Effect of neck flexion angles on neck muscle activity among smartphone users with and without neck pain

The association between mobile phone usage duration, neck muscle endurance, and neck pain among university students

The mobile phone is essential in daily life, especially during the pandemic. Prolonged use can cause postural issues, leading to common neck pain. This study aims to determine the correlation between mobile phone use duration, addiction, neck muscle endurance, and neck pain in university students. The study included 62 participants (30 female, 32 male) aged 18-35 years. Inclusion criteria required participants to have experienced neck pain at least twice in the past year and to have no other concomitant issues, as well as to volunteer for the study. Demographic information and daily mobile phone usage time were collected. Neck pain was assessed with the Visual Analogue Scale, smartphone addiction with the Smartphone Addiction Scale, and cervical muscle endurance was evaluated. Correlation analysis reveals a moderate relationship between neck pain severity (NPS) and cervical extensor muscle endurance (CEME), a strong relationship between NPS and cervical flexor muscle endurance (CFME), as well as a strong relationship among daily phone usage time (DPUT), CFME, and NPS, with a moderate relationship between DPUT and CEME. Participants were divided into two groups based on their DPUT, revealing that those who used their phone for four hours or more showed significantly higher levels of pain (p < 0.05) and reduced endurance in cervical flexor muscles. Our study found a strong correlation between neck pain, muscle endurance, and daily phone usage. Participants using their phones for more than four hours daily reported increased neck pain and decreased muscle endurance. We suggest integrating phone usage duration into neck pain assessments, promoting ergonomic practices, and offering detailed usage guidelines for users.

The prevalence of neck pain among online learning students: An observational study

Neck pain is among the most prevalent musculoskeletal disorders affecting the general population. During the 2019 coronavirus disease 2019 (COVID-19) pandemic, students have increasingly resorted to online learning, requiring prolonged use of electronic devices. This study aimed to investigate the prevalence of and factors influencing neck pain during online learning. The study employed a cross-sectional design. Eligible participants were nursing students who had been receiving online instruction for a duration exceeding 3 months. To develop the study instrument, the researchers integrated the study objectives with insights from an extensive literature review. This process culminated in the creation of a comprehensive online questionnaire designed to capture relevant data. The prevalence of neck pain among students was analyzed for both the pre-COVID-19 and during COVID-19 periods. The chi-square test was utilized to compare the occurrence of neck pain between these 2 periods, while binary logistic regression was employed to examine the association between various influencing factors and neck pain. This study revealed that out of the 426 students who participated in the study, 391 were female (91.8%) and 35 were male (8.2%). The prevalence of neck pain during online learning (62.7%) was significantly higher than before online learning (37.3%) (P < .05). A significant correlation was also found between neck pain and learning while lying on a bed or table, duration of use of electronic devices, and exercising habits (P < .05). The prevalence of neck pain among students has significantly increased during the COVID-19 pandemic. Future research should focus on evaluating the long-term impact of distance learning on undergraduate students. Additionally, it is imperative to develop and implement targeted intervention programs based on the identified influencing factors to mitigate the prevalence of neck pain and alleviate neck discomfort.

Neck and shoulder strains under various head flexing positions while standing and sitting with and without back support for male and female smartphone users

This study recruited 30 young participants (15 men and 15 women) to examine the smartphone usage patterns in three postures (standing, supported sitting, and unsupported sitting) and at five head angle (HA) positions (0°-40°). Cervical erector spinae (CES) and upper trapezius (UTZ) muscle activity, neck flexion (NF), gaze angle (GA), viewing distance (VD), and discomfort scores were collected. Results showed that HA and posture almost affected all responses, while CES muscle activity, NF, and VD differed between sexes. Strain in the neck and shoulder region increased with HA increase. Particularly, when the HA exceeded 20°, the discomfort scores considerably increased. Unsupported sitting should be avoided during smartphone use because of relatively poor responses in all variables. However, both standing and supported sitting have their respective benefits. Sex-related differences were typically observed in the standing position, with women tending to have lower NF but higher CES muscle activity compared with men.Practitioner summary: Although smartphones have become daily necessities, the overall quantitative neck and shoulder strain of using smartphones in different postures is rarely evaluated. We suggest that maintaining the HA within 20° is recommended because of relatively low load on the neck and shoulders. An unsupported sitting should be avoided during smartphone use.

Gender differences in neck muscle activity during near-maximum forward head flexion while using smartphones with varied postures

Women frequently express heightened neck discomfort even though they exhibit smaller neck flexion (NF) during smartphone use. Differences in natural posture while using smartphones may result in varying muscle activation patterns between genders. However, no study focused on this issue. This study investigated the influence of gender on neck muscle activity and NF when using smartphones, ranging from slight (20°) to nearly maximal forward head flexion, across different postures. We analyzed smartphone usage patterns in 16 men and 16 women and examined these behaviors across different scenarios: standing, supported sitting, and unsupported sitting, at 20°, 30°, 40°, and the maximum head angles. During data collection, muscle activity was measured, expressed as a percentage of the maximum voluntary contraction (%MVC), in the cervical erector spinae (CES) and upper trapezius (UTZ), along with NF. Results show significant influences of gender, head angle, and posture on all measures, with notable interactions among these variables. Women displayed higher muscle activities in CES and UTZ, yet exhibited lesser NF, while using smartphones in both standing (12.3%MVC, 10.7% MVC, and 69.0°, respectively) and unsupported sitting (10.8%MVC, 12.3%MVC, and 71.8°, respectively) compared to men (standing: 9.5%MVC, 8.8%MVC, and 76.1°; unsupported sitting: 9.7%MVC, 10.8%MVC, and 76.1°). This study provides a potential rationale for gender-related disparities in injury outcomes, emphasizing that women experience higher neck and shoulder discomfort level, despite their smaller NF during smartphone use, as found in previous research. Additionally, the cervical flexion-relaxation phenomenon may occur when the head angle exceeded 40°. The near-maximum head angle during smartphone use might induce the cervical flexion-relaxation phenomenon, potentially aggravating neck issues. We recommend limiting smartphone usage postures that exceed the near-maximum head angle, as they are commonly adopted by individuals in the daily smartphone activities.

Effect of a slump posture on pain, proprioception, and electrical activity of the muscles in office workers with chronic non-specific neck pain. A retrospective study

BACKGROUND

The impact of computer typing in a slump posture on pain, proprioception and muscle recruitment has not been extensively investigated. Therefore, the purpose of this study was to evaluate the extent of pain, proprioception and muscle activity resulting from computer typing in a slump posture in women who already suffer from chronic neck pain.

