The relationship between adolescents' well-being and their wireless phone use: a cross-sectional study

Impact of mobile phones and wireless devices use on children and adolescents' mental health: a systematic review

Growing use of mobiles phones (MP) and other wireless devices (WD) has raised concerns about their possible effects on children and adolescents' wellbeing. Understanding whether these technologies affect children and adolescents' mental health in positive or detrimental ways has become more urgent following further increase in use since the COVID-19 outbreak. To review the empirical evidence on associations between use of MP/WD and mental health in children and adolescents. A systematic review of literature was carried out on Medline, Embase and PsycINFO for studies published prior to July 15th 2019, PROSPERO ID: CRD42019146750. 25 observational studies published between January 1st 2011 and 2019 were reviewed (ten were cohort studies, 15 were cross-sectional). Overall estimated participant mean age and proportion female were 14.6 years and 47%, respectively. Substantial between-study heterogeneity in design and measurement of MP/WD usage and mental health outcomes limited our ability to infer general conclusions. Observed effects differed depending on time and type of MP/WD usage. We found suggestive but limited evidence that greater use of MP/WD may be associated with poorer mental health in children and adolescents. Risk of bias was rated as 'high' for 16 studies, 'moderate' for five studies and 'low' for four studies. More high-quality longitudinal studies and mechanistic research are needed to clarify the role of sleep and of type of MP/WD use (e.g. social media) on mental health trajectories in children and adolescents.

Use of multimedia devices in pediatric age: risks or advantages? A survey in an Italian center

BACKGROUND

Nowadays children live in a digital world, exposed to relevant risks for their health and safety. The aim of this study is to investigate the use of multimedia devices in a sample of children and adolescents.

METHODS

The study was performed between November 2018 and June 2019 in a third-level University Hospital, recruiting children and adolescents during general or specialistic follow-up visits. Anonymous, age-specific, questionnaires were distributed to 500 children and adolescents and 370 parents.

RESULTS

Among children, 25 (17.1%) had their own mobile device, of which 84% Italian. The 54.1% of them uses multimedia devices half an hour/an hour per day and many of them (37.5% of Italian and 40% of foreign) use it without their parents' control. Most of adolescents had a mobile phone since the age of 10-12 years old. WhatsApp (Meta Inc., Cambridge, MA, USA) is the most used social network, followed by Instagram and Facebook. The use of multimedia devices was widespread between teenagers during classroom hours, meals and before sleeping and they are an important mean for cyberbullying. In addition, in the 29.9% of cases there is no correspondence between information given by parents and respective sons/daughters.

CONCLUSIONS

This study shows more risks than advantages derived from the use of multimedia devices in children and adolescents. Therefore, it is essential to educate them about their correct and responsible use.

Social experiences and youth psychopathology during the COVID-19 pandemic: A longitudinal study

The early stages of the COVID-19 pandemic and associated stay-at-home orders resulted in a stark reduction in daily social interactions for children and adolescents. Given that peer relationships are especially important during this developmental stage, it is crucial to understand the impact of the COVID-19 pandemic on social behavior and risk for psychopathology in children and adolescents. In a longitudinal sample (N=224) of children (7-10y) and adolescents (13-15y) assessed at three strategic time points (before the pandemic, during the initial stay-at-home order period, and six months later after the initial stay-at-home order period was lifted), we examine whether certain social factors protect against increases in stress-related psychopathology during the pandemic, controlling for pre-pandemic symptoms. Youth who reported less in-person and digital socialization, greater social isolation, and less social support had worsened psychopathology during the pandemic. Greater social isolation and decreased digital socialization during the pandemic were associated with greater risk for psychopathology after experiencing pandemic-related stressors. In addition, children, but not adolescents, who maintained some in-person socialization were less likely to develop internalizing symptoms following exposure to pandemic-related stressors. We identify social factors that promote well-being and resilience in youth during this societal event.

Smartphone-based gait and balance assessment in survivors of stroke: a systematic review

PURPOSE

Gait and balance impairments are associated with falls and reduced quality of life among survivors of stroke (SS). Effective methods to assess these impairments at-home and in-clinic can help reduce fall risks and improve functional outcomes. Smartphone technology may be able to evaluate these impairments. This review aims to summarize the validity, reliability, sensitivity, and specificity of smartphone applications for determining gait and balance disorders in SS.

METHOD

Database search through PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss was conducted to retrieve studies that explored the use of smartphone-based applications for assessing gait and balance disorders in SS. Two independent reviewers screened potential articles to determine eligibility for inclusion. Eligible studies were summarized for participant and study characteristics, validity, reliability, sensitivity, and specificity of smartphone assessments. Methodological quality assessment of studies was performed using the NIH Quality Assessment Tool.

RESULTS

Seven cross-sectional studies were included in the review. Quality assessment revealed all studies had low risk of bias. Three of the included studies examined the validity, four examined the reliability, and two examined the specificity and sensitivity of smartphone-based application assessments of gait and balance in SS. Studies revealed that smartphones were valid, reliable, specific, and sensitive. Six of the seven included studies intended their use for SS and one study for clinicians.

CONCLUSION

Preliminary evidence supports that smartphone-based gait and balance assessments are valid, reliable, sensitive, and specific in SS in laboratory settings. Future research is needed to test smartphone-based gait and balance assessments in home settings and determine optimal wear sites for assessments.IMPLICATIONS FOR REHABILITATIONSmartphone-based gait and balance assessments are feasible, valid and reliable for survivors of strokeThe findings may guide future research to standardize the use of smartphone to assess gait and balance in this population.The remote use of smartphone-based assessments to predict fall risk in survivors of stroke needs to be explored.

The association between screen time and depression symptoms severity among adults with diabetes: A cross-sectional study

OBJECTIVE

To investigate the association between time spent on screen-based sedentary behavior (SBSB) and depression symptom severity (DSS) among adults with type 2 diabetes.

METHODS

A cross-sectional study employing secondary data collected by Qatar Biobank (QBB) on 2386 adults with type 2 diabetes aged ≥ 18 years. Self-reported data on DSS measured using the Patient Health Quationnaire-9 and daily time spent on SBSB per week was used.

RESULTS

After adjusting for covariates, including physical activity and sleep duration, subjects who spent 2-4 h or > 4 h a day on SBSB watching TV or other devices other than computers during weekdays had increased odds of higher DSS than subjects who spent < 1 h by 44% (95% Confidence interval (CI) 13-83%) and 52% (95% CI 17-96%), respectively. Subjects who spent > 4 h a day on SBSB using computers during weekdays had increased odds of higher DSS by 115% (95% CI 56-196%) than subjects who spent < 1 h. Similar associations were observed between time spent on SBSB using the mentioned devices during weekends and DSS.

CONCLUSION

Increase in time spent on SBSB is independently associated with increased DSS among adults with type 2 diabetes regardless of the equipment used or timing of the week.

