The influence of smartphone addiction on sleep quality among college students: The parallel mediating roles of perceived stress and health-promoting lifestyle

Yuchen Xie; Qichuan Pei; Yixiao Chen; Lishun Xiao; Dehui Yin

doi:10.1371/journal.pone.0340852

Peer Review History

Original SubmissionJuly 17, 2025
25 Nov 2025 Decision Letter - Pavle Randjelovic, Editor Dear Dr. Yin, Please submit your revised manuscript by Jan 09 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: The impact of smartphone dependence on college students’ sleep quality: the chain-mediated role of negative emotions and health-promoting behaviors - https://doi.org/10.3389/fpubh.2024.1454217 The chain mediating role of family health and physical activity in the relationship between life satisfaction and health-promoting lifestyles among young adults in China - https://doi.org/10.3389/fpubh.2024.1408988 In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed. 3. Thank you for stating in your Funding Statement: “This work was supported by Jiangsu Province Education Science "14th Five-Year Plan" Planning Projects (JS/2021/GH0106-07330). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. 4. In the online submission form, you indicated that [The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.]. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 6. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: This manuscript is clearly written, well organized, and addresses a relevant public health issue. The study benefits from a solid methodological framework, including the use of validated measurement tools, an appropriate analytical strategy, and a sufficiently large sample to support its conclusions. The results are presented in a straightforward manner and the discussion is well grounded in the existing literature. The findings contribute meaningfully to the understanding of the mechanisms linking smartphone addiction and sleep quality, particularly through perceived stress and health-promoting lifestyle. Overall, the work is scientifically sound and fits well within the scope of PLOS ONE. Reviewer #2: In the current study, the authors investigated the relationship between smartphone addiction and sleep quality among college students and specifically tested whether perceived stress and health-promoting lifestyle act as parallel mediators. This study employed a cross-sectional design, with data collected at a single time point (March 2025) among 2317 students. The findings revealed a significant positive correlation between smartphone addiction and poor sleep quality. Furthermore, it highlights the dual mediating roles of perceived stress and health-promoting lifestyle as mediators in this relationship. Overall, the study is interesting. However, some points require clarification throughout to improve the manuscript further. I can only think of a few suggestions, as detailed below, that came into my mind. Comment #1: The abstract (lines 14-50) is long. Please shorten. Comment #2: Please make sure that you explain all abbreviations when they are first mentioned in the abstract and in the main text. No need to repeat the full meaning in the text unless it is necessary. Also, it would be nice to include all abbreviations in the provided section at 326-329. Comment #3: I see that the authors present scientific hypotheses at the end of the introduction (lines 109-117) to justify the aim of this research. I think it is better to briefly explain how the study was performed to verify these hypotheses and highlight the main findings of this study, and how the results support the hypotheses. The transition from line 114 to line 115 is not logical. Do you still elaborate on the hypothesis or move to explain your findings? Please review. Comment #4: In the statistical analysis, two sentences contradict each other. The first statement indicates that all variables are normally distributed (lines 174-175). The second states that the scale scores are not normally distributed, as indicated by the Kolmogorov–Smirnov test (lines 178-179). Pearson’s correlation was used (lines 179–180), although the data were previously described as non-normally distributed. If the scale scores indeed deviate from normality, Spearman’s rank correlation would generally be more appropriate. However, Pearson’s correlation can still be valid with large sample sizes or when deviations from normality are mild. Please clarify this discrepancy and justify the use of Pearson’s correlation. Comment #5: Very limited information is provided on how the mediation analysis was performed. It refers to the model used for parallel mediation, as Model 4 at line 230, but it also stated as Model 4.2 at line 182. I am wondering whether the parallel mediation model proposed by Preacher and Hayes (2008) (line 230), DOI:10.3758/BRM.40.3.879, using the PROCESS feature (line 182) was used. Then, please include a proper reference. Also, no explanation of the model’s equations is provided (e.g., direct and indirect paths, meaning of c, c′, a₁b₁, a₂b₂ in your model). Comment #6: At lines 195, 203, 463, I think there is a typo, where the total number is 2,317 (lines 21, 126), not 2,137. Please check. Comment #7: For mediation analysis and values, I noticed some discrepancies appeared between the text (lines 236-241, Table 4, and Figure 2 regarding the values of the paths. For example, at line 237 and figure 2, the value for path c’ is 0.03145; however, in Table 4 the value is 0.0325. At line 238, the value for path a1b1 is 0.0130, while in Table 4 it is 0.0128. same issue for a2b2. In Table 4, I would prefer to specify the paths corresponding to each row as in Figure 2. Please verify, check and unify the decimal throughout the manuscript. Comment #8: In Tables 1 and 2, please specify whether the smartphone usage duration is measured per day or in another way. And whether every use is counted, including for learning purposes. Comment #9: Figure related: The legend of Figure 1 contains very limited information. I would rather expand some information about the abbreviations, meaning of the “+”, “-”, “M1”, “M2”, “X”, “Y”, and briefly explain your logical flow and proposed hypothesis. Same issue for Figure 2, no explanation for direct, indirect paths, meaning a₁, b₁, a₂, b₂. Comment #10: Given that the results showed that smartphone addiction is associated with poorer sleep quality. And the perceived stress and lifestyle mediate the relationship statistically. Additionally, given the study's limitations, it is not possible to infer causal relationships. However, I am missing information on whether smartphone addiction could lead to poor sleep quality because it increases stress and decreases healthy lifestyles, or what exactly the potential mechanisms for this association. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. 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Revision 1
