The Smartphone technology is sweeping the world at an alarming rate but the advancement in smartphone technology comes at a price; the risk of jeopardizing social life and being addicted to the virtual world. The fondness of owning, overusing and engaging in virtual social life has massively engulfed the youth of the 21st century. The Mobile phone penetration in Nepal is 123% with mobile internet penetration around 58%. In the present study, the smartphone was owned by all 250 (100%) participants. Smartphone addiction in the present study was found to be around 36.8% similar to a study among adolescents in India. The similarity could have been because of similar socio-economic conditions. Nomophobia in the present study reported dissimilarities with previous studies at 72.4%.[6, 10] The difference in the timing of the study could have been the reason for this discrepancy with earlier studies reporting a much lower percentage of nomophobia. Also, earlier, the smartphone and internet penetration was reportedly low, however, a rapid rise has been reported in recent studies with some even reporting a mammoth 92% smartphone addiction among medical students.  Moreover, the lack of validated questionnaire previously could as well be a reason for the variation. Also, the anxiety of separation from family and friends and loneliness at the start of medical school could as well contribute to smartphone addiction and nomophobia. Similar findings have been reported from China and Lebanon.
Our study reported pain in the wrist or on the back of neck due to excessive smart phone use among 39.2% participants which may lead to future physiological and psychological complications.
The result of the present study reported a higher percentage of male to female smartphone addicts similar to a study among Iranian and Chinese medical students and unlike others reporting higher female addiction percentage.[13, 15, 16] The evolution of internet and smartphone based games and its gaining popularity among males could be a cause of such a finding in our study.[14, 17] Our present study reported that females used smartphones mostly for communication and social networking while males used smartphone mostly for communication and gaming. This finding was concurrent with a study from China.  The similarity could have been a result of parallel nature of either gender of similar age and field of study. The present study is not in a situation to speculate the similarity and a need for further studies is recommended to resolve the inconsistent prevalence of smartphone addiction among gender. More internet and gaming addiction studies could prove such a finding in Nepal’s context.
Likewise, our study reported a higher rate of self-perception of smartphone addiction among females than males (42:25) similar to a study in Turkey,  however, the mean addiction score was higher among males than females (30.23±9.40:28.89±8.63).
Studies have shown bidirectional influence of smartphone on psychiatric conditions. Some suggest smartphone addiction to cause insomnia, restlessness, stress, depression and impulsive behavior [18, 19] whereas some studies show smartphone addiction to be a cause of all these disorders. These conflicting evidences warrant further studies. In the present study, we postulated impulsive overuse of smartphone as probable cause of smartphone addiction.
Using smartphone for more than 5 hours a day during weekdays and self-perception of being addicted to smartphone were found to be the most significant predictors of smartphone addiction. This finding was similar to the one reported in Lebanon. The excessive use could be a sign of addiction and carefree nature as evidenced on 42.8% of participants who reported being told about excessive use of smartphone by people nearby. The present study reported smartphone overuse among 16.8% (42/250) participants and its association with addiction similar to a study among medical students in Iran. The similarity could have been a result of homogenous sample population.  Self-acceptance was another factor closely associated with smartphone addiction reinforcing the fact that self-admission and self-esteem had direct effect on mobile phone addiction. This was consistent with study from Korea unlike from China. 
The study showed a significant association between gender and smartphone addiction (p<0.01) unlike one reported in India as recent as 2016. The association could have been observed because of larger female sample population. More such studies are necessary to confirm such fact. Previous educational institute namely government or private academic institutions showed no correlation with smartphone addiction in either sexes which was consistent with a study among nursing students in India.
The study was conducted among first year undergraduate students and a tendency of decrease in smartphone addiction with progressive year has been observed in India.[23, 24] Further studies involving all level of undergraduate students is recommended to establish such a fact.
Studies have shown the use of smartphone for learning purpose as a protective factor over unproductive use for smartphone addiction.[25, 26] In our study only 12/250 (M=5 and F=7) used smartphone solely for study purpose. This could as well be a reason for higher percentage of smartphone addiction in the current study. Use of smartphone for social networking was the commonest cause of smartphone addiction.
There was no correlation between accommodation (hosteller and living with family) and smartphone addiction (p>0.05)