Relationship between cell-phone over-use scale with depression, anxiety and stress among university students
Hashemi, S., Ghazanfari, F., Ebrahimzadeh, F. et al. Investigate the relationship between cell-phone over-use scale with depression, anxiety and stress among university students. BMC Psychiatry 22, 755 (2022). doi:10.1186/s12888-022-04419-8
Methods In this descriptive-analytical and cross-sectional study, 212 students were randomly selected from the Lorestan University of Medical Sciences by a combination of stratified and clustered random sampling. Data were collected by two standard questionnaires including, Cell-phone Over-use Scale (COS) and Depression, Anxiety and Stress (DASS-21) and were analyzed using SPSS V.22.
Results Based on the results, 72.2% of the students were exclusively male, which a majority of them were in age of 21–23 years (46.2%), and 92.5% were single. Based on the multiple linear regression and after adjustment for the confounding effect, there was a significant relationship between cell phone over use scale on student’s stress (t = 2.614, P = 0.010), and student’s anxiety (t = 2.209, P = 0.028); however there was not a significant relationship between cell phone over use scale on student’s depression (t = 1.790, P = 0.075).
Conclusions Harmful use of cell phones can aggravate psychological disorders such as anxiety, stress and depression and by controlling this factor can increase the level of mental health and improve the quality of life in students.
Wanna Chongchitpaisan, Phongtape Wiwatanadate, Surat Tanprawate, Assawin Narkpongphan, Nipapon Siripon. Trigger of a migraine headache among Thai adolescents smartphone users: a time series study. Environ Anal Health Toxicol. 2021 Mar; 36(1):e2021006-0. doi: 10.5620/eaht.2021006.
The study aims to investigate the effect of modern technology in the trigger of migraine headaches in high school students by using generalized estimating equation analysis. The prospective time series study was conducted in one hundred and forty-five smartphones using high school students in Chiang Mai Province who each completed a headache diary giving a total of 12,969 data entries. The smartphone output power was measured and recorded by a smartphone application. Smartphone use, sleep quality, anxiety, and depression also were assessed. Results revealed that the prevalence of repeated headache be 13.4% and migraine 16.9%. The migraine had the strongest association with handfree device use and internet use, followed by age and anxiety. Furthermore, the strongest effect of smartphone output power in triggering a migraine was found at ≤ 1.79×10-5 and 1.80-1.99×10-5 mW ranges. Meanwhile, Lag_6 of daily smartphone output power exposure produced the migraine effect in a reverse dose-response manner. The smartphone electromagnetic radiation was a primary migraine trigger. The study results led to the recommendation to avoid triggers by use of smartphone talking with hand-free devices to prevent a recurrent migraine.
SOP, which is smartphone electromagnetic radiation, has a non-linear correlation with migraine headaches which has been called a window effect response. The result has also found migraine response to a delayed effect of SOP in the form of reverse dose-response. The delayed effect response on repeated exposure can recover and re-balance itself after exposure to electromagnetic radiation. Additionally, smartphone electromagnetic radiation has effects that fit the criteria for triggers that induce migraines. Finally, younger student, internet use and talking without hand-free devices were risk factors of migraines. It is recommended that limited time for smartphone talking with hand-free device and older age starting using smartphone be suggested in order to prevent migraine attack.
Alba Cabré-Riera, Luuk van Wel, Ilaria Liorni, Arno Thielens, Laura Ellen Birks, Livia Pierotti, Wout Joseph, Llúcia González-Safont, Jesús Ibarluzea, Amparo Ferrero, Anke Huss, Joe Wiart, Loreto Santa-Marina, Maties Torrent, Tanja Vrijkotte, Myles Capstick, Roel Vermeulen , Martine Vrijheid, Elisabeth Cardis, Martin Röösli, Mònica Guxens. Association between estimated whole-brain radiofrequency electromagnetic fields dose and cognitive function in preadolescents and adolescents. Int J Hyg Environ Health. 2020 Nov 19;231:113659. doi: 10.1016/j.ijheh.2020.113659.
