Problematic Smartphone Use and Occupational Balance Among High School Students: A Cross-Sectional Study

Problematic smartphone use (PSU) may affect how adolescents organize and experience everyday occupations, yet evidence on occupational balance in school populations is limited. This cross-sectional study examined the association between PSU and occupational balance among 2681 students from six public high schools in Istanbul, Türkiye. PSU was assessed with the Smartphone Addiction Scale (SAS) and occupational balance with the Adolescent Occupational Balance Scale (A-OBS). The A-OBS total score was the primary outcome, and its four dimensions were secondary outcomes. In the common complete-case sample (n = 1573), the crude inverse association between SAS and total A-OBS was markedly attenuated after district adjustment and was not statistically significant in the fully adjusted model (B = -0.027, 95% CI -0.057 to 0.003; β = -0.055; p = 0.078). Small inverse associations were observed for Rest and Sleep (β = -0.086), Occupational Variations and Adaptation (β = -0.099), and Occupational Meaning and Value (β = -0.071), but not for Temporality; all three significant domain associations remained below 0.05 after Holm correction. Sensitivity analyses produced broadly similar patterns. Overall, PSU was not robustly associated with total occupational balance after contextual adjustment, while selected dimensions showed small associations requiring cautious interpretation and longitudinal confirmation.