Reducing overestimation in reported mobile phone use associated with epidemiological studies

Case-control studies of mobile phones are commonly based on retrospective, self-reported exposure information, which are often characterized as involving substantial uncertainty concerning data validity. We assessed the validity of self-reported mobile phone use and developed a statistical model to account for the over-reporting of exposure. We collected information on mobile phone use from 70 volunteers using two sources of data: self-report in an interview and network operator records. We used regression models to obtain bias-corrected estimates of exposure. A correlation coefficient of 0.71 was obtained between the self-reported and the network operators' data on average calling time (log-transformed minutes per month). A simple linear regression model, where the duration of calls acquired from network operators is explained with the self-reported duration fitted the data reasonably well (adjusted R(2) 0.51). The constant term was 2.71 and the regression coefficient 0.49 (logarithmic scale). No significant improvement in the model fit was achieved by including potential predictors of accuracy in self-reported exposure estimates, such as the pattern of mobile phone use, the modality of response to the questionnaire or demographic characteristics. Overestimation in self-reported intensity of mobile phone use can be accounted for by the use of regression calibration. The estimates obtained in our study may not be applicable in other contexts, but similar methods could be used to reduce bias in other studies.     

Impact of random and systematic recall errors and selection bias in case--control studies on mobile phone use and brain tumors in adolescents (CEFALO study)

Whether the use of mobile phones is a risk factor for brain tumors in adolescents is currently being studied. Case--control studies investigating this possible relationship are prone to recall error and selection bias. We assessed the potential impact of random and systematic recall error and selection bias on odds ratios (ORs) by performing simulations based on real data from an ongoing case--control study of mobile phones and brain tumor risk in children and adolescents (CEFALO study). Simulations were conducted for two mobile phone exposure categories: regular and heavy use. Our choice of levels of recall error was guided by a validation study that compared objective network operator data with the self-reported amount of mobile phone use in CEFALO. In our validation study, cases overestimated their number of calls by 9% on average and controls by 34%. Cases also overestimated their duration of calls by 52% on average and controls by 163%. The participation rates in CEFALO were 83% for cases and 71% for controls. In a variety of scenarios, the combined impact of recall error and selection bias on the estimated ORs was complex. These simulations are useful for the interpretation of previous case-control studies on brain tumor and mobile phone use in adults as well as for the interpretation of future studies on adolescents.     

Acoustic neuroma risk in relation to mobile telephone use: results of the INTERPHONE international case-control study

Background: The rapid increase in mobile telephone use has generated concern about possible health risks of radiofrequency electromagnetic fields from these devices. Methods: A case–control study of 1105 patients with newly diagnosed acoustic neuroma (vestibular schwannoma) and 2145 controls was conducted in 13 countries using a common protocol. Past mobile phone use was assessed by personal interview. In the primary analysis, exposure time was censored at one year before the reference date (date of diagnosis for cases and date of diagnosis of the matched case for controls); analyses censoring exposure at five years before the reference date were also done to allow for a possible longer latent period. Results: The odds ratio (OR) of acoustic neuroma with ever having been a regular mobile phone user was 0.85 (95% confidence interval 0.69–1.04). The OR for ≥10 years after first regular mobile phone use was 0.76 (0.52–1.11). There was no trend of increasing ORs with increasing cumulative call time or cumulative number of calls, with the lowest OR (0.48 (0.30–0.78)) observed in the 9th decile of cumulative call time. In the 10th decile (≥1640 h) of cumulative call time, the OR was 1.32 (0.88–1.97); there were, however, implausible values of reported use in those with ≥1640 h of accumulated mobile phone use. With censoring at 5 years before the reference date the OR for ≥10 years after first regular mobile phone use was 0.83 (0.58–1.19) and for ≥1640 h of cumulative call time it was 2.79 (1.51–5.16), but again with no trend in the lower nine deciles and with the lowest OR in the 9th decile. In general, ORs were not greater in subjects who reported usual phone use on the same side of the head as their tumour than in those who reported it on the opposite side, but it was greater in those in the 10th decile of cumulative hours of use. Conclusions: There was no increase in risk of acoustic neuroma with ever regular use of a mobile phone or for users who began regular use 10 years or more before the reference date. Elevated odds ratios observed at the highest level of cumulative call time could be due to chance, reporting bias or a causal effect. As acoustic neuroma is usually a slowly growing tumour, the interval between introduction of mobile phones and occurrence of the tumour might have been too short to observe an effect, if there is one.     