Objective: To investigate the association between estimated whole-brain radiofrequency electromagnetic fields (RF-EMF) dose, using an improved integrated RF-EMF exposure model, and cognitive function in preadolescents and adolescents.
Methods: Cross-sectional analysis in preadolescents aged 9-11 years and adolescents aged 17-18 years from the Dutch Amsterdam Born Children and their Development Study (n = 1664 preadolescents) and the Spanish INfancia y Medio Ambiente Project (n = 1288 preadolescents and n = 261 adolescents), two population-based birth cohort studies. Overall whole-brain RF-EMF doses (mJ/kg/day) were estimated for several RF-EMF sources together including mobile and Digital Enhanced Cordless Telecommunications phone calls (named phone calls), other mobile phone uses than calling, tablet use, laptop use (named screen activities), and far-field sources. We also estimated whole-brain RF-EMF doses in these three groups separately (i.e. phone calls, screen activities, and far-field) that lead to different patterns of RF-EMF exposure. We assessed non-verbal intelligence in the Dutch and Spanish preadolescents, information processing speed, attentional function, and cognitive flexibility in the Spanish preadolescents, and working memory and semantic fluency in the Spanish preadolescents and adolescents using validated neurocognitive tests.
Results: Estimated overall whole-brain RF-EMF dose was 90.1 mJ/kg/day (interquartile range (IQR) 42.7; 164.0) in the Dutch and Spanish preadolescents and 105.1 mJ/kg/day (IQR 51.0; 295.7) in the Spanish adolescents. Higher overall estimated whole-brain RF-EMF doses from all RF-EMF sources together and from phone calls were associated with lower non-verbal intelligence score in the Dutch and Spanish preadolescents (-0.10 points, 95% CI -0.19; -0.02 per 100 mJ/kg/day increase in each exposure). However, none of the whole-brain RF-EMF doses was related to any other cognitive function outcome in the Spanish preadolescents or adolescents.
Conclusions: Our results suggest that higher brain exposure to RF-EMF is related to lower non-verbal intelligence but not to other cognitive function outcomes. Given the cross-sectional nature of the study, the small effect sizes, and the unknown biological mechanisms, we cannot discard that our results are due to chance finding or reverse causality. Longitudinal studies on RF-EMF brain exposure and cognitive function are needed.
Adolescence is a cognitive demanding stage of life, and one of the most rapid phases of human development. Therefore, it is important to identify factors that could compromise brain development at this stage and permanently impair cognitive abilities. Our results suggest that overall estimated whole-brain RF-EMF dose and specific dose from phone calls were related to lower non-verbal intelligence in preadolescents. However, our findings also indicate that whole-brain RF-EMF doses were not related to information processing speed, attentional function, visual attention, and cognitive flexibility in preadolescents or to working memory and semantic fluency in both preadolescents and adolescents. Given the cross-sectional nature of the study, the small effect sizes, and the unknown biological mechanisms, we cannot discard that our results might be due to chance finding or reverse causality. Our findings open the field to future longitudinal studies to further investigate the association between brain exposure to RF-EMF and cognitive function.
Alba Cabré-Riera, Hanan El Marroun, Ryan Muetzel, Luuk van Wel, Ilaria Liorni, Arno Thielens, Laura Ellen Birks, Livia Pierotti, Anke Huss, Wout Joseph, Joe Wiart, Myles Capstick, Manon Hillegers, Roel Vermeulen, Elisabeth Cardis, Martine Vrijheid, Tonya White, Martin Röösli, Henning Tiemeier, Mònica Guxens. Estimated whole-brain and lobe-specific radiofrequency electromagnetic fields doses and brain volumes in preadolescents. Environment International. 142, September 2020, 105808. https://doi.org/10.1016/j.envint.2020.105808.
• We estimated overall and source-specific RF-EMF doses to the brain.
• Estimated overall whole-brain RF-EMF dose was 84.3 mJ/kg/day.
• Overall whole-brain or lobe-specific RF-EMF doses were not related to brain volumes.
• Whole-brain RF-EMF dose from mobile communication devices for screen activities while wirelessly connected to the internet was associated with smaller caudate volume.
• We cannot discard residual confounding, chance finding, or reverse causality.