Effect of WiFi signal exposure in utero and early life on neurodevelopment and behaviors of rats

The aim of this study is to examine the long-term effects of prenatal and early-life WIFI signal exposure on neurodevelopment and behaviors as well as biochemical alterations of Wistar rats. On the first day of pregnancy (E0), expectant rats were allocated into two groups: the control group (n = 12) and the WiFi-exposed group (WiFi group, n = 12). WiFi group was exposed to turn on WiFi for 24 h/day from E0 to postnatal day (PND) 42. The control group was exposed to turn-off WiFi at the same time. On PND7-42, we evaluated the development and behavior of the offspring, including body weight, pain threshold, and swimming ability, spatial learning, and memory among others. Also, levels of proteins involved in apoptosis were analyzed histologically in the hippocampus in response to oxidative stress. The results showed that WiFi signal exposure in utero and early life (1) increased the body weight of WiFi + M (WiFi + male) group; (2) no change in neuro-behavioral development was observed in WiFi group; (3) increased learning and memory function in WiFi + M group; (4) enhanced comparative levels of BDNF and p-CREB proteins in the hippocampus of WiFi + M group; (5) no neuronal loss or degeneration was detected, and neuronal numbers in hippocampal CA1 were no evidently differences in each group; (6) no change in the apoptosis-related proteins (caspase-3 and Bax) levels; and (7) no difference in GSH-PX and SOD activities in the hippocampus. Prenatal WiFi exposure has no effects on hippocampal CA1 neurons, oxidative equilibrium in brain, and neurodevelopment of rats. Some effects of prenatal WiFi exposure are sex dependent. Prenatal WiFi exposure increased the body weight, improved the spatial memory and learning function, and induced behavioral hyperactivity of male rats.

Effect of tablet tilt positioning on ergonomic risks and respiratory function

The static posture associated with continuous tablet use can lead to musculoskeletal disorders of the neck and upper extremities as well as respiratory function disorders. We hypothesized that 0-degree tablet placement (flat on a table) would affect ergonomic risks and respiratory function. Eighteen undergraduate students were divided into two groups (n = 9 per group). In the first group, the tablet was placed at a 0-degree angle, whereas in the second group, it was placed at a 40- to 55-degree angle on a student learning chair. The tablet was used continuously for 2 h for writing and internet use. Rapid upper-limb assessment (RULA), craniovertebral angle, and respiratory function were assessed. There was no significant difference in respiratory function, including forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and FEV₁/FVC, between the groups (p = 0.09) or within groups. However, there was a statistically significant between-group difference in RULA (p = 0.001), with the 0-degree group having a greater ergonomic risk. There were also significant within-group differences between pre- and posttest. The CV angle differed significantly between groups (p = 0.03), whereby the 0-degree group had poor posture, as well as within the 0-degree group (p = 0.039), though not within the 40- to 55-degree group (p = 0.067). Undergraduate students who place their tablets at a 0-degree angle face increased ergonomic risks and higher potential for developing musculoskeletal disorders and poor posture. Thus, elevating the tablet and instituting rest intervals may prevent or decrease the ergonomic risks among tablet users.

The association between problematic smartphone use and symptoms of anxiety and depression-a meta-analysis

BACKGROUND

Recent research links problematic smartphone use (PSU) and mental health problems. The purpose of this meta-analysis was to evaluate the relationship between PSU and symptoms of anxiety and/or depression.

METHODS

We searched for research literature published recently in PubMed and Google Scholar via a systematic literature search. Twenty-seven studies published since 2014 with 120 895 participants were included in the meta-analysis.

RESULTS

PSU was moderately but robustly associated with both anxiety, r = 0.29 (95% CI: 0.23-0.35), and depression, r = 0.28 (95% CI: 0.22-0.34), P < 0.001 for both. Homogeneity tests showed significant P-values for anxiety and depression, but without affecting the results. Neither the age of the participants, publication year nor the study quality could explain the heterogeneity. Furthermore, we found no evidence for publication bias, since Egger's regression test showed no significance for depression (P = 0.21) and anxiety (P = 0.35).

CONCLUSIONS

Our study shows that PSU can be viewed as an indicator of symptoms of anxiety and depression and a possible manifestation of these mental health problems in modern society. Furthermore, PSU as a maladaptive coping behavior may contribute by worsening these symptoms. PSU screening should thus become part of standard clinical psychological diagnostic procedures.

Prevalence and Determinants of Excessive Screen Viewing Time in Children Aged 3-15 Years and Its Effects on Physical Activity, Sleep, Eye Symptoms and Headache

Screen viewing time is the total time spent by a child on any digital/electronic device. The objective of the present study was to determine the prevalence and predictors of excessive screen viewing time in children in Ujjain, India. This cross-sectional, community-based study was conducted through a house-to-house survey using the three-stage cluster sampling method in 36 urban wards and 36 villages of Ujjain District, India. Excessive screen viewing time was defined as screen viewing for >2 h/day. The prevalence of excessive screen viewing time was 18%. Risk factors identified using the multivariate logistic regression model were age (OR: 1.63, p < 0.001); mobile phone use before bedtime (OR: 3.35, p = 0.004); parents' perception about the child's habituation to screen time (OR: 8.46, p < 0.001); television in the bedroom (OR: 35.91, p < 0.001); morning mobile screen viewing time (OR: 6.40, p < 0.001); not reading books other than textbooks (OR: 6.45, p < 0.001); and lack of outdoor play for >2 h (OR: 5.17, p < 0.001). The presence of eye pain was a protective factor for excessive screen viewing time (OR: 0.13, p = 0.012). This study identified multiple modifiable risk factors for excessive screen viewing time.

Pediatric screen exposure and school related headache disability

BACKGROUND AND OBJECTIVES

Prolonged screen exposure is often cited as a trigger for pediatric headache. We present initial findings evaluating the association between adolescent screen use type, duration, and school disability.

METHODS

New patients aged 12-17 years presenting to a headache clinic were screened and surveyed regarding headache characteristics, behavioral habits, school attendance, and screen utilization.

RESULTS

99 adolescents (29 M, 70 F) with average age 14.8 years and average headache frequency of 17 days per month completed the survey. Patients missed an average of five full days and three partial days of school due to headaches over the 90 days prior to survey completion.No statistically significant correlation was found between type or duration of screen exposure and monthly headache frequency, school attendance, or school functioning. A small positive association was seen between increasing duration of computer use, total hours screen use, and school absenteeism. While most adolescents reported prolonged screen use (58.6%) and luminosity (64.6%) worsened headaches, no statistical difference was seen in average number of headache days per month.

CONCLUSIONS

Average monthly headache frequency in an adolescent population was not significantly correlated with type or duration of screen exposure. Further studies are needed to elucidate how screen utilization impacts school related headache disability.

Systematic review of the physiological and health-related effects of radiofrequency electromagnetic field exposure from wireless communication devices on children and adolescents in experimental and epidemiological human studies

BACKGROUND

For more than 20 years, the potential health risks of radiofrequency electromagnetic field (RF EMF) exposure from mobile communication devices on children and adolescents have been examined because they are considered sensitive population groups; however, it remains unclear whether such exposure poses any particular risk to them.

OBJECTIVES

The aim of this review was to systematically analyze and evaluate the physiological and health-related effects of RF EMF exposures from wireless communication devices (mobile phones, cordless phones, Bluetooth, etc.) on children and adolescents.

METHODS

This review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological limitations in individual studies were assessed using the Office of Health Assessment and Translation (OHAT) Risk-of-Bias Rating Tool for Human and Animal Studies.

RESULTS

A total of 42 epidemiological and 11 experimental studies were eligible for this review. Most of the studies displayed several methodological weaknesses that limited the internal validity of the results. Due to a lack of consistency regarding the outcomes as well as the lack of scientific rigor in most reviewed studies, the body of evidence for the effects of RF EMF of mobile communication devices on subjective symptoms, cognition, and behavior in children and adolescents was low to inadequate. Evidence from the studies investigating early childhood development, brain activity, cancer, and physiological parameters was considered inadequate for drawing conclusions about possible effects.

DISCUSSION

Overall, the body of evidence allows no final conclusion on the question whether exposure to RF EMF from mobile communication devices poses a particular risk to children and adolescents. There has been rapid development in technologies generating RF EMF, which are extensively used by children and adolescents. Therefore, we strongly recommend high-quality systematic research on children and adolescents, since they are generally considered as sensitive age groups.