METHODS

This cross-sectional study was conducted between May 20 to July 10, 2021. A total of 15 female 42-(±4.96)-year-old office workers with chronic non-specific neck pain participated in this study. Before and after 60 min of computer typing in a slump posture, proprioception and pain were measured using an inclinometer and visual analog scale (VAS), respectively. The activity of the cervical erector spine (CES) and upper trapezius (UT) muscle was also measured before and after the slump-posture computer typing, in upright, forward, and slump postures. RESU: lts: Paired-samples t-tests showed that pain was increased and proprioception in all directions (flexion, extension, right and left lateral flexion, and right, and left rotation) was less accurate (P < 0.05) after 60 min computer typing. The CES and UT muscle activity were elevated more in the forward head and slump posture than in the upright posture (P < 0.05).

CONCLUSION

Sixty minutes computer typing in a slump posture increased neck pain, resulted in a decreased proprioception in the neck and was accompanied by an increased activity of the neck musculature.

Chronic Neck Pain Prevalence Before and After COVID-19 Restrictions and Its Relationship With Digital Device Screen Viewing: A Population Study

OBJECTIVE

To estimate the prevalence of chronic neck pain (CNP) among the adult population in Peru during the post-coronavirus disease 2019 (COVID-19) restriction period compared with that during the pre-pandemic period and evaluate its association with prolonged digital devices connected to the internet (DDCI) screen viewing.

METHODS

We conducted a cross-sectional study using a representative sample of adults living in Peru in November 2022. A structured survey was employed to identify CNP, and the exposure variable was set as the duration of DDCI screen viewing. The McNemar test was used to compare CNP prevalence pre- and post-COVID-19 restrictions, and ordinal logistic regression was used to evaluate its association with prolonged screen viewing.

RESULTS

A total of 1,202 individuals participated, with 52.8% females and 79.9% residing in urban areas. Following the restrictions, the prevalence of CNP occurring daily or almost daily and at least once a week was 14.8% and 27.8%, respectively (95% confidence Interval [95% CI], 12.6-17.3 and 24.9-30.9), representing a significant increase (p<0.001) compared with pre-pandemic estimates. Notably, among those viewing DDCI screens for ≥8 hours, the odds ratio for CNP frequency escalation compared with those who did not or rarely view screens was 1.61 (95% CI, 1.04-2.50; p=0.033).

CONCLUSION

Approximately 4 of 10 adults in Peru experienced CNP following the lifting of COVID-19 social restrictions, more than double the pre-pandemic prevalence. Furthermore, prolonged viewing of DDCI screens increased the risk of having this condition.

Quantifying the Importance of Active Muscle Repositioning a Finite Element Neck Model in Flexion Using Kinematic, Kinetic, and Tissue-Level Responses

PURPOSE

Non-neutral neck positions are important initial conditions in impact scenarios, associated with a higher incidence of injury. Repositioning in finite element (FE) neck models is often achieved by applying external boundary conditions (BCs) to the head while constraining the first thoracic vertebra (T1). However, in vivo, neck muscles contract to achieve a desired head and neck position generating initial loads and deformations in the tissues. In the present study, a new muscle-based repositioning method was compared to traditional applied BCs using a contemporary FE neck model for forward head flexion of 30°.

METHODS

For the BC method, an external moment (2.6 Nm) was applied to the head with T1 fixed, while for the muscle-based method, the flexors and extensors were co-contracted under gravity loading to achieve the target flexion.

RESULTS

The kinematic response from muscle contraction was within 10% of the in vivo experimental data, while the BC method differed by 18%. The intervertebral disc forces from muscle contraction were agreeable with the literature (167 N compression, 12 N shear), while the BC methodology underpredicted the disc forces owing to the lack of spine compression. Correspondingly, the strains in the annulus fibrosus increased by an average of 60% across all levels due to muscle contraction compared to BC method.

CONCLUSION

The muscle repositioning method enhanced the kinetic response and subsequently led to differences in tissue-level responses compared to the conventional BC method. The improved kinematics and kinetics quantify the importance of repositioning FE neck models using active muscles to achieve non-neutral neck positions.

Text neck is not associated with neck and upper limb disability in young adults who use smartphones

PURPOSE

The objective of the present study was to correlate neck and upper-limb disabilities with neck flexion in university students who are smartphone users. While handling smartphones, a posture with sustained neck flexion known as "Text Neck" is usually adopted, and some authors related to musculoskeletal symptoms on the neck and the upper limb. However, recent studies state that such an association is questionable.

METHODS

This is an observational study when evaluating 192 university students through questionnaires such as the Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), besides the maximal neck flexion, grip and lateral pinch strength of the participants.

RESULTS

The sociodemographic questionnaire demonstrated that most participants had used the device for 5 to 10 years, for five or more hours per day. The DASH questionnaire scores presented an average of 7.2 points, while the data regarding grip and lateral pinch strength showed averages of 29.5 kgf and 8.8 kgf, respectively. The NDI questionnaire scores presented an average of 10.5. The average range of motion of the maximum neck flexion was 27°.

CONCLUSION

There was no association between neck flexion with the DASH and NDI or the grip and lateral pinch strength after the correlation and binary logistic regression analyses. The results show that the scores of DASH, NDI, hand grip and lateral pinch strength, have no association with the maximum neck flexion.

Biomechanical analysis of cervical spine (C2-C7) at different flexed postures

Musculoskeletal diseases are often related with postural changes in the neck region that can be caused by prolonged cervical flexion. This is one of the contributing factors. When determining the prevalence, causes, and related risks of neck discomfort, having a solid understanding of the biomechanics of the cervical spine (C1-C7) is absolutely necessary. The objective of this study is to make predictions regarding the intervertebral disc (IVD) stress values across C2-C7 IVD, the ligament stress, and the variation at 0°, 15°, 30°, 45°, and 60° of cervical neck angle using finite element analysis (FEA). In order to evaluate the mechanical properties of the cervical spine (particularly, C2-C7), this investigation makes use of computed tomography (CT) scans to develop a three-dimensional FEA model of the cervical spine. A preload of 50 N compression force was applied at the apex of the C2 vertebra, and all degrees of freedom below the C7 level were constrained. The primary objective of this investigation is to assess the distribution of von Mises stress within the IVDs and ligaments spanning C2-C7 at various flexion angles: 0°, 15°, 30°, 45°, and 60°, utilizing FEA. The outcomes derived from this analysis were subsequently compared to previously published experimental and FEA data to validate the model's ability to replicate the physiological motion of the cervical spine across different flexion angles.