An evaluation of self‐reported mobile phone use compared to billing records among a group of engineers and scientists

Most epidemiologic studies of potential health impacts of mobile phones rely on self‐reported information, which can lead to exposure misclassification. We compared self‐reported questionnaire data among 60 participants, and phone billing records over a 3‐year period (2002–2004). Phone usage information was compared by the calculation of the mean and median number of calls and duration of use, as well as correlation coefficients and associated P‐values. Average call duration from self‐reports was slightly lower than billing records (2.1 min vs. 2.8 min, P = 0.01). Participants reported a higher number of average daily calls than billing records (7.9 vs. 4.1, P = 0.002). Correlation coefficients for average minutes per day of mobile phone use and average number of calls per day were relatively high (R = 0.71 and 0.69, respectively, P < 0.001). Information reported at the monthly level tended to be more accurate than estimates of weekly or daily use. Our findings of modest correlations between self‐reported mobile phone usage and billing records and substantial variability in recall are consistent with previous studies. However, the direction of over‐ and under‐reporting was not consistent with previous research. We did not observe increased variability over longer periods of recall or a pattern of lower accuracy among older age groups compared with younger groups. Study limitations included a relatively small sample size, low participation rates, and potential limited generalizability. The variability within studies and non‐uniformity across studies indicates that estimation of the frequency and duration of phone use by questionnaires should be supplemented with subscriber records whenever practical. Bioelectromagnetics 32:37–48, 2011. © 2010 Wiley‐Liss, Inc.     

Poor-to-moderate agreement between self and proxy interviews of mobile phone use

In epidemiological studies, cases cannot always be interviewed due to them being too ill or already deceased. Under these circumstances, proxy interviews are often conducted; however, the veridicality of information about mobile phone use gained by proxy interviews has been doubted. The issue is undecided due to the lack of empirical data. We conducted a study of 119 heterosexual couples. Both partners answered two questionnaires about mobile phone use, one about their own use and one about their partner's use. Overall agreement assessed using Cohen's kappa, Passing and Bablok regression, and concordance coefficients between self and proxy data was poor to moderate (e.g., concordance coefficients of 0.55 for duration of use). The only item with good agreement was whether or not a prepaid phone was used (Cohen's kappa 0.78 and 0.63 for male and female estimates, respectively), and to a lesser degree, the onset of mobile phone use (concordance coefficients of 0.66 and 0.61). Poorest agreement was obtained for the side of the head the mobile phone was held during calls (kappa coefficients of 0.20 and 0.24 for female and male estimates, respectively). We conclude that the assessment of mobile phone use by proxy data cannot be relied on except for information about onset of mobile phone use, use of prepaid or contract phones, and, to a lesser degree, duration of daily use. Agreement concerning the important information about side of the head the mobile phone is held during calls was poorest and only slightly better than chance. Bioelectromagnetics 33:561–567, 2012. © 2012 Wiley Periodicals, Inc.     

Factors that influence the radiofrequency power output of GSM mobile phones

Epidemiological studies of mobile phone use and risk of brain cancer have relied on self-reported use, years as a subscriber, and billing records as exposure surrogates without addressing the level of radiofrequency (RF) power output. The objective of this study was to measure environmental, behavioral and engineering factors affecting the RF power output of GSM mobile phones during operation. We estimated the RF-field exposure of volunteer subjects who made mobile phone calls using software-modified phones (SMPs) that recorded output power settings. Subjects recruited from three geographic areas in the U.S. were instructed to log information (place, time, etc.) for each call made and received during a 5-day period. The largest factor affecting energy output was study area, followed by user movement and location (inside or outside), use of a hands-free device, and urbanicity, although the two latter factors accounted for trivial parts of overall variance. Although some highly statistically significant differences were identified, the effects on average energy output rate were usually less than 50% and were generally comparable to the standard deviation. These results provide information applicable to improving the precision of exposure metrics for epidemiological studies of GSM mobile phones and may have broader application for other mobile phone systems and geographic locations.     

