The indirect effects of smartphone addiction on accidental injuries: a cross-sectional study among medical college students

Background Campus pedestrian injury risks are often overlooked. While existing literature focuses on direct links between specific smartphone-related behaviors (e.g., distracted walking) and accidental injuries, the indirect mechanisms through which smartphone addiction influences such injuries remain unclear. This study investigates and quantifies these modifiable behavior-mediated indirect pathways to inform more targeted injury prevention strategies. Methods A cross-sectional survey of 1,235 university students in 2023 assessed demographic characteristics, accidental injuries, smartphone addiction, and smartphone-related behaviors. Multivariable logistic regression identified injury risk factors, and path analysis examined indirect relationships between smartphone addiction and accidental injuries. Results The incidence of accidental injuries was higher in the smartphone addiction group (20.9%) than in the non-addiction group (13.2%). Logistic regression showed that bedtime smartphone use, physical inactivity, and smartphone-engaged walking increased injury risk ( p < 0.05). Path analysis indicated that smartphone addiction indirectly increased injury risk through these behaviors, accounting for 57.7% of the total effect ( β = 0.105, 95% CI: 0.08–0.13). Conclusion Smartphone addiction significantly increases the risk of accidental injuries among university students, primarily mediated by behaviors such as bedtime smartphone use, smartphone-engaged walking, and physical inactivity. Targeted interventions addressing smartphone use could reduce injuries in this population.