Perceived Discomfort, Neck Kinematics, and Muscular Activity During Smartphone Usage: A Comparative Study

OBJECTIVE

The present study aims to evaluate the effects of posture, task, and handgrip style on discomfort, neck kinematics, and concomitant muscular activity when using a smartphone (SP).

BACKGROUND

Along with the popularity of smartphones, musculoskeletal disorders have become prevalent among smartphone users. However, comprehensive aspects of discomfort, kinematics, and electromyographic responses across various conditions remain to be investigated.

METHOD

Twenty-four young smartphone users performed typing, video watching, and reading tasks while holding the smartphone both with one hand and with two hands while either sitting or standing. Neck kinematics and muscular activities were simultaneously recorded.

RESULTS

Working with SPs led to higher discomfort in the neck (p = 0.01), lower back (p = 0.01), and shoulder (p = 0.04) while sitting as compared to standing. Sitting was associated with greater neck flexion and more minor lateral bending for all tasks and grip styles (p < 0.05). Electromyographic analysis indicated significant differences between sitting and standing, with alterations being dependent on the test condition. Moreover, neck kinematics and muscular activities significantly differed based on the task nature, handgrip, and interactions.

CONCLUSION

This study highlights the risk of using smartphones in increased neck angle flexion and muscular activities fatigue. Thus, posture and handgrip should be considered while using SPs. As each test condition affects a specific dependent variable, a holistic approach is required to evaluate the responses of SP users' musculoskeletal systems.

APPLICATION

Results can be applied to develop guidelines for musculoskeletal disorders/discomfort prevention among SP users, especially with the rise of smartphone use during the COVID-19 pandemic.

Defining text neck: a scoping review

BACKGROUND

Text neck is regarded as a global epidemic. Yet, there is a lack of consensus concerning the definitions of text neck which challenges researchers and clinicians alike.

PURPOSE

To investigate how text neck is defined in peer-reviewed articles.

METHODS

We conducted a scoping review to identify all articles using the terms "text neck" or "tech neck." Embase, Medline, CINAHL, PubMed and Web of Science were searched from inception to 30 April 2022. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. No limitation was applied for language or study design. Data extraction included study characteristics and the primary outcome relating to text neck definitions.

RESULTS

Forty-one articles were included. Text neck definitions varied across studies. The most frequent components of definitions were grouped into five basis for definition: Posture (n = 38; 92.7%), with qualifying adjectives meaning incorrect posture (n = 23; 56.1%) and posture without a qualifying adjective (n = 15; 36.6%); Overuse (n = 26; 63.4%); Mechanical stress or tensions (n = 17; 41.4%); Musculoskeletal symptoms (n = 15; 36.6%) and; Tissue damage (n = 7; 17.1%).

CONCLUSION

This study showed that posture is the defining characteristic of text neck in the academic literature. For research purposes, it seems that text neck is a habit of texting on the smartphone in a flexed neck position. Since there is no scientific evidence linking text neck with neck pain regardless of the definition used, adjectives like inappropriate or incorrect should be avoided when intended to qualify posture.

Severity of slouched posture during smartphone use is associated with the musculoskeletal discomfort, daily usage, and school year among adolescents

Real-time measurement of the craniovertebral, thoracic kyphosis, and lumbar lordosis angles during natural and smartphone usage postures in sitting were analysed in a cohort of 560 adolescents using independent t-tests and Spearman's correlations between their reported musculoskeletal symptoms, daily device use and school year. Students with musculoskeletal symptoms (mean difference: 4.1-9.4°, p < .001) and in secondary schools (mean difference: 13.6-29.4°, p < .001) had a greater forward-head posture quantified by craniovertebral angle in both postures. Loss of lumbar lordosis was found in students spending ≥2 h/day on electronic devices (mean difference: 3.2°, p = .029) and those with musculoskeletal symptoms (mean difference: 5.4°, p = .001). Secondary school students exhibited a greater thoracic kyphosis when using smartphones (mean difference: 3.3°, p = .003). Findings suggest the urgent need for early and proactive intervention targeted to minimise the risk of developing musculoskeletal disorders related to intense device use for young adolescents.Practitioner Summary: Adolescents: (1) in higher school year had increased forward-head posture (FHP) and thoracic kyphosis; (2) with musculoskeletal symptoms had increased FHP and loss of lumbar lordosis, and; (3) with extended device use had a loss of lumbar lordosis. Early intervention targeting young adolescents promoting optimal posture and habit of device use is warranted.

Effectiveness of Different Cervical Range of Motion Measurement Techniques for Home-Use to Prevent Cervical Spondylosis

Cervical spondylosis is a non-specific degenerative of cervical spine which results in spinal canal and nerve root foramen stenosis. The stenosis of the canals results in injury of spinal cord and nerve root. The nerve root compression causes a various symptom, such as referred pain and numbness in neck and upper extremities. Motion sensors allow for the tracking and observation of cervical movement activities with the purpose of preventing cervical spondylosis. In the proposed study, Inertia Measurement Unit (IMU) sensors and comparative 2- Dimensional Motion Capture (2D-MC) system were considered to determine the effective of cervical range of motion in various environments. The results indicated that both methods provided strong correlations of craniovertebral angles, with the IMU sensors showing a higher correlation coefficient than the 2D-MC system. Therefore, the craniovertebral angles from IMU sensors were utilized to identify the safety and warning zones of neck movements.Clinical Relevance- The degenerative of the cervical spine results in different degrees of severity in cervical spondylosis. To prevent further deterioration, it is recommended to adopt lifestyle changes, especially neck movement changes, that reduce the spinal cord or nerve root compression. An innovation that can detect harmful neck movements in real-time can provide feedback to users on whether they are moving their head into dangerous angles. By training regularly with this innovation, individuals can delay the onset and severity of cervical spondylosis symptoms and make adjustments to their lifestyles to prevent recurrence of the condition in the future.

Pediatric Text Neck Syndrome

Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.

Effects of typing positions on the upper trapezius and neck extensor muscles electromyography in office employees: A single-blind cross-sectional study

BACKGROUND

Holding incorrect postures over a long period could lead to chronic nonspecific neck pain (CNNP) in office employees.

