. When the monthly allowance exceeds 1,500 CNY for boarding students or 1,000 CNY for non-boarding students, the family is classified as having high economic status.

This study utilized propensity score matching (PSM) to control for potential confounding factors. Four baseline characteristics were matched: sex, grade, boarding status, and place of residence. We employed 1∶3 nearest-neighbor matching with a caliper width of 0.02. Following matching, 747 participants were included in two groups. A standardized mean difference (SMD) below 0.10 was considered acceptable for balance assessment.

Qualitative data are presented as frequencies and percentages (n, %), while quantitative data following normal distribution are expressed as means and standard deviations. Univariate analyses were conducted on matched data to compare individual and family characteristics between MPDS and non-MPDS participants. Multivariate logistic regression models examined the association between family upbringing environment and middle school students’ MPDS. Model 1 remained unadjusted; Model 2 adjusted for sex and grade; Model 3 incorporated all covariates. Database construction utilized Epidata software (version 3.1, Epidata Association, Odense, Denmark). Statistical analyses were performed using R software (version 4.3.1, R Foundation for Statistical Computing, Vienna, Austria) and SPSS software (version 26.0, IBM Corp., Armonk, NY, USA). Statistical significance was set at P<0.05, with all tests being two-tailed.

Among the 1,883 enrolled middle school students, 1,035 were male (54.97%) and 848 were female (45.03%). The mean MPDS scale score was 35.74±10.61, with 189 students (10.04%) classified as having MPDS (Table 1). Following propensity score matching, the analysis included 558 students (74.70%) in the non-MPDS group and 189 students (25.30%) in the MPDS group. The PSM procedure successfully balanced the distributions of sex, grade, boarding status, and place of residence across groups (P>0.05) (Table 2).

Univariate logistic regression analysis demonstrated that personality traits (P=0.026) and academic performance (P=0.007) among middle school students were significantly associated with MPDS variations. Within family upbringing environment factors, fathers’ educational attainment (P=0.010), fathers’ parenting style (P<0.001), and fathers’ caring level (P=0.003) showed significant associations with MPDS among middle school students (Table 3).

After controlling for all relevant confounding factors in Model 3, fathers’ educational attainment and parenting style remained significantly associated with MPDS scores among middle school students. Compared with students whose fathers had completed only elementary school or below, those whose fathers had completed junior high school [odds ratio (OR)=0.39, 95% confidence interval (95% CI): 0.17–0.90], senior high school/junior college/technical secondary school/vocational university (OR=0.28, 95% CI: 0.12–0.67), and bachelor’s degree or above (OR=0.34, 95% CI: 0.12–0.92) demonstrated protective effects against MPDS. Students with authoritarian fathers showed a 98% higher odds of MPDS compared to those with democratic fathers (OR=1.98, 95% CI: 1.22–3.21) (Table 4). We also found that mothers with senior high school, junior college, technical secondary school, or vocational university degrees were associated with increased odds of middle school students’ MPDS. However, this association did not attain statistical significance in the crude model. The parenting style of the mother, the caring level of the father, the caring level of the mother, and the family’s economic condition were not statistically correlated with MPDS among middle school students.