15 Dec 2025 Author Response Dear Editor and Reviewer, Thank you for your comments. We have revised our manuscript carefully according to your comments and all the major changes have been marked in red color. We appreciate these useful comments and suggestions from you. The responses are as follows: Response to Editor, 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: We have carefully reviewed the provided style template and have reformatted the entire manuscript to ensure it fully complies with PLOS ONE's style requirements, including file naming conventions. All formatting details (e.g., font, line spacing, heading levels, figure placement) have been adjusted accordingly. 2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: The impact of smartphone dependence on college students’ sleep quality: the chain-mediated role of negative emotions and health-promoting behaviors - https://doi.org/10.3389/fpubh.2024.1454217 The chain mediating role of family health and physical activity in the relationship between life satisfaction and health-promoting lifestyles among young adults in China - https://doi.org/10.3389/fpubh.2024.1408988 In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed. Response: We performed plagiarism assessments on the manuscript utilizing Turnitin and thoroughly examined the two articles you supplied. Corresponding revisions have been implemented, resulting in a substantially reduced similarity index, with the exception of the Methods section. Additionally, we have incorporated appropriate citations for all relevant sources where necessary, either by directly quoting or extensively paraphrasing any duplicated content outside the Methods section. The revised manuscript now guarantees that all sources are properly acknowledged and that the text is either original or correctly cited. All modifications have been highlighted for your convenience. 3. Thank you for stating in your Funding Statement: “This work was supported by Jiangsu Province Education Science "14th Five-Year Plan" Planning Projects (JS/2021/GH0106-07330). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. Response: As requested, we have amended the Funding Statement to declare all sources of support for this study. 4. In the online submission form, you indicated that [The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.]. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. Response: We have ensured compliance with PLOS’s data policy. All data required to replicate the findings are now freely available as Supporting Information file uploaded with this submission. We have updated the Data Availability Statement in the manuscript to reflect this and revised the online submission form. 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Response: We have revised the manuscript as requested: Moved the ethics statement exclusively to the Methods section. Deleted any duplicate ethics statements from all other sections of the manuscript. 6. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Response: Thank you for the suggestions. We have thoroughly evaluated the recommended publications. 7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: We have verified that all references cited in the text are present in the list. All bibliographic details have been checked for accuracy against the original sources. We have specifically screened the entire list against databases and confirmed that no cited articles have been retracted. Response to Reviewer 2 Comment #1: The abstract (lines 14-50) is long. Please shorten. Response: We have thoroughly revised the abstract to enhance its conciseness. Unnecessary details and repetitions have been removed, resulting in a more focused and compact abstract. Comment #2: Please make sure that you explain all abbreviations when they are first mentioned in the abstract and in the main text. No need to repeat the full meaning in the text unless it is necessary. Also, it would be nice to include all abbreviations in the provided section at 326-329. Response: In accordance with the suggestions, we have conducted a full review of the manuscript to confirm that all abbreviations are defined at first use in the abstract and main text, eliminated redundant full-term repetitions for conciseness, and updated the Abbreviations list. Comment #3: I see that the authors present scientific hypotheses at the end of the introduction (lines 109-117) to justify the aim of this research. I think it is better to briefly explain how the study was performed to verify these hypotheses and highlight the main findings of this study, and how the results support the hypotheses. The transition from line 114 to line 115 is not logical. Do you still elaborate on the hypothesis or move to explain your findings? Please review. Response: To test the parallel mediation hypotheses, we employed the bootstrap method with 5000 samples to generate 95% confidence intervals (CIs). The results indicated that the mediation effects were statistically significant, as the 95% CIs did not include zero, thus supporting the proposed hypotheses. A detailed elaboration of the main findings and how they substantiate the hypotheses is provided in Section 3.5. Furthermore, we have refined the logical flow between lines 107 and 111 to enhance clarity. Comment #4: In the statistical analysis, two sentences contradict each other. The first statement indicates that all variables are normally distributed (lines 174-175). The second states that the scale scores are not normally