Screen time and depression risk: A meta-analysis of cohort studies

BACKGROUND

The impact of screen time on mental health, including depression, has attracted increasing attention from not only children and adolescents but also the elderly. Thus, we conducted a meta-analysis of cohort studies to evaluate the association between screen time and depression risk.

METHODS

The PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases were searched for cohort studies up to May 2022, and the reference lists of the included studies were also retrieved. A random-effect model was used to estimate the combined effect size. Heterogeneity was assessed with the I ² statistic. Potential publication bias was evaluated using a funnel plot and Begg's and Egger's tests.

RESULTS

The final analysis included 18 cohort studies with a combined total of 241,398 participants. The pooled risk ratio (RR) was 1.10 (95% confidence interval: 1.05-1.14), with significant heterogeneity (I ² = 82.7%, P < 0.001). The results of subgroup analyses showed that the pooled RRs varied according to geographic locations, gender, age group, screen time in the control group, depression at the baseline, and whether the study was conducted during the COVID-19 pandemic. No obvious evidence of publication bias was found.

CONCLUSION

This study indicates that screen time is a predictor of depressive symptoms. The effects of screen time on depression risk may vary based on the participant's age, gender, location, and screen time duration. The findings could have important implications for the prevention of depression.

Perceptions and Experiences About Device-Emitted Radiofrequency Radiation and Its Effects on Selected Brain Health Parameters in Southwest Nigeria

Introduction

Radiofrequency radiation (RFR) is a form of non-ionising radiation that is used or emitted by a number of technologies and innovative devices including mobile phones and computers and gadgets. Exposure to RFR has been reported to have certain negative effects on human health. It is clear that quality and reliable data will be required with respect to the specific nature of RFR effects on mental health. This research considered the perceptions and exposure-related experiences of people within a Nigerian population with respect to RFR.

Methods

Structured and validated questionnaires were used to profile self-reported patterns of behaviour and sleep in humans. Questionnaire administration-electronic was opened for exactly one week, consisting of 25 specific questions and five open-ended questions [total = 30 questions]. A total population approach was adopted [N=~240]. Bivariate analysis using Chi-square tests were conducted to determine the association between knowledge of electronic gadgets as a source of radiofrequency radiation and sociodemographic characteristics of respondents. Binary logistic regression was used to determine the factors associated with good knowledge of electronic gadgets as a source of radiofrequency radiation. The level of statistical significance was set at p ≤ 0.05.

Results

The response rate was approximately 84%. Fatigue/tiredness [69.6%], attention deficit [69.1%] and headache [62.4%] ranked top amongst RFR-associated negative effects on mental health. Among the respondents, 29 (56.9%) among those above 20 years had good knowledge of radiofrequency radiation from electronic gadgets compared to 72 (47.2%) aged 20 years and below (X² = 1.285, p = 0.257). Also, 45 (59.2%) of persons who lived in a town/village had good knowledge of radiofrequency radiation from electronic gadgets compared to 56 (44.4%) who lived in the city (X² = 4.135, p = 0.042). Persons who lived in a town/village had nearly two times the odds of having good knowledge of RFR from electronic gadgets.

Conclusion

The study showed that respondents had experienced significant and negative effects of RFR on their mental health. The current level of knowledge and awareness on the nature of RFR and exposures was just about average, indicating a critical and urgent need to educate the public on the subject.

Electronic media use and sleep in children and adolescents in western countries: a systematic review

Background

Sleep is essential for child and adolescent health and well-being. There is an increasing interest in whether electronic media use affects children and young adolescents’ sleep. Prior reviews have focused on a school-aged population. Moreover, it is crucial that research continuously addresses the processes of technology and media use and the implication on sleep. This systematic review examines the evidence of electronic media use related to sleep among 0–15-year-olds.

Methods

Searches were carried out in four databases (CINAHL, Web of Science, EMBASE, and Medline). Inclusion criteria included age ≤ 15 years, and intervention, cohort, or cross-sectional studies from western countries. Methodological quality was rated using the Quality Assessment Tool for Quantitative Studies by two independent reviewers. Data was extracted using a standardized data extraction form. Synthesis was done by summarizing results across studies by age groups of 0–5, 6–12, and 13–15 years within four sleep domains: Bedtime and sleep onset; Sleep quality; Sleep duration; Daytime tiredness.

Results

The search identified 10,719 unique studies, of which 109 fulfilled inclusion and exclusion criteria and were assessed for methodological quality. In total, 49 studies were included in the review. The study designs were randomized controlled trials (n = 3), quasi-experimental studies (n = 2), prospective cohort studies (n = 15), and cross-sectional studies (n = 29). Evidence for an association between electronic media use and sleep duration was identified, with stronger evidence for 6–15-years-olds than 0–5-year-olds. The evidence for a relationship between electronic media use and other sleep outcomes was more inconclusive. However, for 6–12-year-old children, there was evidence for associations of electronic media use with delayed bedtime and poor sleep quality. For 13–15-year-olds, there was evidence for associations between screen time and problems falling asleep, and between social media use and poor sleep quality.

Conclusions

Overall, electronic media use was generally associated with shorter sleep duration in children and adolescents. Studies with stronger research design and of higher quality are needed to draw solid conclusions about electronic media’s impact on other sleep outcomes. Public awareness and interventions could be promoted about the potential negative impact on children’s sleep of electronic media devices that are used excessively and close to bedtime.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11640-9.

A year in the social life of a teenager: Within-person fluctuations in stress, phone communication, and anxiety and depression

Stressful life events (SLEs) are strongly associated with the emergence of adolescent anxiety and depression, but the underlying mechanisms remain poorly understood, especially at the within-person level. We investigated how adolescent social communication (i.e., frequency of calls and texts) following SLEs relates to changes in internalizing symptoms in a multi-timescale intensive year-long study (N=30; n=355 monthly observations; n=~5,000 experience-sampling observations). Within-person increases in SLEs were associated with receiving more calls than usual at both monthly- and momentary-levels, and making more calls at the monthly-level. Increased calls were prospectively associated with worsening internalizing symptoms at the monthly-level only, suggesting that SLEs rapidly influences phone communication patterns, but these communication changes may have a more protracted, cumulative influence on internalizing symptoms. Finally, increased incoming calls prospectively mediated the association between SLEs and anxiety at the monthly-level. We identify adolescent social communication fluctuations as a potential mechanism conferring risk for stress-related internalizing psychopathology.

Plant Robot for At-Home Behavioral Activation Therapy Reminders to Young Adults with Depression

Adolescents with depression who participate in behavioral activation therapy may find it hard to be motivated to perform tasks at home that their therapists recommend. We describe the initial design and usability evaluation of a home device (“PlantBot”) that could be used to remind young adults with depression at home of their behavioral activation therapy-related tasks. The prototype features electronics in a two-layer base, with a fake plant on top and supported using the Amazon Echo voice agent. We use an online panel study to evaluate the usability of our system with youth with past depression ( N = 30). Initial findings highlight the device’s usability, potential benefit, and attractiveness of the plant component, as well as multiple improvements to be made.