OBJECTIVE

The present study aimed to evaluate the effects of different typing positions on the activity of the neck extensor and upper trapezius (UT) muscles of office employees diagnosed with CNNP.

METHODS

This assessor-blinded cross-sectional study was performed on 22 female subjects with the mean age of 39.95±5.30 years. The neck extensors and UT muscle activities of the participants were assessed in the upright, forward, and slouching postures by electromyography (EMG). In addition, neck proprioception and the performance of the cervical stabilizer muscles were evaluated using an inclinometer and biofeedback pressure unit, respectively.

RESULTS

A significant difference was observed between the cervical erector spine (CES) and UT muscle activities in the upright, forward, and slouching typing positions (P < 0.05). In addition, a difference was observed between the upright and slouching postures in these muscles. A positive correlation was denoted between CES muscle activity in the slouching and forward postures and the activation index of neck muscles (P < 0.05). Furthermore, a significant, negative correlation was observed between the UT muscle activity in the slouching posture and neck proprioception (P < 0.05). A positive correlation was also noted between the pain index and repositioning error rates (P < 0.05).

CONCLUSION

CES muscle activity increased in a forward head posture, which could damage neck proprioception through causing early fatigue and stimulating a cumulative damage cycle.

The effect of tablet tilt angles and time on posture, muscle activity, and discomfort at the neck and shoulder in healthy young adults

BACKGROUND

Although young adults regularly perform tablet writing, biomechanics during the tablet writing with different tilt angles has not been studied. The objective of this study was to compare posture, muscle activity, and discomfort at the neck and shoulder between tablet writing with 0° (horizontal) and 30° tablet tilt angles over 40 minutes in healthy young adults.

METHODS

Twenty participants wrote continuously for 40 minutes on a tablet with both tilt angles in a randomized order. Between conditions, there was a 5-minute activity break. Differences in neck and shoulder posture, muscle activity, and discomfort between both tablet tilt angles and changes in the outcomes every 10 minutes over 40 minutes were investigated.

RESULTS

With the tilted tablet, there were lower neck flexion (Z = -4.637, P<0.001), lower shoulder extension (Z = -3.734, P<0.001), and lower neck Visual Analogue Scale (VAS) (left; Z = -4.699, P<0.001 and right; Z = -3.874, P<0.001) as compared to the no tilt condition. However, the right upper trapezius muscle activity was higher in the tilted condition as compared to the no tilt one. Over 40 minutes, the neck VAS (left; χ2(4) = 30.235, P<0.001 and right; χ2(4) = 32.560, P<0.001) and heart rate variability (χ2(4) = 12.906, P = 0.012) showed notable increases after 20 minutes compared to baseline.

CONCLUSION

In conclusion, adjusting the tablet tilt to 30° and limiting time spent to 20 minutes are recommended for young adults during the tablet writing to prevent neck problems.

Effects of lying posture and task type on muscle fatigue, visual fatigue, and discomfort while using a smartphone on the bed

BACKGROUND

Neck-shoulder and arm musculoskeletal disorders in smartphone use have attracted increasing attention.

OBJECTIVE

This study aimed to examine the effect of different lying postures and task types by comparing the electrooculography (EOG) responses, perceived discomfort, and the activity of neck-shoulder and arm muscles while using a smartphone on the bed.

METHODS

Twenty participants were recruited to perform 30-min tasks (texting/ watching video) while holding the smartphone in three different lying postures (half-lying/lying/side-lying). Subjective discomfort, muscular activities including the abductor pollicis brevis (APB), upper trapezius (UT), and extensor carpi radialis (ECR), and EOG signals were simultaneously monitored.

RESULTS

The results showed that the perceived discomfort of measured body parts increased significantly over time in all postures. Watching video significantly increases muscle activities of APB and UT and decreases blink frequency and blink duration. Compared to lying or half-lying, the side-lying posture has the highest blink frequency, blink duration, and muscle activities in ECR and UT.

CONCLUSION

The findings of this study indicate that side-lying posture should be avoided while using a smartphone on the bed. It provides an understanding of the association between the postures of using smartphones on the bed and fatigue, which can help prevent muscle and visual fatigue in smartphone use.

Influence of the Text Neck Posture on the Static Dental Occlusion

Background and Objectives: The excessive use of smartphones for various tasks led to a new adverse postural phenomenon called text neck. The aim of this study was to investigate the effect of the text neck posture (TNP) on static occlusion by using the T-Scan III occlusal diagnostic system. Materials and Methods: Nineteen subjects (aged 20 to 24 years) were considered for this research. They had normal values for anterior overbite and overjet, Angle Class I occlusion, no posterior crossbite, and no signs or symptoms of cervical or temporo-mandibular disorders. Occlusal registrations were performed with the T-Scan III system in a normal, neutral head posture (NHP), as well as in the TNP. The investigated parameters were: occlusion time (OT), asymmetry index of the occlusal force (AOF), percent of the maximum movie force (%MMF), and the time elapsed from the last occlusal contact until the maximum intercuspation (MAT-OTB). The last three parameters were analyzed in the maximum area frame (MA) of the registrations. For the statistical analysis of the recorded data, the Wilcoxon Signed Ranks test and the Spearman’s correlation coefficient were used. Results: The following values were obtained in NHP and in TNP: for AOF, 14.88 ± 10.39% and 18.04 ± 12.83%, respectively; for OT, 1.34 ± 1.84 s and 1.32 ± 1.8 s, respectively; for the %MMF, 97.5 ± 2.83% and 96.31 ± 3.17%, respectively; for MAT-OTB, 2.08 ± 1.82 s and 1.45 ± 2.3 s, respectively. There were no statistically significant differences between the static occlusal parameters measured in NHP and those in TNP. However, the high values of the AOF and OT in NHP revealed an imbalance of the occlusal force distribution between the right and left side in maximum intercuspation (MI), as well as a lack of simultaneity of static occlusal contacts. Furthermore, there was a significant, direct, and strong correlation between OT and AOF in NHP. Conclusions: The NHP should not be used as the starting position in TNP simulations in T-Scan studies, so as to avoid statistically insignificant differences between static occlusion in NHP and TNP. The healthy standing subjects, with normal occlusal relationships from the clinical point of view, revealed an occlusal instability in NHP when examined with the T-Scan.

