Smartphone addiction, nomophobia, and neck-related functional disability among undergraduate students in a Nigerian University: a cross-sectional study

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Abstract Background The rapid increase in smartphone use among university students has raised concerns regarding digital dependence and associated musculoskeletal problems, particularly neck-related functional disability (NFD). However, the relative contributions of behavioural dependence (smartphone addiction and nomophobia) and ergonomic factors (posture and usage patterns) to neck disability remain insufficiently understood in low- and middle-income settings. Methods A cross-sectional study was conducted among 399 undergraduate students at the University of Nigeria, Enugu Campus. Data were collected using a structured questionnaire and validated instruments: the Smartphone Addiction Scale–Short Version (SAS-SV), Nomophobia Questionnaire (NMP-Q), and Neck Disability Index (NDI). Descriptive statistics were computed for all variables. NDI scores were categorised to estimate prevalence of NFD. Pearson correlations were used to assess associations, with Spearman correlation conducted as a sensitivity analysis. Multiple linear regression models were fitted using log-transformed NDI (log NDI) as the outcome. Binary logistic regression was additionally performed to identify factors associated with moderate-to-severe disability (NDI ≥ 15). Statistical significance was set at p < 0.05. Results Participants reported high smartphone use (6.18 ± 2.39 h/day). The mean smartpone addiction score was 35.60 ± 9.99, and the mean nomopobia score was 95.58 ± 31.57, indicating moderate-to-high digital dependence. The mean NFD score was 8.76 ± 6.38, with 82.7% of participants classified as having no or mild disability and 17.3% exhibiting moderate-to-severe disability. Smartphone addiction was significantly associated with NFD (r = 0.249, p < 0.001) and remained the strongest independent correlate in both linear (b = 0.0220, p < 0.001) and logistic regression models (OR = 1.04, 95% CI: 1.02–1.07). Neck flexion angle was also significantly associated with NFD. Nomophobia was correlated with smartphone addiction but was not an independent predictor of NFD. Conclusions Smartphone addiction and forward-flexed neck posture were significantly associated with neck-related functional disability among university students. Nomophobia appears to reflect psychological dependence without direct physical impact. These findings highlight the need for integrated behavioural and ergonomic interventions to reduce digital-health risks in university settings.

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