1800 MHz Radiofrequency Electromagnetic Field Impairs Neurite Outgrowth Through Inhibiting EPHA5 Signaling

The increasing intensity of environmental radiofrequency electromagnetic fields (RF-EMF) has increased public concern about its health effects. Of particular concern are the influences of RF-EMF exposure on the development of the brain. The mechanisms of how RF-EMF acts on the developing brain are not fully understood. Here, based on high-throughput RNA sequencing techniques, we revealed that transcripts related to neurite development were significantly influenced by 1800 MHz RF-EMF exposure during neuronal differentiation. Exposure to RF-EMF remarkably decreased the total length of neurite and the number of branch points in neural stem cells-derived neurons and retinoic acid-induced Neuro-2A cells. The expression of Eph receptors 5 (EPHA5), which is required for neurite outgrowth, was inhibited remarkably after RF-EMF exposure. Enhancing EPHA5 signaling rescued the inhibitory effects of RF-EMF on neurite outgrowth. Besides, we identified that cAMP-response element-binding protein (CREB) and RhoA were critical downstream factors of EPHA5 signaling in mediating the inhibitory effects of RF-EMF on neurite outgrowth. Together, our finding revealed that RF-EMF exposure impaired neurite outgrowth through EPHA5 signaling. This finding explored the effects and key mechanisms of how RF-EMF exposure impaired neurite outgrowth and also provided a new clue to understanding the influences of RF-EMF on brain development.

Electronic Screen Exposure and Headache in Children

Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. Electronic screens are becoming increasingly important in the lives of preteens and teens. In this review, we discussed effects of electronic screens on primary headache in childhood to emphasize the importance of electronic screen exposure in children with headache. Using digital and social media can bring some benefits and risks for mental and physical health. Time spent on screen-based activities contributes to the chance of reporting general physical complaints, in particular, headache and backache during early adolescence. We suggest that all children with primary headache should be evaluated for abuse of electronic screens in neurology practice. We also think that restriction of electronic screen should be advised in children with migraine and tension type headache before initiation of pharmacotherapy. As online classes are a reality, use of electronic screen may be allowed for school age children up to 2 h/day with taking time away from digital media every 20 min for 20 sec. In conclusion, we would like to emphasize that limiting the time spent on the screen is important for the reduction of headache symptoms of children and adolescents.

The Impact of Mobile Phone Use on Tinnitus: A Systematic Review and Meta-Analysis

Tinnitus is a perception of sound in the absence of an external source. The aim of our study was to investigate with a meta-analytical approach, whether mobile phone (MP) use increases the risk of tinnitus. Eight studies reporting the risk of tinnitus in relation to MP use were identified, and six high-quality studies (two cohort studies, one case-control study, and three cross-sectional ones) were included in the meta-analysis. The quality assessment was performed using the Newcastle-Ottawa scale. The risk of tinnitus was analyzed depending on the exposure to MPs in subgroups according to the study design and method of exposure assessment. Two cohort studies, which assessed the exposure to MPs using network operator data, indicated no significantly increased risk of tinnitus among highly exposed MP users in comparison to lightly exposed individuals (odds ratio [OR]: 1.03 [95% confidence interval [CI]: 0.93-1.15]). Likewise, the self-reported exposure data from two cohorts/case-control and four cross-sectional studies did not find an association between exposure to MPs and tinnitus (OR: 1.20 [95% CI: 0.40-3.61] and OR: 1.73 [95% CI: 0.67-4.49], respectively). Current scientific knowledge, including high-quality studies with a reliable exposure assessment based on network operator data, does not support the hypothesis that MP use is associated with tinnitus. © 2020 Bioelectromagnetics Society.

Risks to Health and Well-Being From Radio-Frequency Radiation Emitted by Cell Phones and Other Wireless Devices

Radiation exposure has long been a concern for the public, policy makers, and health researchers. Beginning with radar during World War II, human exposure to radio-frequency radiation (RFR) technologies has grown substantially over time. In 2011, the International Agency for Research on Cancer (IARC) reviewed the published literature and categorized RFR as a "possible" (Group 2B) human carcinogen. A broad range of adverse human health effects associated with RFR have been reported since the IARC review. In addition, three large-scale carcinogenicity studies in rodents exposed to levels of RFR that mimic lifetime human exposures have shown significantly increased rates of Schwannomas and malignant gliomas, as well as chromosomal DNA damage. Of particular concern are the effects of RFR exposure on the developing brain in children. Compared with an adult male, a cell phone held against the head of a child exposes deeper brain structures to greater radiation doses per unit volume, and the young, thin skull's bone marrow absorbs a roughly 10-fold higher local dose. Experimental and observational studies also suggest that men who keep cell phones in their trouser pockets have significantly lower sperm counts and significantly impaired sperm motility and morphology, including mitochondrial DNA damage. Based on the accumulated evidence, we recommend that IARC re-evaluate its 2011 classification of the human carcinogenicity of RFR, and that WHO complete a systematic review of multiple other health effects such as sperm damage. In the interim, current knowledge provides justification for governments, public health authorities, and physicians/allied health professionals to warn the population that having a cell phone next to the body is harmful, and to support measures to reduce all exposures to RFR.

Effects of smartphone overuse on headache, sleep and quality of life in migraine patients

Objectives:

To investigate the effects of smartphone overuse on headache, sleep quality, daytime sleepiness and quality of life in migraine patients.

Methods:

This study is a single-center, cross sectional comparative study. This study was conducted between July and September 2017 in the Neurology Clinic of a private hospital. Migraine disability assessment (MIDAS) questionnaire was used to evaluate the disability status, and Mobile Phone Problematic Use Scale (MPPUS) was used to evaluate smartphone use frequency. The Visual Analogue Scale (VAS), 24-h Migraine Quality of Life Questionnaire (24-h MQoLQ), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate the pain intensity, quality of life, sleep quality and daytime sleepiness, respectively.

Results:

The study included a total of 123 patients. There was a significant difference between the groups in terms of pain intensity, frequency and duration as well as VAS, PSQI, 24-h MQoLQ and ESS (p<0.05) scores. There was a negative correlation between MPPUS and PSQI (r=−0.367, p<0.05); a strong positive correlation between MPPUS and ESS (r=0.675, p<0.05) and a negative correlation between MPPUS and 24-h MQoLQ (r=−0.508, p<0.05).

Conclusion:

Smartphone use has been observed to increase headache duration and frequency in migraine patients. Its overuse in migraine patients is related to poor sleep quality and daytime sleepiness; furthermore, as the smartphone use increases, sleep quality decreases, daytime sleepiness increases and quality of life decreases.

Environmental Exposures and Depression: Biological Mechanisms and Epidemiological Evidence

Mental health and well-being are consistently influenced—directly or indirectly—by multiple environmental exposures. In this review, we have attempted to address some of the most common exposures of the biophysical environment, with a goal of demonstrating how those factors interact with central structures and functions of the brain and thus influence the neurobiology of depression. We emphasize biochemical mechanisms, observational evidence, and areas for future research. Finally, we include aspects of contextual environments—city living, nature, natural disasters, and climate change—and call for improved integration of environmental issues in public health science, policies, and activities. This integration is necessary for reducing the global pandemic of depression.

Complications of nonionizing radiofrequency on divided attention

Exposure to electromagnetic fields is considered as a potential hazard for biological systems. The objective of our investigation is the study of probable consequences of radiofrequency electromagnetic fields from Wi-Fi router devices on the short-term memory, and attention's levels. A population consisting of 312 female college students (14 to 17 years old) was elected by cluster random sampling. Teenagers were divided into two groups of control group (Wi-Fi nonusers; n = 138), and experiment group (Wi-Fi users; n = 174). Both groups have been examined using short-term memory tests; selective attention, and also divided attention tests. According to the results, there was no significant difference between using Wi-Fi router devices on levels of selective attentions and short-term memory of the sample students with the control group. However, analyses revealed that there is a significant correlation between the use of Wi-Fi routers and declining levels of divided attentions. Our investigation has demonstrated the adverse consequences of 2.4-2.48 GHz radiofrequency electromagnetic fields of Wi-Fi router devices on divided attention levels of female university students that should be mentioned as a technological risk factor and taken into account by healthcare organizations.