Sex differences in factors associated with neck pain among undergraduate healthcare students: a cross-sectional survey

Background

Neck pain is widespread among students in healthcare-related fields. Although neck pain is more prevalent in females, since most research involves mixed-sex samples we know very little about sex differences in contributors to neck pain. Thus, this study sought to explore sex differences in the risk factors for neck pain in this high-risk population.

Methods

This cross-sectional study was conducted in China in 2021 and included a sample of 1921 undergraduate healthcare students (693 males, 1228 females) from 7 health professional schools at Fujian Medical University. We collected data on neck pain symptoms, demographics, behavioral and psychological factors. Multiple regression analysis was conducted to examine sex differences in the risk factors of neck pain.

Results

The overall prevalence of neck pain was 41.6% with female students having a higher prevalence than male students (44.4% vs. 36.7%, respectively). The adjusted analyses showed that self-study time ≥ 6 h/day (OR = 1.44, 95% CI:1.13-1.83), flexed neck posture >20 degrees (OR = 2.19, 95% CI: 1.28-3.74), static duration posture >2 h (OR = 1.42, 95% CI: 1.02-1.97), and psychological distress (high: OR = 2.04, 95% CI:1.42-2.94; very high: OR = 2.50, 95% CI:1.57-3.74; respectively) were independent factors for neck pain in females. Among males, self-study time ≥ 6 h/day (OR = 1.43, 95% CI: 1.02-2.01) and psychological distress (moderate: OR = 2.04, 95% CI:1.28-3.25; high: OR = 2.37, 95% CI:1.49-3.79; very high: OR = 2.97, 95% CI:1.75-5.02; respectively) were significant risk factors for neck pain.

Conclusions

These findings suggest that the risk profiles of neck pain differ between females and males. The modifiable risk factors for neck pain, such as prolonged self-study time and elevated psychological distress, as well as poor posture among females, could be targeted through health promotion interventions in university settings.

Factors affecting the performance of the deep cervical flexors in young people using smartphones

OBJECTIVE

To determine the factors affecting the performance of the deep cervical flexors (DCFs) in young people using smartphones.

METHODS

Eighty-six individuals were enrolled in this study. Joint position sense errors, forward head and protracted shoulder posture, DCFs, and the superficial cervical muscles were evaluated. Smartphone Addiction Scale, State-Trait Anxiety Inventory, and International Physical Activity Questionnaire were used.

RESULTS

Regression analysis indicated that smartphone addiction and superficial cervical muscle strengths affect the performance of DCFs independently (p < 0.05). SAS was correlated with JPSE-flexion (r = 0.408), DCF activity/performance score (r = -0.453/r = -0.431), forward head posture (r = -0.412), and cervical flexor/extensor muscle strengths (r = -0.313/r = -0.319).

CONCLUSION

Smartphone addiction and cervical superficial muscles are related to the performance of the DCFs in young people. Using smartphones causes impaired joint position sense in flexion, decreased DCF activity, and forward head posture.

Prevalence and Associated Factors of Clinical Myelopathy Signs in Smartphone-Using University Students with Neck Pain

University students have the highest smartphone-use addiction, which coincides with a rising number in instances of neck pain. As the time in smartphone use increases, neck flexion tends to increase. These positions can affect the spinal cord by the direct and indirect mechanisms which lead to cervical myelopathy. Thus, the current study aimed to determine the prevalence and associated factors of clinical myelopathic signs in smartphone-using university students with neck pain. A total of 237 smartphone-using university students with neck pain participated in the study. They were 20 to 25 years old. Their clinical myelopathic signs were evaluated using standardized test procedures. The prevalence of the clinical myelopathic sign was the Trömner sign at 41.35%, the finger escape sign at 28.27%, Hoffmann’s sign at 25.74%, and the inverted supinator sign at 18.14%. Smartphone usage ≥9.15 h per day was associated with ≥1 of a positive clinical myelopathic sign (adjusted OR = 1.85, 95% CI = 1.05 to 3.26, p = 0.05). The current study highlighted that prolonged smartphone usage may affect the spinal cord. Long duration (≥9 h per day) was associated with at least one positive clinical myelopathic sign. Therefore, smartphone-using university students need to keep their duration of smartphone use to less than 9 h per day. More attention should be given to increasing awareness about the importance of having healthy positions when using smartphones and using them for restricted durations in order to control the increasing prevalence of cervical myelopathy among smartphone-using university student in our societies.

Field Study of Postural Characteristics of Standing and Seated Smartphone Use

Prior investigations have been primarily conducted in a laboratory to examine the effects of the smartphone use on the neck and head positions, whether these results are applicable to actual conditions is still unknown. This field survey thus analyzed the neck flexion (NF), head flexion (HF), gaze angle (GA), and viewing distance (VD) of smartphone users in public areas in Taipei, Taiwan. Six hundred smartphone users (300 men and 300 women) were photographed sagittally in standing, supported sitting, or unsupported sitting postures while using a smartphone. Results showed that women had significantly less NF and HF and shorter VDs than male users. Regardless of gender, higher NF was observed for standing than for sitting. Women had similar NF and HF while sitting supported and unsupported, but both were significantly lower than those while standing. By contrast, male users had higher NF and HF during unsupported sitting than during supported sitting. The NF (45°-50°) was much greater than the recommended maximum safe NF of 15°. Women may be at higher risk of visual strain because of shorter VD.

A predictive model to quantify joint torques and support reaction forces when using a smartphone while standing with support

The present study had a dual objective: (1) to present and validate a predictive model of standing posture in the sagittal plane, joint torques and support forces for a smartphone user built from biomechanical principles; (2) propose risk scales for joint torques and reaction forces based on simulations in order to use them into the musculoskeletal disorders prevention. Comparison of the modelled data with experimental measurements (400 tested postures with sample size verification) for calling and texting tasks highlights the model's ability to correctly estimate posture and reaction forces on the ground. The model was able to provide estimates of the range of variation of each parameter for a wide range of environmental conditions as a function of the user body mass index (setting between 12.5 and 50). Joint torques risk scales have been constructed, especially for shoulder and elbow, to characterise the risks incurred by the users. Practitioner summary: The proposed model enables the postures, joint torques and reaction forces to be estimated from subject's body mass index and environmental configuration without resorting to experimentation, which is relevant in industry. This approach allows the proposition of new scales based on joint torques to reinforce the recommendations for MSDs prevention. Abbreviations: BMI: body mass index; LUBA: postural loading on the upper body assessment; MSDs: musculoskeletal disorders; RULA: rapid upper limb assessment; WHO: World Health Organization.

