Abstract
Objective: The authors gathered survey data regarding the use of cellular telephones among families who reside in the New York metropolitan area and whose children receive medical care in a hospital-affiliated general pediatrics clinic.
Methods: Two investigators distributed a 34-question, self-administered survey in pencil-and-paper format to pediatric patients and the adults who accompanied them in the waiting room of a hospital-affiliated, outpatient pediatric practice in Mineola, New York.
Results: Completed surveys were obtained from 35 families. Twenty-eight (80%) of the 35 families completing surveys reported that at least one family member owned and used a cellular telephone. Of these 28 families, 9 (32%) reported that at least one household member aged to 18 years owned and used a cellular telephone. The mean age at which children obtained their first cellular telephone was 15.3 years. The primary reason these respondents cited for providing children with cellular telephones was safety (75%).
Conclusion: The authors conclude that cellular telephone use is widespread among families in the New York metropolitan area. Although the primary reason families provide for obtaining cellular telephones is safety, convenience to household members and peer pressure also play roles.
This survey-based study examines the pattern of electronic communication among families who reside in metropolitan New York. We suggest that patterns of cellular telephone use are indicative of today's often-hectic family lifestyles and can be evaluated as a component of health maintenance interviewing.
Today's new pediatricians are accustomed to addressing issues of preventive care with their patients and patients' families (eg, nutrition, sleep patterns, the use of bicycle helmets and sunscreen). As the use of cellular telephones becomes commonplace, there may be a role for physician counseling on this topic as well. For example, physicians may need to be ready to address safety issues with their teenaged patients by reinforcing the message that they should not talk on their cellular phones while driving an automobile.
In fact, cellular telephone use may be an example of how, today more than ever, physicians who seek to provide whole person healthcare must stay attuned to the nonbiologic and cultural changes that may impact the well-being of their patients.
In the 1950s, television entered and became a mainstay in the American family household––and the issue of violence in the media has been of concern to the medical community since then.
1 Television was later found to be a significant factor in human development worthy of anticipatory guidance––and the medical community took the lead.
1-4
Physicians should consider that the more recent phenomenon of instant communication via new technologies such as pagers, cellular telephones, and personal digital assistants (PDAs) may have more far-reaching effects on their patients than they currently appreciate.
Anecdotal evidence reported in the public media in November 2002 stated that in an informal study of 50 New Yorkers observed walking down a city block in Manhattan, 21 were using cellular telephones. We hypothesize that cellular telephone use is ubiquitous and reflects the complicated, anxious lives of modern society.
To gather normative data about cellular telephone use among the pediatric population––a clearly emerging paradigm in modern family communication patterns––we surveyed families seeking care in our general pediatrics division.
Methods
Investigators obtained approval from the Winthrop Hospital Institutional Review Board in Mineola, NY, prior to distributing surveys (Figure) to pediatric patients and the adults who accompanied them.
At random, study investigators (J.L.S. and S.A.) approached pediatric patients and the adults who accompanied them as they were waiting to receive care at an off-site hospital-affiliated pediatrics office. Pediatric patients and the adults who accompanied them were asked if they would be interested in participating in a self-administered, pencil-and-paper survey on their electronic communication patterns. Completion of the 34-question survey was voluntary and anonymous.
Surveys were distributed in a hospital-affiliated, general pediatrics clinic in the metropolitan New York area from November 2002 through March 2003.
Results
Thirty-five surveys were completed and returned to investigators for review and analysis. Designated heads of household (ie, mainly parents) completed 32 (91%) of these surveys; pediatric patients completed 3 (9%) of the surveys. A summary of demographic characteristics for adult survey respondents is presented in
Table 1.
Table 1
Cellular Telephone Use Survey: Characteristics of Study Subjects (n=32)
Characteristic
|
No. (%)*
|
|---|
| ▪ Race † | |
| □ African American | 5 (16) |
| □ Asian | 1 (3) |
| □ Hispanic | 7 (22) |
| □ White | 15 (47) |
| □ Other | 2 (6) |
| □ No Response | 3 (9) |
| ▪ Annual Household Income | |
| □ $15,000-$25,000 | 4 (13) |
| □ $25,000-$50,000 | 8 (25) |
| □ $50,000-$75,000 | 3 (9) |
| □ $75,000-$100,000 | 4 (13) |
| □ More than $100,000 | 6 (19) |
| □ No Response‡ | 7 (22) |
| ▪ Health Insurance Type | |
| □ Healthcare Maintenance Organization | 10 (31) |
| □ Indemnity Plan | ... |
| □ Managed Care Organization | 2 (6) |
| □ Medicaid | 5 (16) |
| □ Preferred Provider Organization | 6 (19) |
| □ Unsure | 2 (6) |
| □ Uninsured | 3 (9) |
□ No Response
| 4 (13)
|
Table 1
Cellular Telephone Use Survey: Characteristics of Study Subjects (n=32)
Characteristic
|
No. (%)*
|
|---|
| ▪ Race † | |
| □ African American | 5 (16) |
| □ Asian | 1 (3) |
| □ Hispanic | 7 (22) |
| □ White | 15 (47) |
| □ Other | 2 (6) |
| □ No Response | 3 (9) |
| ▪ Annual Household Income | |
| □ $15,000-$25,000 | 4 (13) |
| □ $25,000-$50,000 | 8 (25) |
| □ $50,000-$75,000 | 3 (9) |
| □ $75,000-$100,000 | 4 (13) |
| □ More than $100,000 | 6 (19) |
| □ No Response‡ | 7 (22) |
| ▪ Health Insurance Type | |
| □ Healthcare Maintenance Organization | 10 (31) |
| □ Indemnity Plan | ... |
| □ Managed Care Organization | 2 (6) |
| □ Medicaid | 5 (16) |
| □ Preferred Provider Organization | 6 (19) |
| □ Unsure | 2 (6) |
| □ Uninsured | 3 (9) |
□ No Response
| 4 (13)
|
×
Of the 35 individuals who completed this survey, 28 (80%) reported that at least one member of the household currently owned and used a cellular telephone. Of this group, 9 (32%) reported that one child or nonadult member of the household (defined, for the purposes of this study, as all individuals aged 18 years and younger) currently owned and used a cellular telephone.