Blocking Short-Wavelength Component of the Visible Light Emitted by Smartphones' Screens Improves Human Sleep Quality

BACKGROUND

It has been shown that short-wavelength blue component of the visible light spectrum can alter the circadian rhythm and suppress the level of melatonin hormone. The short-wavelength light emitted by smartphones' screens can affect the sleep quality of the people who use these devices at night through suppression of melatonin.

OBJECTIVES

In this study, we examined the effects of covering the screens of smartphones with different filters (changing the effective wavelength of the light) on sleep delay time in 43 healthy students.

MATERIALS AND METHODS

Volunteer students were asked to go to bed at 23:00 and to use their mobile phones in bed for watching a natural life documentary movie for 60 minutes. No filter was used for one night while amber and blue filters were used for other 2 nights. Photospectrometry method was used to determine the output spectrum of the light passing through the filters used for covering the screens of the mobile phones. The order for utilizing amber or blue filters or using no filter was selected randomly. After 1 hour, the participants were asked to record their sleep delay time measured by a modified form of sleep time record sheet.

RESULTS

The mean sleep delay time for the "no-filter" night was 20.84±9.15 minutes, while the sleep delay times for the nights with amber and blue filters were 15.26±1.04 and 26.33±1.59 minutes, respectively.

CONCLUSION

The findings obtained in this study support this hypothesis that blue light possibly suppresses the secretion of melatonin more than the longer wavelengths of the visible light spectrum. Using amber filter in this study significantly improved the sleep quality. Altogether, these findings lead us to this conclusion that blocking the short-wavelength component of the light emitted by smartphones' screens improves human sleep.

A comparison of upper body and limb postures across technology and handheld device use in college students

[Purpose] People using technology and handheld devices adopt postures of the upper limb and neck that could result in musculoskeletal pathology. Previous research has explored the postures assumed during isolated use of technology devices, such as a smartphone, however a comparison of posture assumed between multiple devices has not been completed. The purpose of this study was to compare the posture of the upper body and limb between handheld devices and technology. [Participants and Methods] Twenty one healthy college students completed this study. Pictures of participants were taken in a neutral posture and as they performed standard tasks with 3 devices (mobile phone, tablet, laptop). A mobile application calculated sagittal and coronal plane posture variables, which were compared between device conditions with an ANOVA and post-hoc tests. [Results] Head translation and angulation and shoulder angulation varied significantly between conditions in both planes. Shoulder translation varied significantly between conditions in the sagittal plane. Rib translation varied significantly between conditions in the coronal plane. Tablet use produced postures that were statistically different than the other devices. [Conclusion] Use of each device altered posture however, frequent, regular use of a tablet may produce greater deleterious effects than regular use of other handheld devices/technology.

Children's exposure assessment of radiofrequency fields: Comparison between spot and personal measurements

INTRODUCTION

Radiofrequency (RF) fields are widely used and, while it is still unknown whether children are more vulnerable to this type of exposure, it is essential to explore their level of exposure in order to conduct adequate epidemiological studies. Personal measurements provide individualized information, but they are costly in terms of time and resources, especially in large epidemiological studies. Other approaches, such as estimation of time-weighted averages (TWAs) based on spot measurements could simplify the work.

OBJECTIVES

The aims of this study were to assess RF exposure in the Spanish INMA birth cohort by spot measurements and by personal measurements in the settings where children tend to spend most of their time, i.e., homes, schools and parks; to identify the settings and sources that contribute most to that exposure; and to explore if exposure assessment based on spot measurements is a valid proxy for personal exposure.

METHODS

When children were 8 years old, spot measurements were conducted in the principal settings of 104 participants: homes (104), schools and their playgrounds (26) and parks (79). At the same time, personal measurements were taken for a subsample of 50 children during 3 days. Exposure assessment based on personal and on spot measurements were compared both in terms of mean exposures and in exposure-dependent categories by means of Bland-Altman plots, Cohen's kappa and McNemar test.

RESULTS

Median exposure levels ranged from 29.73 (in children's bedrooms) to 200.10 μW/m² (in school playgrounds) for spot measurements and were higher outdoors than indoors. Median personal exposure was 52.13 μW/m² and median levels of assessments based on spot measurements ranged from 25.46 to 123.21 μW/m². Based on spot measurements, the sources that contributed most to the exposure were FM radio, mobile phone downlink and Digital Video Broadcasting-Terrestrial, while indoor and personal sources contributed very little (altogether <20%). Similar distribution was observed with personal measurements. There was a bias proportional to power density between personal measurements and estimates based on spot measurements, with the latter providing higher exposure estimates. Nevertheless, there were no systematic differences between those methodologies when classifying subjects into exposure categories. Personal measurements of total RF exposure showed low to moderate agreement with home and bedroom spot measurements and agreed better, though moderately, with TWA based on spot measurements in the main settings where children spend time (homes, schools and parks; Kappa = 0.46).

CONCLUSIONS

Exposure assessment based on spot measurements could be a feasible proxy to rank personal RF exposure in children population, providing that all relevant locations are being measured.

The Effect of a Single 30-Min Long Term Evolution Mobile Phone-Like Exposure on Thermal Pain Threshold of Young Healthy Volunteers

Although the majority of mobile phone (MP) users do not attribute adverse effects on health or well-being to MP-emitted radiofrequency (RF) electromagnetic fields (EMFs), the exponential increase in the number of RF devices necessitates continuing research aimed at the objective investigation of such concerns. Here we investigated the effects of acute exposure from Long Term Evolution (LTE) MP EMFs on thermal pain threshold in healthy young adults. We use a protocol that was validated in a previous study in a capsaicin-induced hyperalgesia model and was also successfully used to show that exposure from an RF source mimicking a Universal Mobile Telecommunications System (UMTS) MP led to mildly stronger desensitization to repeated noxious thermal stimulation relative to the sham condition. Using the same experimental design, we did not find any effects of LTE exposure on thermal pain threshold. The present results, contrary to previous evidence obtained with the UMTS modulation, are likely to originate from placebo/nocebo effects and are unrelated to the brief acute LTE EMF exposure itself. The fact that this is dissimilar to our previous results on UMTS exposure implies that RF modulations might differentially affect pain perception and points to the necessity of further research on the topic.

A Prospective Cohort Study of Adolescents' Memory Performance and Individual Brain Dose of Microwave Radiation from Wireless Communication

BACKGROUND

The potential impact of microwave radiofrequency electromagnetic fields (RF-EMF) emitted by wireless communication devices on neurocognitive functions of adolescents is controversial. In a previous analysis, we found changes in figural memory scores associated with a higher cumulative RF-EMF brain dose in adolescents.

OBJECTIVE

We aimed to follow-up our previous results using a new study population, dose estimation, and approach to controlling for confounding from media usage itself.

METHODS

RF-EMF brain dose for each participant was modeled. Multivariable linear regression models were fitted on verbal and figural memory score changes over 1 y and on estimated cumulative brain dose and RF-EMF related and unrelated media usage (n=669-676). Because of the hemispheric lateralization of memory, we conducted a laterality analysis for phone call ear preference. To control for the confounding of media use behaviors, a stratified analysis for different media usage groups was also conducted.

RESULTS

We found decreased figural memory scores in association with an interquartile range (IQR) increase in estimated cumulative RF-EMF brain dose scores: -0.22 (95% CI: -0.47, 0.03; IQR: 953 mJ/kg per day) in the whole sample, -0.39 (95% CI: -0.67, -0.10; IQR: 953 mJ/kg per day) in right-side users (n=532), and -0.26 (95% CI: -0.42, -0.10; IQR: 341 mJ/kg per day) when recorded network operator data were used for RF-EMF dose estimation (n=274). Media usage unrelated to RF-EMF did not show significant associations or consistent patterns, with the exception of consistent (nonsignificant) positive associations between data traffic duration and verbal memory.