Objective To assess the association between estimated whole-brain and lobe-specific radiofrequency electromagnetic fields (RF-EMF) doses, using an improved integrated RF-EMF exposure model, and brain volumes in preadolescents at 9–12 years old.
Methods Cross-sectional analysis in preadolescents aged 9–12 years from the Generation R Study, a population-based birth cohort set up in Rotterdam, The Netherlands (n = 2592). An integrated exposure model was used to estimate whole-brain and lobe-specific RF-EMF doses (mJ/kg/day) from different RF-EMF sources including mobile and Digital Enhanced Cordless Telecommunications (DECT) phone calls, other mobile phone uses than calling, tablet use, laptop use, and far-field sources. Whole-brain and lobe-specific RF-EMF doses were estimated for all RF-EMF sources together (i.e. overall) and for three groups of RF-EMF sources that lead to a different pattern of RF-EMF exposure. Information on brain volumes was extracted from magnetic resonance imaging scans.
Results Estimated overall whole-brain RF-EMF dose was 84.3 mJ/kg/day. The highest overall lobe-specific dose was estimated in the temporal lobe (307.1 mJ/kg/day). Whole-brain and lobe-specific RF-EMF doses from all RF-EMF sources together, from mobile and DECT phone calls, and from far-field sources were not associated with global, cortical, or subcortical brain volumes. However, a higher whole-brain RF-EMF dose from mobile phone use for internet browsing, e-mailing, and text messaging, tablet use, and laptop use while wirelessly connected to the internet was associated with a smaller caudate volume.
Conclusions Our results suggest that estimated whole-brain and lobe-specific RF-EMF doses were not related to brain volumes in preadolescents at 9–12 years old. Screen activities with mobile communication devices while wirelessly connected to the internet lead to low RF-EMF dose to the brain and our observed association may thus rather reflect effects of social or individual factors related to these specific uses of mobile communication devices. However, we cannot discard residual confounding, chance finding, or reverse causality. Further studies on mobile communication devices and their potential negative associations with brain development are warranted, regardless whether associations are due to RF-EMF exposure or to other factors related to their use.
Delayed sleep in six-year-old children was associated with excessive use of electronic devices at 12 years
Long-Term Symptoms of Mobile Phone Use on Mobile Phone Addiction
Short-term longitudinal relationships between smartphone use/dependency
Night-time screen-based media device use and adolescents' sleep
Prolonged mobile phone use is associated with depressive symptoms in Chinese adolescents
Problematic cell phone use, depression, anxiety & self-regulation:
3-year longitudinal study from adolescence to emerging adulthood
Social media use and adolescent mental health: Findings From the UK Millennium Cohort Study
Telecommunication devices use, screen time and sleep in adolescents
Foerster M., Thielens A., Joseph W., Eeftens M., Röösli M. A prospective cohort study of adolescents' memory performance and individual brain dose of microwave radiation from wireless communication. Environmental Health Perspectives.126(7):077007. 2018. DOI: 10.1289/EHP2427.
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 of RF-EMF brain dose on cognitive functions that involve brain regions mostly exposed during mobile phone use.
We found preliminary evidence suggesting that RF-EMF may affect brain functions such as figural memory in regions that are most exposed during mobile phone use. Our findings do not provide conclusive evidence of causal effects and should be interpreted with caution until confirmed in other populations. Associations with media use parameters with low RF-EMF exposures did not provide clear or consistent support of effects of media use unrelated to RF-EMF (with the possible exception of consistent positive associations between verbal memory and data traffic duration). It is not yet clear which brain processes could be potentially affected and what biophysical mechanism may play a role. Potential long-term risk can be minimized by avoiding high brain-exposure situations as occurs when using a mobile phone with maximum power close to the ear because of, for example, bad network quality.
Open access paper: https://ehp.niehs.nih.gov/EHP2427/
• More adolescents in 2015 (vs. 2009) slept less than 7 h a night on most nights.
Sangün Ö, Dündar B, Çömlekçi S, Büyükgebiz A. The effects of electromagnetic field on the endocrine system in children and adolescents. Pediatr Endocrinol Rev. 2015 Dec;13(2):531-45.