distributed, as indicated by the Kolmogorov–Smirnov test (lines 178-179). Pearson’s correlation was used (lines 179–180), although the data were previously described as non-normally distributed. If the scale scores indeed deviate from normality, Spearman’s rank correlation would generally be more appropriate. However, Pearson’s correlation can still be valid with large sample sizes or when deviations from normality are mild. Please clarify this discrepancy and justify the use of Pearson’s correlation. Response: The original phrasing may have been ambiguous. Our intended meaning was that all variables were tested for normality. To prevent any potential misunderstanding, we have revised the relevant descriptions in the manuscript. [Page 8, line 166-167] Comment #5: Very limited information is provided on how the mediation analysis was performed. It refers to the model used for parallel mediation, as Model 4 at line 230, but it also stated as Model 4.2 at line 182. I am wondering whether the parallel mediation model proposed by Preacher and Hayes (2008) (line 230), DOI:10.3758/BRM.40.3.879, using the PROCESS feature (line 182) was used. Then, please include a proper reference. Also, no explanation of the model’s equations is provided (e.g., direct and indirect paths, meaning of c, c′, a₁b₁, a₂b₂ in your model). Response: As outlined in the manuscript, we have provided a detailed description of the mediation analysis procedure. [line 172-178; line 225-227] Specifically, the parallel mediation model has been uniformly designated as Model 4.2, and relevant references have been updated accordingly. [line 223] Additionally, we have explained the direct and indirect pathways in the model equations, along with the interpretations of the coefficients c, c′, a₁b₁, and a₂b₂. [line 231-235] Comment #6: At lines 195, 203, 463, I think there is a typo, where the total number is 2,317 (lines 21, 126), not 2,137. Please check. Response: We thank the reviewer for pointing out this typographical error. The correct total number should indeed be 2,317, not 2,137. This was a clerical error that has now been corrected in the manuscript at lines 185, 193, and 465. We have also rechecked the entire manuscript to ensure no similar errors exist. We appreciate the reviewer's careful reading and valuable comments. Comment #7: For mediation analysis and values, I noticed some discrepancies appeared between the text (lines 236-241, Table 4, and Figure 2 regarding the values of the paths. For example, at line 237 and figure 2, the value for path c’ is 0.03145; however, in Table 4 the value is 0.0325. At line 238, the value for path a1b1 is 0.0130, while in Table 4 it is 0.0128. same issue for a2b2. In Table 4, I would prefer to specify the paths corresponding to each row as in Figure 2. Please verify, check and unify the decimal throughout the manuscript. Response: The path coefficient c′ in Figure 1 has been corrected to 0.0325, and corresponding revisions have been made both in the figure and the relevant sections of the text. Comment #8: In Tables 1 and 2, please specify whether the smartphone usage duration is measured per day or in another way. And whether every use is counted, including for learning purposes. Response: The smartphone use duration in Tables 1 and 2 is expressed on a daily basis and has been revised accordingly. It should be noted that the study was not designed to capture a detailed account of all specific usage behaviors. However, your comment is very insightful. We did indeed overlook the time students spend learning on their phones during our investigation. Comment #9: Figure related: The legend of Figure 1 contains very limited information. I would rather expand some information about the abbreviations, meaning of the “+”, “-”, “M1”, “M2”, “X”, “Y”, and briefly explain your logical flow and proposed hypothesis. Same issue for Figure 2, no explanation for direct, indirect paths, meaning a₁, b₁, a₂, b₂. Response: We have expanded the abbreviations related to the mediation analysis model in the manuscript to include the full terminology. Comment #10: Given that the results showed that smartphone addiction is associated with poorer sleep quality. And the perceived stress and lifestyle mediate the relationship statistically. Additionally, given the study's limitations, it is not possible to infer causal relationships. However, I am missing information on whether smartphone addiction could lead to poor sleep quality because it increases stress and decreases healthy lifestyles, or what exactly the potential mechanisms for this association. Response: We sincerely thank the reviewer for this insightful comment. We agree that a deeper theoretical discussion of the potential mechanisms underlying these statistical associations is crucial. In response, we have thoroughly revised the Discussion section to elaborate on the potential causal pathways by which smartphone addiction might impair sleep quality through increased perceived stress and reduced engagement in health-promoting behaviors. Once again, thank you very much. Best wishes, Dehui Yin Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0340852.r002
29 Dec 2025 Decision Letter - Pavle Randjelovic, Editor The Influence of Smartphone Addiction on Sleep Quality Among College Students: The Parallel Mediating Roles of Perceived Stress and Health-Promoting Lifestyle PONE-D-25-36906R1 Dear Dr. Yin, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Pavle Randjelovic, Ph.D. Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Thanks the authors for making the corresponding responses and revisions. I have no further comments and recommend acceptence of this work to be published on Plos One. Reviewer #2: I do not have any further comments. The authors have significantly improved the manuscript. In my opinion, all my concerns have been addressed. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0340852.r003
Formally Accepted
Acceptance Letter - Pavle Randjelovic, Editor PONE-D-25-36906R1 PLOS One Dear Dr. Yin, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Pavle Randjelovic Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0340852.r004

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