CONCLUSIONS

Our findings for a cohort of Swiss adolescents require confirmation in other populations but suggest a potential adverse effect of RF-EMF brain dose on cognitive functions that involve brain regions mostly exposed during mobile phone use. https://doi.org/10.1289/EHP2427.

Is the relationship between parental abuse and mobile phone dependency (MPD) contingent across neighborhood characteristics? A multilevel analysis of Korean Children and Youth Panel Survey

Research indicates that mobile phone dependency (MPD) is associated with various behavioral and internalizing problems. While a significant amount of findings points to its negative outcomes, there is a dearth of evidence concerning the determinants of MPD. This study focuses on this critical, yet understudied, subject by analyzing the associations between abusive parenting style, neighborhood characteristics, and MPD among youths in South Korea, a country with one of the highest mobile broadband penetration rates in the world. Based on the secondary analysis of two waves of Korean Children and Youth Panel Survey (KCYPS), a government-funded multiyear study, we investigate individual- and contextual-level factors underlying MPD. Findings show that, net of a host of time-lagged controls (including baseline dependency from the previous year), abusive parenting style significantly increases adolescent MPD. After adjusting for individual level characteristics, however, no contextual-level effect is found, i.e., residing in a neighborhood with a relatively higher proportion of parental abuse is not related to greater MPD. Finally, two cross-level interaction effects are observed. First, the association between parental abuse and MPD is weaker in a neighborhood context with better educated inhabitants (more college graduates). Second, it is reinforced in demographically “aged” communities with more elderly residents.

Effects of 1800 MHz RF-EMF exposure on DNA damage and cellular functions in primary cultured neurogenic cells

PURPOSE

To systematically evaluate the effects of 1800 MHz radiofrequency electromagnetic fields (RF-EMF) exposure on DNA damage and cellular functions in primary cultured neurogenic cells.

MATERIALS AND METHODS

The primary cultured astrocytes, microglia and cortical neurons were exposed to RF-EMF at a SAR of 4.0 W/kg. The DNA damage was evaluated by γH2AX foci formation assay. The secretions of pro-inflammatory cytokines (TNF-α, IL-6 and IL-1β) in astrocytes and microglia, microglial phagocytic activity and neuronal development were examined by enzyme-linked immunosorbent assay, phagocytosis assay and immunofluorescent staining on microtubule-associated protein tau, microtubule-associated protein 2, postsynaptic density 95 and gephyrin, respectively.

RESULTS

RF-EMF exposure did not significantly induce γH2AX foci formation in three primary cultured neurogenic cells. Furthermore, RF-EMF exposure did not significantly affect the secretion of cytokines in astrocytes and microglia, and the morphological indicators of dendrites or synapses of cortical neurons. However, the exposure significantly reduced the phagocytic activity of microglia and inhibited the axon branch length and branch number of cortical neurons.

CONCLUSIONS

Our data demonstrated that exposure to RF-EMF did not elicit DNA damage but inhibited the phagocytic ability of microglia and the axon branch length and branch number of cortical neurons.

Mobile Phone Use and The Risk of Headache: A Systematic Review and Meta-analysis of Cross-sectional Studies

Headache is increasingly being reported as a detrimental effect of mobile phone (MP) use. However, studies aimed to investigate the association between MP use and headache yielded conflicting results. To assess the consistency of the data on the topic, we performed a systematic review and meta-analysis of the available cross-sectional studies. Published literature from PubMed and other databases were retrieved and screened, and 7 cross-sectional studies were finally included in this meta-analysis. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated. We found that the risk of headache was increased by 38% in MP user compared with non-MP user (OR, 1.38; 95% CI, 1.18–1.61, p < 0.001). Among MP users, the risk of headache was also increased in those who had longer daily call duration (2–15 min vs. <2 min: OR, 1.62; 95% CI, 1.34–1.98, p < 0.001; >15 min vs. <2 min: OR, 2.50; 95% CI, 1.76–3.54, p < 0.001) and higher daily call frequency (2–4 calls vs. <2 calls: OR, 1.37; 95% CI, 1.07–1.76, p < 0.001; >4 calls vs. <2 calls: OR, 2.52; 95% CI, 1.78–3.58, p < 0.001). Our data indicate that MP use is significantly associated with headache, further epidemiologic and experimental studies are required to affirm and understand this association.

Symptoms and the use of wireless communication devices: A prospective cohort study in Swiss adolescents

BACKGROUND

We investigated whether radiofrequency electromagnetic fields (RF-EMF) from mobile phones and other wireless devices or by the wireless device use itself due to non-radiation related factors in that context are associated with an increase in health symptom reports of adolescents in Central Switzerland.

METHODS

In a prospective cohort study, 439 study participants (participation rate: 36.8%) aged 12-17 years, completed questionnaires about their mobile and cordless phone use, their self-reported symptoms and possible confounding factors at baseline (2012/2013) and one year later (2013/2014). Operator recorded mobile phone data was obtained for a subgroup of 234 adolescents. RF-EMF dose measures considering various factors affecting RF-EMF exposure were computed for the brain and the whole body. Data were analysed using a mixed-logistic cross-sectional model and a cohort approach, where we investigated whether cumulative dose over one year was related to a new onset of a symptom between baseline and follow-up. All analyses were adjusted for relevant confounders.

RESULTS

Participation rate in the follow-up was 97% (425 participants). In both analyses, cross-sectional and cohort, various symptoms tended to be mostly associated with usage measures that are only marginally related to RF-EMF exposure such as the number of text messages sent per day (e.g. tiredness: OR:1.81; 95%CI:1.20-2.74 for cross-sectional analyses and OR:1.87; 95%CI:1.04-3.38 for cohort analyses). Outcomes were generally less strongly or not associated with mobile phone call duration and RF-EMF dose measures.

CONCLUSIONS

Stronger associations between symptoms of ill health and wireless communication device use than for RF-EMF dose measures were observed. Such a result pattern does not support a causal association between RF-EMF exposure and health symptoms of adolescents but rather suggests that other aspects of extensive media use are related to symptoms.

Effects of prenatal exposure to WIFI signal (2.45GHz) on postnatal development and behavior in rat: Influence of maternal restraint

The present study was carried out to investigate the potential combined influence of maternal restraint stress and 2.45GHz WiFi signal exposure on postnatal development and behavior in the offspring of exposed rats. 24 pregnant albino Wistar rats were randomly assigned to four groups: Control, WiFi-exposed, restrained and both WiFi-exposed and restrained groups. Each of WiFi exposure and restraint occurred 2h/day along gestation till parturition. The pups were evaluated for physical development and neuromotor maturation. Moreover, elevated plus maze test, open field activity and stationary beam test were also determined on postnatal days 28, 30 and 31, respectively. After behavioral tests, the rats were anesthetized and their brains were removed for biochemical analysis. Our main findings showed no detrimental effects on gestation progress and outcomes at delivery in all groups. Subsequently, WiFi and restraint, per se and mainly in concert altered physical development of pups with slight differences between genders. Behaviorally, the gestational WiFi irradiation, restraint and especially the associated treatment affected the neuromotor maturation mainly in male progeny. At adult age, we noticed anxiety, motor deficit and exploratory behavior impairment in male offspring co-exposed to WiFi radiation and restraint, and in female progeny subjected to three treatments. The biochemical investigation showed that, all three treatments produced global oxidative stress in brain of both sexes. As for serum biochemistry, phosphorus, magnesium, glucose, triglycerides and calcium levels were disrupted. Taken together, prenatal WiFi radiation and restraint, alone and combined, provoked several behavioral and biochemical impairments at both juvenile and adult age of the offspring.