The Effect of Parent Phubbing on Chinese Adolescents’ Smartphone Addiction During COVID-19 Pandemic: Testing a Moderated Mediation Model

Purpose

COVID-19 has affected the health and well-being of tens of millions of people and contributed to smartphone addiction. The prior studies found several characteristics that influenced smartphone addiction, but little research was undertaken on the epidemic. This study aims to test a moderated mediation model of smartphone addiction.

Methods

Three classes in each grade from grade 7 through grade 9 at random were recruited in the target junior high schools. A total of 931 Chinese adolescents (M_age=13.54 years, SD_age =1.08) completed valid questionnaires via online surveys from February 5–19, 2021.

Results

Parent phubbing had a positive effect on smartphone addiction. Boredom proneness played a mediating role in this relationship. Additionally, refusal self-efficacy moderated the effect of parent phubbing on smartphone addiction. Refusal self-efficacy moderated the effect of boredom proneness on smartphone addiction.

Conclusion

Findings of this study shed light on a correlation between parent phubbing and smartphone addiction. Moreover, this study emphasizes the value of intervening in adolescents’ boredom proneness and increasing the ability of refusal self-efficacy to prevent and intervene in the context of COVID-19.

Preventing the progression of text neck in a young man: A case report

Text neck describes an overuse injury of the cervical spine resulting from the repetitive stress of prolonged forward head flexion while looking down on a mobile screen. This case report describes a 24-year-old young man who presented with a 12-month history of head and neck pain and paresthesia of the right upper limb. The patient worked as a YouTuber and has been editing and posting videos on the website for three years. One year prior to referral for chiropractic assessment, the patient first visited his family physician for similar complaints. Based on cervical radiographs, the diagnosis of cervical spondylosis was given. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief during the subsequent year. However, severe flare-up of the symptoms occurred, which was brought about by working for extended periods on his smartphone, for which the patient sought chiropractic attention. X-ray imaging showed cervical kyphosis with C5 vertebral rotation, hypertonicity of the paraspinal muscles, and paresthesia in the right C6 dermatome distribution, which were consistent with text neck syndrome associated with cervical spondylosis and right C6 radiculopathy. The intervention consisted of improving posture while texting, cervical manipulation, and extension traction therapy. After 9 months of treatment sessions, the symptomatic and functional improvement was reflected by the radiographic changes in the cervical curve correction and the normalized paraspinal muscle tension on surface electromyology. Frequent breaks along with correct posture while using smartphones will be the key entities to prevent the occurrence of text neck syndrome.

The association between forward head posture and non-specific neck pain: A cross-sectional study

BACKGROUND

Poor posture is traditionally associated with various musculoskeletal disorders. Consequently, educators in the musculoskeletal field have been teaching postural observation as part of the physical assessment. Forward head posture (FHP) is hypothesized to be associated with neck pain; however, evidence in this topic remains inconclusive.

PURPOSE

To investigate the association between FHP and neck pain intensity, disability, and cervical kinematics in individuals with neck pain compared to asymptomatic individuals. A secondary aim of this study was to explore the possible effect of a head-mounted display (HMD) used in a virtual reality (VR) assessment on FHP.

METHODS

The study was conducted with 43 volunteers (20 asymptomatic individuals, 23 individuals with neck pain) aged 19 to 62. FHP was assessed by measuring craniovertebral angle on profile photographs. Secondary outcome measures included pain intensity, the neck disability index (NDI) questionnaire, and neck kinematics using specialized VR software.

RESULTS

There were no significant differences between individuals with neck pain and asymptomatic individuals in FHP (craniovertebral angle = 48.24°±7.29; 48.90°±5.89, respectively, p > .05). The neck pain group demonstrated a restricted range of motion and slower neck movements (p < .05). We found no significant correlation between FHP and visual analog scale, NDI, and most neck kinematic measures.

CONCLUSIONS

Our findings cannot support a clinically applicable association between FHP and neck pain. Additionally, individuals with neck pain had a lower range of motion and slower neck movements.

Effects of smartphone screen viewing duration and body position on head and neck posture in elementary school children

BACKGROUND

Electronic media have become integral parts of modern life, in which prolonged screen viewing time (SVT) by children is nearly unavoidable. Prolonged use of smartphones could lead to musculoskeletal problems.

OBJECTIVES

To investigate the effect of SVT on head and neck posture during and after using smartphones for various periods of time in either standing or sitting postures.

METHODS

This observational study included 34 male children aged 5-12 years who were assigned to one of two groups based on average smartphone use duration per day: group A comprised 18 children averaging > 4 hours per day (h/day) of smartphone use, and group B comprised 16 children with < 4 h/day of smartphone use. The children's postures were photographed in standing and sitting positions while using a smartphone and 30 min after ceasing smartphone use. The head flexion, neck flexion, gaze, and craniocervical angles were measured using the software program Kinovea.

RESULTS

Significant increases were found in head flexion, neck flexion, and gaze angles. Furthermore, both groups saw a significant decrease in craniocervical angle when sitting compared to when standing, both during and 30 min after smartphone use. The head flexion, neck flexion, and gaze angles of group A were significantly higher than those of group B, and the craniocervical angle of group A was significantly lower than that of group B in both postures (p< 0.05).

CONCLUSION

SVT is associated with increased neck and head flexion posture in children, especially in a sitting position.

Weaknesses of research methodologies on musculoskeletal disorders associated with mobile touch-screen devices

The objective of the currently study is to point out the weaknesses of some recent researches, which were done about the effects or symptoms of using Touch Screen Mobile Devices on the human musculoskeletal system. In this article, we reviewed the research processes performed in recent 26 randomly selected papers about musculoskeletal disorder to clarify the common weaknesses of these published articles. The electronic database search and reference search were conducted in four different databases: Medline, PubMed, Web of Science, and Scopus. We noticed that none of the reviewed papers had performed the experimental design phase of a scientific research. Additionally they had not validated the assumptions of the statistical methods used in their researches. Therefore, their findings are doubtful. In this article, we proposed practical outlines for a reliable experimental research.