The association between socioeconomic status and exposure to mobile telecommunication networks in children and adolescents

A potential association between socioeconomic status (SES) and self‐reported use of mobile phones has been investigated in a few studies. If measured exposure to mobile phone networks differs by SES in children, it has not yet been studied. Interview data of 1,481 children and 1,505 adolescents on participants' mobile phone use, socio‐demographic characteristics and potential confounders were taken from the German MobilEe‐study. Sociodemographic data was used to stratify participants into three “status groups” (low, middle, high). Using a personal dosimeter, we obtained an exposure profile over 24 h for each of the participants. Exposure levels during waking hours were expressed as mean percentage of the reference level. Children with a low SES were more likely to own a mobile phone (OR 2.1; 95% CI: 1.1–3.9) and also reported to use their mobile phone longer per day (OR 2.4; 95% CI: 1.1–5.4) than children with a high SES. For adolescents, self‐reported duration of mobile phone use per day was also higher with a low SES (OR: 3.4; 95% CI: 1.4–8.4) compared with a high SES. No association between SES and measured exposure to mobile telecommunication networks was seen for children or adolescents. Mobile phone use may differ between status groups with higher use among disadvantaged groups. However, this does not result in higher overall exposure to mobile telecommunication networks. Whether short duration of own mobile phone use or the small numbers of participants with a low SES are causal, have to be investigated in further studies. Bioelectromagnetics 31:20–27, 2010. © 2009 Wiley‐Liss, Inc.     

Mobile Phone Use,Blood Lead Levels,and Attention Deficit Hyperactivity Symptoms in Children: A Longitudinal Study

Background

Concerns have developed for the possible negative health effects of radiofrequency electromagnetic field (RF-EMF) exposure to children’s brains. The purpose of this longitudinal study was to investigate the association between mobile phone use and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) considering the modifying effect of lead exposure.

Methods

A total of 2,422 children at 27 elementary schools in 10 Korean cities were examined and followed up 2 years later. Parents or guardians were administered a questionnaire including the Korean version of the ADHD rating scale and questions about mobile phone use, as well as socio-demographic factors. The ADHD symptom risk for mobile phone use was estimated at two time points using logistic regression and combined over 2 years using the generalized estimating equation model with repeatedly measured variables of mobile phone use, blood lead, and ADHD symptoms, adjusted for covariates.

Results

The ADHD symptom risk associated with mobile phone use for voice calls but the association was limited to children exposed to relatively high lead.

Conclusions

The results suggest that simultaneous exposure to lead and RF from mobile phone use was associated with increased ADHD symptom risk, although possible reverse causality could not be ruled out.     

Prevalence of subjective poor health symptoms associated with exposure to electromagnetic fields among university students

The number of people complaining about different symptoms that may be associated with exposure to electromagnetic fields (EMF) has increased rapidly during past years. Students use both mobile phones and video display terminals frequently. The purpose of this study was to investigate the association of mobile phone use and EMF health hazards. Basic demographic data and self-reported symptoms were sought using a questionnaire administered to all apparently healthy students at Rafsanjan University of Medical Sciences (RUMS) and Vali-e-Asr University (VAU). Questions about some major confounding factors such as age, gender, amount of video display terminal work were also included. Exact Fischer Test was used for data analysis. Among self-reported symptoms, headache (53.5%), fatigue (35.6%), difficulties in concentration (32.5%), vertigo/dizziness (30.4%), attention disorders (28.8%), nervousness (28.1%), palpitation (14.7%), low back pain (14.3%), myalgia (12.4%), and tinnitus (9.9%) were the main self-reported symptoms. No significant differences in the prevalence of these symptoms were found between CRT users and those who did not use CRTs. A significant association was found between cordless phone use and difficulties in concentration (P < .05) or attention disorders (P < .05). However, after correction of the gender role, these differences were not significant. No association was found between mobile phone use and the above-mentioned symptoms. No significantly higher prevalence of self-reported symptoms was found in individuals who had used mobile phones, video display terminals or cordless phones more frequently than others. Mass-media's lack of interest in the possible hazards of exposure to EMF in developing countries can explain the difference observed between the results of this study and those of other researchers in some developed countries who have shown an association between EMF exposure and the prevalence of self-reported subjective symptoms. This finding can confirm the results obtained in provocative studies which indicated the role of psychological factors in electromagnetic hypersensitivity. More research is needed to clarify whether daily environmental EMF may cause health problems.     

