A descriptive cross-sectional study was conducted among the dental students studying at D. J. College of Dental Sciences and Research, Modinagar city, which is located in the western part of Uttar Pradesh, India. Students from all academic years including interns and postgraduates using mobile phone and willing to participate were included in the study. Ethical approval was obtained from the Institutional review board. Informed written consent was obtained from all the study participants. Participation in the study was voluntary and confidentiality of data was maintained.

A self administered questionnaire was distributed among 588 students who gave their consent to participate in the study after explanation of the study design and protocol. They were given reminder the next day and finally the questionnaire was collected personally after three days. The study duration was from January 2016 to March, 2016. The questionnaire consisted of three parts. The first part assessed student demographic data including age, gender and academic year, type of mobile phone used and the age at which they started using mobile phone, second part assessed the associated anxiety with the mobile phone which consisted of 11 questions (Question 1-11). Students were then categorized based on the usage of mobile phones into nomophobes and risk of nomophobia. These 11 questions were designed based on the study conducted by Ramadu RV et al., in 2015 in India as well as Yildrim C et al., in 2015 in Turkey [6,17].

The questionnaire which assessed nomophobia (Question 1-11) had eight elements:

The third part assessed the attitude towards the usage of mobile phones and consisted of eight questions (Question 12-19). Every question was mandatory.

The questionnaire was modified and pretested by a pilot study on 112 of the study participants which comprised of 20% of the total study sample. Reliability of the questionnaire was analyzed by using Test-Retest conducted over two week duration, and the intra-rater reliability of the participants for the questions was assessed using kappa (k) and Weighted kappa values. Internal consistency of the questionnaire was estimated by applying Chronbach’s-Alpha (α) .

The individual responses thus, obtained were then compiled, processed and analyzed. Scoring was allotted depicting maximum to minimum mobile phone association.

Participants having score of ≥ 40 were categorized as nomophobic, 34-39 score - at risk of nomophobia, < 34 score – normal.

All questions were based on five point Likert scale ranging from strongly disagree to strongly agree.

The returned questionnaires were coded and entered on computer, using SPSS (Statistical Package for Social Sciences) software, version 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistical method (mean±standard deviation) were applied. Kruskal wallis test, Mann-whitney U-test and chi-square test was applied to compare the attitude of phone usage among the students. The level of significance was set at p<0.05.

The questionnaire based study was carried out among the 588 students regarding the usage of mobile phone. Reliability measured through Test-Retest showed measured kappa (k) of 0.84 and weighted kappa (k) of 0.90. Internal consistency measured through Chronbach’s-Alpha (α) was found to be α=0.82.

Among 588 dental students, 554 students responded to the questionnaire thus, the response rate was 94.21%. Only completely filled questionnaire were considered for this study. The mean age of the subjects was 21.99±2.95 years (range: 17-35 years). All subjects used android phones and the mean age when the subjects started using the android phone was 16.96 years. Around 47.1% were males and 52.9% were females. Overall, 34.3% respondents belonged to preclinical group (BDS 1^st year and II^nd year), 33.9% were from clinical group (BDS IIIrd and Final year) and 16.3% were interns and 15.5% were postgraduate students [Table/Fig-1].

[Table/Fig-2] shows the response of students in percentage towards the attitude and associated anxiety with mobile phone based on their academic year i.e., preclinical, clinical, interns and postgraduates and their mean scores as well as in total. It was found that there was statistically significant difference among the four groups on perception of usage of mobile phones and associated anxiety with it. (p<0.05).

[Table/Fig-3] shows the response of students towards the attitude and associated anxiety with mobile phone in terms of mean scores based on their gender. It was found that there was statistically significant difference among males and females in questions related to worry when running out of battery and if they could not stay up to date with social media, women have more sleep loss when using phone at night as compared to males, also females hardly use mobile phone to download educational material and used their phone mostly not to feel lonely in public places as compared to males (p<0.05).

[Table/Fig-4,5] shows the prevalence of nomophobia and risk of nomophobia among respondents. It was seen that prevalence of nomophobia (score ≥ 40) were 32.6% among preclinical followed by 24.4% among interns; 20.9% among postgraduates and 18.6% among clinicals whereas at risk of being nomophobes (score-34 to 39) were 52.6% among clinical, 41.8% among postgraduates, 37.3% among preclinical and 32.2% among interns.

Among total students, the students who were Nomophobic (score≥ 40) was 24.12% and at risk of being nomophobes were 40.97% (score- 34 to 39).