Peer Phubbing and Chinese College Students' Smartphone Addiction During COVID-19 Pandemic: The Mediating Role of Boredom Proneness and the Moderating Role of Refusal Self-Efficacy

PURPOSE

COVID-19 has had a huge impact on the physical behavior and mental health of people. Long-term and strict isolation policies are widely used to ensure social distancing, which may cause excessive smartphone use and increase the risk of smartphone addiction. Previous researchers have identified that some factors that affect smartphone addiction, but there was little research conducted during COVID-19 pandemic. The present study aims to examine the effect of peer phubbing on smartphone addiction, how boredom proneness may mediate this effect, and lastly how refusal self-efficacy may moderate the indirect and direct pathways during COVID-19 pandemic.

METHODS

A total of 1396 college students (mean age=20.48, SD=1.08) were surveyed and completed four scales (Peer Phubbing Scale, Refusal Self-efficacy Scale, Smartphone Addiction Index Scale, Boredom Proneness Scale). The statistical analyses were conducted by SPSS 22.0 and SPSS PROCESS macro.

RESULTS

This study found that peer phubbing was positively associated with smartphone addiction. Boredom proneness mediated the effect of peer phubbing and smartphone addiction. Furthermore, refusal self-efficacy moderated the relationship between peer phubbing and smartphone addiction as well as boredom proneness and smartphone addiction. Specifically, peer phubbing had a greater impact on smartphone addiction for college students with higher levels of refusal self-efficacy, and the boredom proneness on smartphone addiction was stronger for college students with low levels of refusal self-efficacy.

CONCLUSION

This study is important in investigating how peer phubbing is related to the smartphone addiction of Chinese college students during COVID-19 pandemic. The results suggest that college students' boredom proneness and refusal self-efficacy may be prime targets for prevention and intervention programs. Thus, this study explored "how" and "when" peer phubbing may enhance college students' smartphone addiction during COVID-19 pandemic.

Healthcare students' mental and physical well-being during the COVID-19 lockdown and distance learning

BACKGROUND

The sudden shift into distance learning during the coronavirus (COVID-19) lockdown might have impacted university students' well-being.

OBJECTIVE

This study aimed to investigate undergraduate healthcare university students' health-related quality of life (HRQoL) and its predictors during COVID-19.

METHODS

A cross-sectional study used an online self-administered questionnaire. The study targeted undergraduate medical, dental, pharmacy, and nursing students at Jordanian universities. Data collected included demographics,12-item Short Form health survey (SF-12), students' evaluation of distance learning, Neck Disability Index (NDI), Depression Anxiety Stress Scale (DASS21), and the International Physical Activity Questionnaire (IPAQ). Descriptive analyses were conducted to summarize primary outcome measures data. Predictors of HRQoL were determined using a multiple variable regression analysis.

RESULTS

In total, 485 university students successfully completed this study with a mean age of 20.6 (±2.0). Participants' HRQoL level measured by SF-12 mean scores were 66.5 (±20.2) for physical health component and 44.8 (±21.2) for mental health component. The regression model explained 65.5% of the variation (r2 = 0.655, F = 127.8, P < 0.001) in participants' HRQoL. Factors significantly associated with HRQoL included depression, neck disability index score, stress, health self-evaluation, average of satisfaction with distance learning, IPAQ score, and weekly studying hours.

CONCLUSIONS

This study showed that healthcare students had a relatively low level of HRQoL during COVID-19 pandemic in Jordan. Academic and non-academic factors associated with HRQoL were identified and should be considered by healthcare educational institutions for better academic planning in future similar pandemics.

Ergonomic arm support prototype device for smartphone users reduces neck and shoulder musculoskeletal loading and fatigue

Smartphone use is a risk factor for both neck and shoulder musculoskeletal disorders. The objective of this study was to evaluate an ergonomic arm support prototype device, which may help improve posture while using a smartphone, by determining its effect on muscle activity, muscle fatigue, and neck and shoulder discomfort. Twenty-four healthy young adult smartphone users performed 20 min of smartphone game playing under two different conditions, smartphone use with support prototype device (i.e. intervention condition) and without (i.e. control condition), while neck and shoulder posture were controlled at 0° neck flexion and 30° shoulder flexion. Activity and fatigue of four muscles were measured using surface electromyography (sEMG), these were: anterior deltoid (AD), cervical erector spinae (CES), upper trapezius (UT) and lower trapezius (LT). The intervention condition showed significantly decreased activity of all muscles. Fatigue of all muscles, except LT, significantly increased over time compared to the start point in the control condition. There was no significant difference in muscle fatigue between each time point in the intervention condition. In conclusion, the ergonomic arm support prototype device can be used as ergonomic intervention to reduce neck and shoulder muscle loading and fatigue.

Spinal and Pelvic Alignment of Sitting Posture Associated with Smartphone Use in Adolescents with Low Back Pain

This study aimed to assess the association between smartphone use in the sitting posture and changes in thoracolumbar kyphosis, lumbar lordosis, and pelvic asymmetry in adolescents with low back pain (LBP). Twenty-five adolescents with LBP and 25 healthy adolescents participated in this study. They were instructed to sit on a height-adjustable chair with their hips and knees bent at 90° for 30 min in their usual sitting postures. Thoracolumbar kyphosis, lumbar lordosis, and pelvic asymmetry were measured using a three-dimensional motion capture system. Thoracolumbar kyphosis and lumbar lordosis increased after 30 min of sitting compared to the baseline. In both groups, thoracic kyphosis and lumbar lordosis angle increased with increasing sitting time. Compared to healthy adolescents, adolescents with LBP presented greater thoracolumbar kyphosis and lumbar lordosis after prolonged sitting. Pelvic asymmetry showed no significant difference between the sitting time and groups. Using a smartphone during prolonged sitting may lead to a slumped posture; these associations were more pronounced in adolescents with LBP.

Neck Muscular Load When Using a Smartphone While Sitting, Standing, and Walking

OBJECTIVE

Myoelectric activity of neck extensor muscles and head kinematic variables, when using a smartphone for one-handed browsing and two-handed texting while sitting, standing, and walking, were evaluated to compare the neck muscular load during these tasks and across the posture conditions.

BACKGROUND

There has been limited research on the relation between head-down postures and the muscular load on the neck of smartphone users.

METHODS

Twenty-one asymptomatic young users were asked to perform one-handed browsing and two-handed texting tasks in each of the posture conditions, and the myoelectric activities of the neck extensor muscles, head kinematic variables, and upper back posture were quantified.

RESULTS

The muscle activation level when using a phone during walking was 21.2% and 41.7% higher than that of sitting and standing on average (p < .01). Head vertical and angular accelerations were also significantly greater (p < .01) for walking than for sitting and standing conditions. Between the two conducted tasks, participants flexed their heads more significantly (p < .01) with higher activation of the neck extensor muscles (p < .01) when texting as compared to when browsing.