Beyond Self-Report: Tools to Compare Estimated and Real-World Smartphone Use

Psychologists typically rely on self-report data when quantifying mobile phone usage, despite little evidence of its validity. In this paper we explore the accuracy of using self-reported estimates when compared with actual smartphone use. We also include source code to process and visualise these data. We compared 23 participants’ actual smartphone use over a two-week period with self-reported estimates and the Mobile Phone Problem Use Scale. Our results indicate that estimated time spent using a smartphone may be an adequate measure of use, unless a greater resolution of data are required. Estimates concerning the number of times an individual used their phone across a typical day did not correlate with actual smartphone use. Neither estimated duration nor number of uses correlated with the Mobile Phone Problem Use Scale. We conclude that estimated smartphone use should be interpreted with caution in psychological research.     

Mobile phone ownership and use among school children in three Hungarian cities

In spite of rapid worldwide increase in mobile phone use and public concerns about associated potential health effects, little is known about patterns of mobile phone ownership and use in the general population and among children. In April 2005, we conducted a survey of mobile phone ownership and use among fourth grade school children in three Hungarian cities. From 24 schools, 1301 student filled out a short, self-administered questionnaire on basic demographics, mobile phone ownership, pattern of mobile phone use, and after-school activities. Overall, 989 students (76%) owned a mobile phone. Three hundred thirteen students (24%) used a mobile phone daily to make phone calls, and an additional 427 students (33%) used mobile phones for phone calls at least several times per week. Sixty-six students (5%) sent text messages daily and an additional 308 students (24%) sent text messages at least several times per week. Girls, children with no siblings, children who were members of a sport club, and children who played computer games daily were more likely to own and use mobile phones regularly. A higher number of socially disadvantaged children in a class predicted lower likelihood of regular mobile phone use among children. Our results suggest that mobile phone ownership and regular use is highly prevalent among school children in Hungary. Due to rapid changes in ownership patterns follow up surveys will be required to obtain information on temporal trends and changes in mobile phone ownership and pattern of use among school children.     

Weather Effects on Mobile Social Interactions: A Case Study of Mobile Phone Users in Lisbon,Portugal

The effect of weather on social interactions has been explored through the analysis of a large mobile phone use dataset. Time spent on phone calls, numbers of connected social ties, and tie strength were used as proxies for social interactions; while weather conditions were characterized in terms of temperature, relative humidity, air pressure, and wind speed. Our results are based on the analysis of a full calendar year of data for 22,696 mobile phone users (53.2 million call logs) in Lisbon, Portugal. The results suggest that different weather parameters have correlations to the level and character of social interactions. We found that although weather did not show much influence upon people''s average call duration, the likelihood of longer calls was found to increase during periods of colder weather. During periods of weather that were generally considered to be uncomfortable (i.e., very cold/warm, very low/high air pressure, and windy), people were found to be more likely to communicate with fewer social ties. Despite this tendency, we found that people are more likely to maintain their connections with those they have strong ties with much more than those of weak ties. This study sheds new light on the influence of weather conditions on social relationships and how mobile phone data can be used to investigate the influence of environmental factors on social dynamics.     

The effects of 884 MHz GSM wireless communication signals on headache and other symptoms: an experimental provocation study

Findings from prior studies of possible health and physiological effects from mobile phone use have been inconsistent. Exposure periods in provocation studies have been rather short and personal characteristics of the participants poorly defined. We studied the effect of radiofrequency field (RF) on self-reported symptoms and detection of fields after a prolonged exposure time and with a well defined study group including subjects reporting symptoms attributed to mobile phone use. The design was a double blind, cross-over provocation study testing a 3-h long GSM handset exposure versus sham. The study group was 71 subjects age 18-45, including 38 subjects reporting headache or vertigo in relation to mobile phone use (symptom group) and 33 non-symptomatic subjects. Symptoms were scored on a 7-point Likert scale before, after 1(1/2) and 2(3/4) h of exposure. Subjects reported their belief of actual exposure status. The results showed that headache was more commonly reported after RF exposure than sham, mainly due to an increase in the non-symptom group. Neither group could detect RF exposure better than by chance. A belief that the RF exposure had been active was associated with skin symptoms. The higher prevalence of headache in the non-symptom group towards the end of RF exposure justifies further investigation of possible physiological correlates. The current study indicates a need to better characterize study participants in mobile phone exposure studies and differences between symptom and non-symptom groups.     