Smart Device Use and Perceived Physical and Psychosocial Outcomes among Hong Kong Adolescents

Excessive electronic screen-based activities have been found to be associated with negative outcomes. The aim of this study was to investigate the prevalences and patterns of smart device activities and the purposes and perceived outcomes related to smart device use, and the differences in patterns of smart device activities between adolescents who did and did not perceive these outcomes. The study was a cross-sectional survey of Hong Kong primary and secondary school students. Demographic characteristics, purpose and pattern of the activities, and frequencies of the outcomes were measured. Data from 960 adolescents aged 10-19 were analyzed. Nearly 86% of the sample use smart device daily. The one-week prevalence of perceived sleep deprivation, eye discomfort, musculoskeletal discomfort, family conflict and cyberbullying victimization related to smart device use were nearly 50%, 45%, 40%, 20% and 5% respectively. More than 25% of the respondents were at risk of negative outcomes related to smart device activities for more than 1 h per day, browsing and gaming on at least 4 days per week and watching TV/movies and posting on more than 2 days per week. Their patterns of smart device activities may put a significant number of them at risk of negative outcomes.

The Effects of Exposure to Low Frequency Electromagnetic Fields in the Treatment of Migraine Headache: A Cohort Study

Introduction

Findings have indicated that increased usage of mobile phones may be concomitant with higher rate of headache attacks due to the low radiofrequency electromagnetic fields (RF-EMF). The aim of this study was to determine the effects of low RF-EMF on the treatment outcome in migraine patients.

Methods

This cohort study was performed on 114 migraine patients referred to the Neurology Clinic of Golestan Hospital in Ahvaz, Southwest Iran, from September 2014 to March 2015. Patients with migraine were interviewed using a standardized questionnaire exploring mobile phones, Wi-Fi devices and fixed-line telephone use as RF-EMF sources. After 3 months, we determined patients’ response to treatment. Generalized estimating equation (GEE) tests were carried out to analyze data, using SPSS version 17.

Results

Out of 114 individuals who participated, 82 (71.9%) were female and 32 (28.1%) cases were male. The number and severity of migraine headaches were correlated significantly with an increased use of mobile phones during day and Wi-Fi per week (p<0.05). The usage of fixed-line telephones had no significant relationship with the study variables (p>0.05).

Conclusion

It is recommended that the patients with migraine headache limit mobile phone use and instead, use the fixed-line telephone for their daily telecommunications.

Where's Your Phone? A Survey of Where Women Aged 15-40 Carry Their Smartphone and Related Risk Perception: A Survey and Pilot Study

Smartphones are now owned by most young adults in many countries. Installed applications regularly update while the phone is in standby. If it is kept near the body, this can lead to considerably higher exposure to radiofrequency electromagnetic radiation than occurred without internet access. Very little is known about current smartphone carrying habits of young women. This survey used an online questionnaire to ask about smartphone location under several circumstances to inform the power calculation for a women’s health study. They were also asked about risk perceptions. Data was analysed using Pearson chi square. Three age categories were made: 15–20, 21–30, 31–40. Smartphones were generally kept on standby (96% by day, 83% at night). Of all participants, in the last week the most common locations of the phone when not in use or during passive use was off-body (86%), in the hand (58%), a skirt/trouser pocket (57%), or against the breast (15%). Pocket and near-the-breast storage were significant by age (χ²15.04, p = 0.001 and χ²10.96, p = 0.04, respectively), both positively influenced by the youngest group. The same influence lay in the association between holding the phone (χ²11.082, p = 0.004) and pocket-storage (χ²19.971, p<0.001) during passive use. For calls, 36.5% solely used the phone against the head. More than half kept the phone 20–50 cms from their head at night (53%), while 13% kept it closer than 20 cms. Many (36%) thought RF-EMR exposure was related to health problems while 16% did not. There was no relationship between thinking RF-EMR exposure causes health problems in general and carrying the phone against the upper or lower body (p = 0.69 and p = 0.212, respectively). However, calls with the phone against the head were positively related to perception of health risk (χ² 6.695, p = 0.035). Our findings can be used in the power calculation for a case-control study.

Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis

IMPORTANCE

Sleep is vital to children's biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children's lives and may affect their sleep duration and quality.

OBJECTIVE

To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes.

DATA SOURCES

A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied.

STUDY SELECTION

The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation.

DATA EXTRACTION AND SYNTHESIS

Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data.

MAIN OUTCOMES AND MEASURES

The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol.

RESULTS

Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%).

CONCLUSIONS AND RELEVANCE

To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes.

Instruments to assess and measure personal and environmental radiofrequency-electromagnetic field exposures

Radiofrequency-electromagnetic field (RF-EMF) exposure of human populations is increasing due to the widespread use of mobile phones and other telecommunication and broadcasting technologies. There are ongoing concerns about potential short- and long-term public health consequences from RF-EMF exposures. To elucidate the RF-EMF exposure-effect relationships, an objective evaluation of the exposures with robust assessment tools is necessary. This review discusses and compares currently available RF-EMF exposure assessment instruments, which can be used in human epidemiological studies. Quantitative assessment instruments are either mobile phone-based (apps/software-modified and hardware-modified) or exposimeters. Each of these tool has its usefulness and limitations. Our review suggests that assessment of RF-EMF exposures can be improved by using these tools compared to the proxy measures of exposure (e.g. questionnaires and billing records). This in turn, could be used to help increase knowledge about RF-EMF exposure induced health effects in human populations.

Environmental Radiofrequency Electromagnetic Fields Exposure at Home, Mobile and Cordless Phone Use, and Sleep Problems in 7-Year-Old Children

BACKGROUND

We evaluated if exposure to RF-EMF was associated with reported quality of sleep in 2,361 children, aged 7 years.

METHODS

This study was embedded in the Amsterdam Born Children and their Development (ABCD) birth cohort study. When children were about five years old, school and residential exposure to RF-EMF from base stations was assessed with a geospatial model (NISMap) and from indoor sources (cordless phone/WiFi) using parental self-reports. Parents also reported their children's use of mobile or cordless phones. When children were seven years old, we evaluated sleep quality as measured with the Child Sleep Habits Questionnaire (CSHQ) filled in by parents. Of eight CSHQ subscales, we evaluated sleep onset delay, sleep duration, night wakenings, parasomnias and daytime sleepiness with logistic or negative binomial regression models, adjusting for child's age and sex and indicators of socio-economic position of the parents. We evaluated the remaining three subscales (bedtime resistance, sleep anxiety, sleep disordered breathing) as unrelated outcomes (negative control) because these were a priori hypothesised not to be associated with RF-EMF.

RESULTS

Sleep onset delay, night wakenings, parasomnias and daytime sleepiness were not associated with residential exposure to RF-EMF from base stations. Sleep duration scores were associated with RF-EMF levels from base stations. Higher use mobile phones was associated with less favourable sleep duration, night wakenings and parasomnias, and also with bedtime resistance. Cordless phone use was not related to any of the sleeping scores.

CONCLUSION

Given the different results across the evaluated RF-EMF exposure sources and the observed association between mobile phone use and the negative control sleep scale, our study does not support the hypothesis that it is the exposure to RF-EMF that is detrimental to sleep quality in 7-year old children, but potentially other factors that are related to mobile phone usage.

Problematic mobile phone use of Swiss adolescents: is it linked with mental health or behaviour?

OBJECTIVES

To investigate the associations between problematic mobile phone use and mental health and behavioural problems in 412 Swiss adolescents owning a mobile phone while controlling for amount of mobile phone use.

METHODS

Problematic mobile phone use was determined by the MPPUS-10 (Mobile Phone Problem Use Scale) and related to health and behavioural problems by means of multivariable regression modelling.