One respondent of the 9 (11%) who reported that one child or nonadult member of the household currently owned and used a cellular telephone did not complete all 34 survey questions. Therefore, in this study group (n=28), we have quantifiable data for 8 (89%) children or nonadult household members who owned and used a cellular telephone at the time of the study.
Based on the responses of the 8 respondents in this group who completed the survey, we estimate that the mean age at which children obtain their first cellular telephone was 15.3 years. The average age of the children listed by survey respondents as currently owning and using cellular telephones was 16.5 years.
Although survey respondents were permitted to provide more than one reason for providing their children with cellular telephones, the primary reason given for doing so was parents' concerns about their children's safety (6, 75%). In fact, all 8 parents whose children owned and used cellular telephones reported that they felt their children were safer because they have and use a cellular telephone.
Patients and their parents were questioned as to whether the terrorist attacks of September 11, 2001, had an impact on household use of cellular telephones. Twenty-four (86%) of the 28 families who have and use cellular telephones responded that there was no change in their levels of cellular telephone use as a result of September 11.
Another reason given for furnishing children with cellular telephones was issues of convenience within the household (4, 50%).
Seven (88%) of the respondents whose children owned and used cellular telephones indicated that a head of household was responsible for paying the child's monthly cellular telephone bill.
Additionally, 7 (88%) of 8 survey respondents whose children owned and used cellular telephones believed that most of their children's friends also owned and used cellular telephones.
Survey respondents reported that 2 (25%) of the 8 children who have and use cellular telephones use that device to contact household family members more than nonfamily members. Most of the children (6, 75%), however, used the cellular telephone to speak primarily with nonfamily members.
Interestingly, when survey respondents whose children own and use cellular telephones were queried about the impact of cellular telephone use on communication patterns among family members, most (6, 75%) reported that face-to-face interaction among family members remained the same since their children obtained cellular telephones. Two (25%) of the survey respondents reported that face-to-face interaction among family members decreased since they had given their children cellular telephones.
A summary of the distribution of use in this survey group (ie, adults only, n=35) for other common electronic communication devices indicated on this 34-question survey is provided in
Table 2.
Table 2
Cellular Telephone Use Survey: Other Electronic Communication Technologies Currently Used by Household Members (n=32)
Device
|
No. (%)
|
|---|
| Answering Machine or Voice Mail* | 30 (94) |
| Call Waiting* | 17 (53) |
| Internet Access† | 23 (72) |
| Pager (ie, beeper) | 25 (78) |
Personal Digital Assistant (eg, Palm Pilot)
| 10 (31)
|
Table 2
Cellular Telephone Use Survey: Other Electronic Communication Technologies Currently Used by Household Members (n=32)
Device
|
No. (%)
|
|---|
| Answering Machine or Voice Mail* | 30 (94) |
| Call Waiting* | 17 (53) |
| Internet Access† | 23 (72) |
| Pager (ie, beeper) | 25 (78) |
Personal Digital Assistant (eg, Palm Pilot)
| 10 (31)
|
×
Comment
Although the impact of our findings are limited because our sample size was small (N=35), in this survey-based study, we have been able to gather normative data so as to examine emerging patterns of electronic communication in the 21st century in metropolitan New York. We suggest that levels of cellular telephones use may become relevant in health maintenance settings as a potential indicator of complex family lifestyles, anxiety, and patterns of interaction among family members.
Our data indicate that safety is a major concern for families who purchase cellular telephones for the children in the household.
We found that among survey respondents, the average age for first obtaining and using a cellular telephone is 15.3 years––close to the legal driving age in the United States. It is likely that, as children become increasingly independent and able to venture farther from home by themselves and with friends, parents feel their children are more secure if they have a cellular telephone.
Convenience was also cited as a major factor in heads of households' decisions to purchase cellular telephones for their children. We would suggest that this result might be a reflection of how complicated the lives of children and their parents have become, though our survey did not attempt to measure respondents' perceptions on this matter. Anecdotal evidence certainly suggests that parents find that cellular telephones facilitate scheduling flexibility in designating rendezvous points and times––and in organizing drop-offs and pickups for their children's activities. Cellular telephones, then, may allow adolescents greater access to available opportunities and responsibilities in their communities (eg, sports, extracurricular academic activities, part-time employment), while still permitting their parents full access to attend to their own opportunities and responsibilities.
The influence of perceived societal norms may also affect parent's decisions regarding their children's access to cellular telephones. For example, as noted, 7 (88%) of the survey respondents whose children own and use cellular telephones believe that their children's peers also own and use cellular telephones. An 11-year-old child who completed the survey (one of three children to do so) noted as fact that cellular telephones are a fashion accessory to be worn, even if the telephone's batteries are dead.
The combination of these three factors––safety, convenience, and perceived societal expectations––may explain why so many parents among our survey respondents (7, 88%) were willing to pay for the monthly expense of their children's cellular telephones.
Additional research is recommended to explore the use levels of cellular telephones among pediatric patients and their families and to determine how cellular telephone use relates to levels of stress in the household. Gathering similar normative data from other regions in the United States may provide more understanding of the psychosocial implications of this new and emerging communication paradigm.