Analysis of ear side of mobile phone use in the general population of Japan

This study aimed to clarify the distribution of the ear side of mobile phone use in the general population of Japan and clarify what factors are associated with the ear side of mobile phone use. Children at elementary and junior high schools (n = 2,518) and adults aged ≥20 years (n = 1,529) completed an Internet‐based survey. Data were subjected to a logistic regression analysis. In children, due to the tendency to use the dominant hand, we analyzed the factors associated with the use of right ear in right‐handed people. Statistically significant differences were observed only in talk time per call (odds ratio (OR) = 2.17; 95% confidence interval (CI): 1.22–3.99). In adults, due to the tendency to use the left ear, we analyzed factors associated with the use of left ear in right‐handed people. Significant differences were observed in those aged 30–39 years (OR = 2.55; 95% CI: 1.79–3.68), those aged 40–49 years (OR = 3.08; 95% CI: 2.15–4.43), those aged >50 years (OR = 1.85; 95% CI: 1.20–2.85), and in those with a percentage of total talk time when using mobile phones at work of 51–100% (OR = 1.75; 95% CI: 1.21–2.55). We believe that future epidemiological studies on mobile phone use can be improved by considering the trends in mobile phone use identified in this study. Bioelectromagnetics. 39:53–59, 2018. © 2017 Wiley Periodicals, Inc.     

Mobile telephone use is associated with changes in cognitive function in young adolescents

As part of the Mobile Radiofrequency Phone Exposed Users' Study (MoRPhEUS), a cross‐sectional epidemiological study examined cognitive function in secondary school students. We recruited 317, 7th grade students (144 boys, 173 girls, median age 13 years) from 20 schools around Melbourne, Australia. Participants completed an exposure questionnaire based on the Interphone study, a computerised cognitive test battery, and the Stroop colour‐word test. The principal exposure metric was the total number of reported mobile phone voice calls per week. Linear regression models were fitted to cognitive test response times and accuracies. Age, gender, ethnicity, socio‐economic status and handedness were fitted as covariates and standard errors were adjusted for clustering by school. The accuracy of working memory was poorer, reaction time for a simple learning task shorter, associative learning response time shorter and accuracy poorer in children reporting more mobile phone voice calls. There were no significant relationships between exposure and signal detection, movement monitoring or estimation. The completion time for Stroop word naming tasks was longer for those reporting more mobile phone voice calls. The findings were similar for total short message service (SMS, also known as text) messages per week, suggesting these cognitive changes were unlikely due to radiofrequency (RF) exposure. Overall, mobile phone use was associated with faster and less accurate responding to higher level cognitive tasks. These behaviours may have been learned through frequent use of a mobile phone. Bioelectromagnetics 30:678–686, 2009. © 2009 Wiley‐Liss, Inc.     

Daily Rhythms in Mobile Telephone Communication

Circadian rhythms are known to be important drivers of human activity and the recent availability of electronic records of human behaviour has provided fine-grained data of temporal patterns of activity on a large scale. Further, questionnaire studies have identified important individual differences in circadian rhythms, with people broadly categorised into morning-like or evening-like individuals. However, little is known about the social aspects of these circadian rhythms, or how they vary across individuals. In this study we use a unique 18-month dataset that combines mobile phone calls and questionnaire data to examine individual differences in the daily rhythms of mobile phone activity. We demonstrate clear individual differences in daily patterns of phone calls, and show that these individual differences are persistent despite a high degree of turnover in the individuals’ social networks. Further, women’s calls were longer than men’s calls, especially during the evening and at night, and these calls were typically focused on a small number of emotionally intense relationships. These results demonstrate that individual differences in circadian rhythms are not just related to broad patterns of morningness and eveningness, but have a strong social component, in directing phone calls to specific individuals at specific times of day.     

Mobile Phones: The Next Step towards Healthcare Delivery in Rural India?