CONCLUSION

Results indicate that two-handed texting while walking would be the most physically demanding scenario for neck musculature, and it might be attributable to the dynamics of the head while walking with the head facing downwards.

APPLICATION

These findings can be used to better understand the potential relation between smartphone use and the occurrence of neck musculoskeletal problems and to inform the users of the ergonomic risks of using smartphones while walking.

Influence of neck flexion angle on gravitational moment and neck muscle activity when using a smartphone while standing

This study compares the effects of different neck flexion angles on neck gravitational moment and muscle activity of users that stand and operate a smartphone. Thirty-two healthy young adult smartphone users performed texting tasks for three minutes at four different neck flexion angles (0°, 15°, 30°, and 45°) while standing. Neck gravitational moment and cervical erector spinae (CES) and upper trapezius (UT) activity were investigated. When the neck flexion angle increased, the gravitational moment of the neck increased significantly. The muscle activity of CES significantly increased when the neck flexion angle increased, whereas that of UT decreased. The lowest gravitational moment of the neck at 0° flexion was consistent with the lowest CES muscle activity and the lowest neck discomfort score. In conclusion, for texting while standing, adults should maintain their neck posture at 0° flexion to reduce the gravitational force acting on the cervical spine and alleviate neck discomfort. Practitioner Summary: During smartphone use when standing, excessive neck flexion (30° and 45° flexion) should be avoided. The suggested neck posture when operating a smartphone while standing is 0° flexion. Abbreviations: CES: cervical erector spinae; UT: upper trapezius; COG: centre of gravity; MSDs: musculoskeletal disorders; CROM: cervical range of motion; sEMG: surface electromyography; VAS: visual analogue scale; MVCs: maximum voluntary contractions.

A Review of Relevant Regulations, Requirements and Assessment Methods Concerning Physical Load in Workplaces in the Slovak Republic

This review brings an overview of the Slovak regulations concerning occupational safety and health at work (OSH) primarily considering the parameter of physical load. In addition to regulations, this article focuses on particular requirements at workplaces with an increased physical load and describes the permissible values of the physical load (see tables). Attention is given to assessing the working posture and handling of loads. The main purpose of the evaluation is to determine the parameters of physical load, which is the first important step in the process of health risk assessment. Based on the physical load assessment and the categorization of tasks for the physical load factor in the Slovak Republic, further steps and measures should be taken to improve working conditions, to reduce the workload, number of health problems, fatigue, and ultimately to prevent accidents at work and work-related musculoskeletal diseases.

Effects of environmental illumination and screen brightness settings on upper limb and axial skeleton parameters: how do users adapt postures?

79% of smartphone users carry their phone 22 hours a day. In this context, the main task worldwide, texting, is performed under a wide range of light and position conditions. The aim of this study was to test the effects of environmental illumination and screen brightness settings on upper limb and axial skeleton parameters. Twelve subjects performed three trials of texting under three experimental positions, two screen luminance settings and three environmental light conditions. 3 D axial skeleton and upper limb angles, smartphone orientation and face-to-smartphone distance were used as dependent variables. High environmental illumination and/or low screen brightness resulted in an increase in interaction time and a reduction in the face-to-smartphone distance by approximately 10%. Subjects attempted to compensate for the unfavourable effects of such light conditions by adopting postures rated 5 in the Rapid Upper Limb Assessment, indicating an increased risk of developing musculoskeletal disorders. Practitioner's summary: The purpose of the study was to quantify the joint angles of the upper body in experimental conditions that represent daily life. Postures were influenced by ambient illumination and display brightness. The most harmful postures were observed when the display brightness was minimum, and the ambient light was similar to a sunny day. Abbreviations: ST: seated with table; SWT: seated without any support; STA: standing; 0L: in the dark, no light; AL: ambient light; SL: strong light; BrightMin: minimum display brightness; BrightMax: maximum display brightness (BrightMax); ISB: International Society of Biomechanics; RULA: rapid upper limb assessment; MSDs: musculoskeletal disorders.

A field study on spinal postures and postural variations during smartphone use among university students

This field study compared the real-time spinal movements and postural variations during smartphone-use versus non-use in university students. Ten males and eight females (mean age of 21.5 ± 2.6 years) participated, with similar daily phone use time between the two sexes. Five inertial motion sensors were attached to the cervical, thoracic and lumbar spinal regions, and kinematics was recorded for 3 h while participants went about their usual academic activities within the university campus. Significantly greater degrees of cervical and upper thoracic flexion were adopted during phone use versus non-use time (p < 0.01). There were also significantly greater frequency of postural variations (zero crossing per min) in all spinal regions in the sagittal plane (all p < 0.05), and in some of the movements in transverse and frontal planes comparing phone use vs non-use. The postural variables also showed some significant correlations with self-reported pre-existing neck and upper back pain scores.

COVID-19 anxiety symptoms associated with problematic smartphone use severity in Chinese adults

BACKGROUND

COVID-19 is fast-spreading and potentially fatal, introducing home quarantine, social distancing, and increased internet usage globally. We investigated COVID-19 anxiety, general anxiety and depression symptoms, and their impact on problematic smartphone use (PSU) severity METHODS: Participants were 908 residents of a large Eastern Chinese city, surveyed from late-February to mid-March, 2020. We administered online measures including the Depression Anxiety Stress Scale-21, Smartphone Addiction Scale-Short Version, and items querying COVID-19-related news exposure and threat of death. Additionally, participants rated anxiety using the Generalized Anxiety Disorder Scale-7 with reference to COVID-19.

RESULTS

COVID-19 anxiety correlated with severity of PSU, depression and anxiety. Using established cut-off scores, 12% of participants were identified with at least moderate depression, and 24% with moderate anxiety. Using structural equation modeling, COVID-19 anxiety related to PSU severity, mediating relations between general anxiety and PSU severity. However, controlling PSU for general anxiety and depression severity, COVID-19 anxiety no longer predicted PSU severity.

LIMITATIONS

Limitations include the cross-sectional research design and reliance on data from only one country.

CONCLUSIONS

Results are discussed in context of the I-PACE model of excessive internet use. While COVID-19 anxiety is likely a global anxiety-provoking event, other everyday worries and anxiety are additionally clinically important in driving excessive internet use.