RESULTS

MPPUS-10 was 4.7 (95 % CI 1.8, 7.6) units higher in girls than in boys, increased significantly with age and was significantly decreased with increasing educational level of the parents. Furthermore, problematic mobile phone use was associated with impaired psychological well-being, impaired parent and school relationships and more behavioural problems but was not related to peer support and social acceptance.

CONCLUSIONS

Our study indicates that problematic mobile phone use is associated with external factors such as worse home and school environment and internal factors such as impaired mental health and behavioural problems of the adolescents and thus problematic mobile phone use should be addressed, in particular when dealing with adolescents showing behavioural or emotional problems.

Symptoms and Cognitive Functions in Adolescents in Relation to Mobile Phone Use during Night

Many adolescents tend to leave their mobile phones turned on during night, accepting that they may be awakened by an incoming text message or call. Using self-reported and objective operator recorded mobile phone use data, we thus aimed to analyze how being awakened during night by mobile phone affects adolescents' perceived health and cognitive functions. In this cross-sectional study, 439 adolescents completed questionnaires about their mobile phone use during night, health related quality of life and possible confounding factors. Standardized computerized cognitive tests were performed to assess memory and concentration capacity. Objective operator recorded mobile phone use data was further collected for 233 study participants. Data were analyzed by multivariable regression models adjusted for relevant confounders including amount of mobile phone use. For adolescents reporting to be awakened by a mobile phone during night at least once a month the odds ratio for daytime tiredness and rapid exhaustibility were 1.86 (95% CI: 1.02-3.39) and 2.28 (95% CI: 0.97-5.34), respectively. Similar results were found when analyzing objective operator recorded mobile phone use data (tiredness: 1.63, 95% CI: 0.94-2.82 and rapid exhaustibility: 2.32, 95% CI: 1.01-5.36). The cognitive tests on memory and concentration capacity were not related to mobile phone use during night. Overall, being awakened during night by mobile phone was associated with an increase in health symptom reports such as tiredness, rapid exhaustibility, headache and physical ill-being, but not with memory and concentration capacity. Prevention strategies should focus on helping adolescents set limits for their accessibility by mobile phone, especially during night.

Association between mobile phone use and self-reported well-being in children: a questionnaire-based cross-sectional study in Chongqing, China

OBJECTIVES

In the past decade, the mobile phone (MP) has become extremely popular among children and the average age at which children own their first MP has decreased. The potential health effects of children's exposure to MP have been the subject of widespread public concern. The aim of our study is to investigate the associations between MP use and well-being in children.

DESIGN

Cross-sectional study.

SETTING

The questionnaires were completed in class with items regarding demographics, MP usage, self-reported well-being (symptoms were taken from the questionnaire of the HBSC survey) and possible confounding factors between October 2011 and May 2012 in Chongqing, China. Data were analysed using χ(2) tests and logistic regression models.

PARTICIPANTS

Among the 793 children invited to participate, 781 returned the questionnaires.

RESULTS

In total, 746 (94.1%) valid questionnaires were received. Fatigue was significantly associated with the years of MP usage (OR 1.85; 95% CI 1.07 to 3.22) and the daily duration of MP calls (OR 2.98; 95% CI 1.46 to 6.12). Headache was significantly associated with the daily duration of MP calls (OR 2.85; 95% CI 1.23 to 6.57). However, after adjusting for confounders only, the association between fatigue and MP usage remained statistically significant. There was no significant association between MP use and other physical symptoms in children.

CONCLUSIONS

The present study indicated that there was a consistent significant association between MP use and fatigue in children. Further in-depth research is needed to explore the potential health effects of MP use in children.

Radiofrequency exposure in young and old: different sensitivities in light of age-relevant natural differences

Our environment is now permeated by anthropogenic radiofrequency electromagnetic radiation, and individuals of all ages are exposed for most of each 24 h period from transmitting devices. Despite claims that children are more likely to be vulnerable than healthy adults to unwanted effects of this exposure, there has been no recent examination of this, nor of comparative risk to the elderly or ill. We sought to clarify whether research supports the claim of increased risk in specific age-groups. First, we identified the literature which has explored age-specific pathophysiological impacts of RF-EMR. Natural life-span changes relevant to these different impacts provides context for our review of the selected literature, followed by discussion of health and well-being implications. We conclude that age-dependent RF-EMR study results, when considered in the context of developmental stage, indicate increased specific vulnerabilities in the young (fetus to adolescent), the elderly, and those with cancer. There appears to be at least one mechanism other than the known thermal mechanism causing different responses to RF-EMR depending upon the exposure parameters, the cell/physiological process involved, and according to age and health status. As well as personal health and quality-of-life impacts, an ageing population means there are economic implications for public health and policy.

Differential pro-inflammatory responses of astrocytes and microglia involve STAT3 activation in response to 1800 MHz radiofrequency fields

Microglia and astrocytes play important role in maintaining the homeostasis of central nervous system (CNS). Several CNS impacts have been postulated to be associated with radiofrequency (RF) electromagnetic fields exposure. Given the important role of inflammation in neural physiopathologic processes, we investigated the pro-inflammatory responses of microglia and astrocytes and the involved mechanism in response to RF fields. Microglial N9 and astroglial C8-D1A cells were exposed to 1800 MHz RF for different time with or without pretreatment with STAT3 inhibitor. Microglia and astrocytes were activated by RF exposure indicated by up-regulated CD11b and glial fibrillary acidic protein (GFAP). However, RF exposure induced differential pro-inflammatory responses in astrocytes and microglia, characterized by different expression and release profiles of IL-1β, TNF-α, IL-6, PGE2, nitric oxide (NO), inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX2). Moreover, the RF exposure activated STAT3 in microglia but not in astrocytes. Furthermore, the STAT3 inhibitor Stattic ameliorated the RF-induced release of pro-inflammatory cytokines in microglia but not in astrocytes. Our results demonstrated that RF exposure differentially induced pro-inflammatory responses in microglia and astrocytes, which involved differential activation of STAT3 in microglia and astrocytes. Our data provide novel insights into the potential mechanisms of the reported CNS impacts associated with mobile phone use and present STAT3 as a promising target to protect humans against increasing RF exposure.

Could myelin damage from radiofrequency electromagnetic field exposure help explain the functional impairment electrohypersensitivity? A review of the evidence

Myelin provides the electrical insulation for the central and peripheral nervous system and develops rapidly in the first years of life, but continues into mid-life or later. Myelin integrity is vital to healthy nervous system development and functioning. This review outlines the development of myelin through life, and then considers the evidence for an association between myelin integrity and exposure to low-intensity radiofrequency electromagnetic fields (RF-EMFs) typical in the modern world. In RF-EMF peer-reviewed literature examining relevant impacts such as myelin sheath, multiple sclerosis, and other myelin-related diseases, cellular examination was included. There are surprisingly little data available in each area, but considered together a picture begins to emerge in RF-EMF-exposed cases: (1) significant morphological lesions in the myelin sheath of rats; (2) a greater risk of multiple sclerosis in a study subgroup; (3) effects in proteins related to myelin production; and (4) physical symptoms in individuals with functional impairment electrohypersensitivity, many of which are the same as if myelin were affected by RF-EMF exposure, giving rise to symptoms of demyelination. In the latter, there are exceptions; headache is common only in electrohypersensitivity, while ataxia is typical of demyelination but infrequently found in the former group. Overall, evidence from in vivo and in vitro and epidemiological studies suggests an association between RF-EMF exposure and either myelin deterioration or a direct impact on neuronal conduction, which may account for many electrohypersensitivity symptoms. The most vulnerable are likely to be those in utero through to at least mid-teen years, as well as ill and elderly individuals.