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Purpose: This study aimed to investigate the effects of various factors on smartphone addiction according to types of risk groups among middle school students. Methods: Data of 223 students were collected from February 1st to 22nd of 2020. The collected data were analyzed through t-test, x2 test, correlaton coefficients, and multiple regression analysis. The smartphone addiction scale was used to classify the participants into two groups; 18.8% (n=42) of the total respondents were categorized as the addiction risk group and 81.2% (n=181) were categorized as the general population group. Results: The factors associated with the students in the high risk group were grade (t=3.89, p=.036) and religion (F=3.79, p=.044). In the high risk group, psychological anxiety (β=.39, p=.005) and relapse of internet addiction (β=.38, p=.006) explained 46.0% of smartphone addiction, while in the normal risk group, relapse of internet addiction (β=.42, p<.001), psychological anxiety (β=.22, p=.004), tolerance of internet addiction (β=.17, p=.007), and academic stress (β=.14, p=.027) explained 51.0% of smartphone addiction. Conclusion: In order to prevent smartphone addiction in middle school students, a more specific nursing intervention is needed that can reduce psychological anxiety and relapse of internet addiction. It is clear that urgent measures need to be taken for the highly addicted students such as academic counseling.