[Table/Fig-6] represents the prevalence of nomophobia (score≥ 40) and risk of nomophobia (score-34 to 39) based on gender. It was seen that among 261 males 54 (20.68%) were nomophobic and 118 (45.21%) were at risk of being nomophobes. Among 293 females 84 (28.66%) were nomophobic and 116 (39.59%) were at risk of being nomophobes.

It is certain that technology can convey information to human beings without any difficulty. It also renders people with a luxurious life and convenient connection. Still, excessive use (i.e., texting in the classroom, frequently checking the cell phone) of cell phones among dental students leads to several problems (i.e., concentration difficulties which results in negative academic impacts).

Our study revealed 24.12% of prevalence of nomophobia and 40.97% of prevalence of having risk of being nomophobes and majority of nomophobes were from preclinical (32.6%) and least were from clinical (18.6%) whereas, risk of nomophobes was highest among clinical (52.6%) and least among interns (32.2%). This could be due to being away from the family and becoming homesick thus making them more dependent on the mobile phone. A study conducted by Dixit S et al., in 2010 revealed that 18.5% of students were nomophobic as well as highest number of students being nomophobic were from 3^rd professional part-I (7%) and least number of students were from internship (1%) [18]. Another study conducted by Ramadu RV et al., in 2015 revealed that 22.3% of total population were nomophobic. The students having nomophobia were maximum from interns (34.28%) and minimum for 2^nd year (14%) and risk of nomophobia is higher for 2^nd year (51.2%) and least for final year part-II(31.2%) [6].

The prevalence of nomophobia were higher among females (28.66%) when compared to males (20.68%) whereas, the risk of nomophobia were more in males (45.21%) as compared to females (39.59%). A statistically significant difference on usage of mobile phones between females and males was found.

The study revealed that about 85.9% of total dental students can’t stay without their phone for more than a week. The findings are in accordance to the study conducted by Akanferi AA et al., in 2014 where 88% of all respondents disagreed that they can stay without using mobile phones [4]. Also, 46.2% of the total students hardly use their phone to download or view educational material implying the usage of mobile phone for recreational purpose also. Undoubtedly, mobile phone and its functions such as listening to music and messaging with Whatsapp, facebook have become addiction to young adults.

The present study showed that 39.5% of students perceived their academic performance to be poorer due to spending of more time on phone and the association was statistically significant (p<0.05). The present findings are in agreement to the study conducted by Baghianimoghadam MH et al., in 2013, Krithika M et al., in 2013, Aman T et al., in 2015 and Chen YF in 2006 in Taiwan which shows that mobile phone have severe adverse effects on their study and academic achievement [19–22]. These findings are in contrast to study conducted by Ezemenaka E in 2013 which found that there is no significant relationship affecting the academic performance of students in using internet enabled phones [2]. The present study shows that 24.7% agreed and 6.9% strongly agreed to use their cell phones while their classes are going on. In a study conducted by Li M et al., it was seen that about 69% use their cell phones in class [23]. This shows that the students have cell phone obsessesion which is destructive for their academic purpose.

Our study shows that 47.5% of students agreed and 13.9% of students strongly agreed that they will go anxious while running out of battery or out of signal in phone. A study from United Kingdom by Katherin B in 2008 on 2163 people revealed that 53% of the subjects tend to be anxious when they lose their mobile phone, run out of battery or credit or have no network coverage [5]. This shows that the young adults has become reliant on mobile phone which has affected their social behaviour as well as their mental health.

The study revealed 31.4% students agreed and 13.2% students strongly agreed that they spend more than three hours for phone calls per day which is similar to the finding of Li M et al., which shows that 50.8% students spent their time about more than four hours on cell phone usage [23].

Mobile phones use if not correctly controlled may become a very critical problem in our society and the dental students who are future dentists should be careful about the excessive phone use while providing service to the society.

Thus, the finding from the study proves significantly that the mobile phones has a great impact on the social life and academics of students. Also despite student’s understanding about the negative effects of mobile phone on their academics, they still continue to use cell phones. Thus, the students must be encouraged to use their mobile phones judiciously.

The pattern of usage of mobile phone showed self perceived poor academic performance among the study population and majority of the students having the risk of being nomophobes. Thus, the students must be made aware of the positive and negative effects of excessive usage of mobile phones. Further studies are required to analyse the existing problem to facilitate the steps to be taken to handle the emerging problem of nomophobia.