Background

Given the ubiquity of mobile phones, their use to support healthcare in the Indian context is inevitable. It is however necessary to assess end-user perceptions regarding mobile health interventions especially in the rural Indian context prior to its use in healthcare. This would contextualize the use of mobile phone communication for health to 70% of the country''s population that resides in rural India.

Objectives

To explore the acceptability of delivering healthcare interventions through mobile phones among users in a village in rural Bangalore.

Methods

This was an exploratory study of 488 mobile phone users, residing in a village, near Bangalore city, Karnataka, South India. A pretested, translated, interviewer-administered questionnaire was used to obtain data on mobile phone usage patterns and acceptability of the mobile phone, as a tool for health-related communication. The data is described using basic statistical measures.

Results

The primary use of mobile phones was to make or receive phone calls (100%). Text messaging (SMS) was used by only 70 (14%) of the respondents. Most of the respondents, 484 (99%), were willing to receive health-related information on their mobile phones and did not consider receiving such information, an intrusion into their personal life. While receiving reminders for drug adherence was acceptable to most 479 (98%) of our respondents, 424 (89%) preferred voice calls alone to other forms of communication. Nearly all were willing to use their mobile phones to communicate with health personnel in emergencies and 367 (75%) were willing to consult a doctor via the phone in an acute illness. Factors such as sex, English literacy, employment status, and presence of chronic disease affected preferences regarding mode and content of communication.

Conclusion

The mobile phone, as a tool for receiving health information and supporting healthcare through mHealth interventions was acceptable in the rural Indian context.     

Mobile phones, radiofrequency fields, and health effects in children--epidemiological studies

In 2004, when WHO organized a workshop on children's sensitivity to electromagnetic fields, very few studies on radiofrequency fields were available. With the recent increase in mobile phone use among children and adolescents, WHO has identified studies on health effects in this age-group as a high priority research area. There are no empirical data supporting the notion that children and adolescents are more susceptible to RF exposure, but the number of studies is still relatively small. There are a few cross-sectional studies on well-being, cognitive effects and behavioral problems, and some cohort studies, mainly of maternal use of mobile phones during pregnancy. Cancer outcomes have been studied in relation to environmental RF exposure, e.g. from transmitters, and only one study on mobile phone use in children and adolescents and brain tumor risk has been published. Several methodological limitations need to be taken into consideration when interpreting the findings of the epidemiological studies. The cross-sectional design does not allow determination of the temporal sequence of exposure and outcome, and for several outcomes there is a large potential for reversed causality, i.e. that the outcome causes an increased RF exposure rather than the opposite. Biases such as recall errors in self-reported mobile phone use, lack of confounding control, e.g. of other aspects of mobile phone use than RF fields, trained behaviors, and pubertal development, makes causal interpretations impossible. Future studies need to include prospectively collected exposure information, incident outcomes, and proper confounding control. Monitoring of brain tumor incidence trends is strongly recommended.     

Health outcomes of road-traffic pollution among exposed roadside workers in Rawalpindi City,Pakistan

To document ill-health effects of air pollution on the local inhabitants, we analyzed the self-reported health issues associated with the inhalation of road traffic on daily basis. For this purpose, a revised version of ALS-DLD-78S questionnaire was administered, comprising the personal information and details related to the clinical history of the surveyed population (i.e. n = 580). Five dependent (outcome) variables, including chest pain, redness of eyes, shortness of breath, eye-tearing, and skin-itching were taken into account. The results revealed that ～80% of the surveyed population were directly or indirectly exposed to road traffic, and the incidence of chest pain among exposed individuals was estimated to increase with age (odds ratio (OR) = 6.49; 95% confidence interval (CI) = 1.46–28.81), especially among cardiac patients (OR = 13.87; 95%-CI = 3.28–58.61). However, the shortness of breath was predominantly observed among those who reported to have asthmatic symptoms (OR = 32.84; 95%-CI = 15.59–69.15) and cardiovascular symptoms (OR = 13.8: 95%-CI = 3.63–52.41). In case of itching, the population along the roadside were more vulnerable to exposure (OR = 5.79; 95%-CI = 2.81–11.93). While, exposure to traffic exhaust could be attributed to ～3.13% rise in the incidences of redness of eyes among general population, the outcomes of this survey show that daily exposure to traffic pollution is an important health concern for the urban population in general, as well as for various occupational groups in particular, working in outdoor environment.