Children are exposed to various kind of non-ionizing radiation in their daily life involuntarily. The potential sensitivity of developing organism to the effects of radiofrequency (RF) signals, the higher estimated specific absorption rate (SAR) values of children and greater lifetime cumulative risk raised the scientific interest for children's vulnerability to electromagnetic fields (EMFs). In modern societies, children are being exposed to EMFs in very early ages. There are many researches in scientific literature investigating the alterations of biological parameters in living organisms after EMFs. Although the international guidelines did not report definite, convincing data about the causality, there are unignorable amount of studies indicating the increased risk of cancer, hematologic effects and cognitive impairment. Although they are less in amount; growing number of studies reveal the impacts on metabolism and endocrine function. Reproductive system and growth look like the most challenging fields. However there are also some concerns on detrimental effects of EMFs on thyroid functions, adrenal hormones, glucose homeostasis and melatonin levels. It is not easy to conduct a study investigating the effects of EMFs on a fetus or child due to ethical issues. Hence, the studies are usually performed on virtual models or animals. Although the results are conflicting and cannot be totally matched with humans; there is growing evidence to distress us about the threats of EMF on children.
Calvente, I., Pérez-Lobato, R., Núñez, M.-I., Ramos, R., Guxens, M., Villalba, J., Olea, N. and Fernández, M. F. (2016), Does exposure to environmental radiofrequency electromagnetic fields cause cognitive and behavioral effects in 10-year-old boys?. Bioelectromagnetics, 37: 25–36. doi: 10.1002/bem.21951.
A subsample of 123 boys belonging to the Environment and Childhood cohort from Granada (Spain), recruited at birth from 2000 through 2002, were evaluated at the age of 9–11 years. Spot electric field measurements within the 100 kHz to 6 GHz frequency range, expressed as both root mean-square (SRMS) and maximum power density (SMAX) magnitudes, were performed in the immediate surrounds of children's dwellings. Neurocognitive and behavioral functions were assessed with a comprehensive battery of tests. Multivariate linear and logistic regression models were used, adjusting for potential confounders.
All measurements were lower than reference guideline limits, with median SRMS and SMAX values of 285.94 and 2759.68 μW/m2, respectively. Most of the cognitive and behavioral parameters did not show any effect, but children living in higher RF exposure areas (above median SRMS levels) had lower scores for verbal expression/ comprehension and higher scores for internalizing and total problems, and obsessive-compulsive and post-traumatic stress disorders, in comparison to those living in areas with lower exposure. These associations were stronger when SMAX values were considered.
Although some of our results may suggest that low-level environmental RF-EMF exposure has a negative impact on cognitive and/or behavior development in children; given limitations in the study design and that the majority of neurobehavioral functioning tasks were not affected, definitive conclusions cannot be drawn.
November 19, 2015
Schoeni A, Roser K, Röösli M. Symptoms and cognitive functions in adolescents in relation to mobile phone use during night. PLoS One. 2015 Jul 29;10(7):e0133528. doi: 10.1371/journal.pone.0133528.
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.
Open Access Paper: http://1.usa.gov/1NeP2lJ
• This is a prospective cohort study with approx. one year of follow-up.
• Self-reported and operator recorded mobile phone use data were collected.
• The cumulative RF-EMF dose for the brain and for the whole body was calculated.
• Associations were stronger for RF-EMF dose than for use of wireless devices.
• RF-EMF exposure might impair memory performance in adolescents.
BACKGROUND: The aim of this study is to investigate whether memory performance in adolescents is affected by radiofrequency electromagnetic fields (RF-EMF) from wireless device use or by the wireless device use itself due to non-radiation related factors in that context.
METHODS: We conducted a prospective cohort study with 439 adolescents. Verbal and figural memory tasks at baseline and after one year were completed using a standardized, computerized cognitive test battery. Use of wireless devices was inquired by questionnaire and operator recorded mobile phone use 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 longitudinal approach, to investigate whether cumulative exposure over one year was related to changes in memory performance. All analyses were adjusted for relevant confounders.
RESULTS: The kappa coefficients between cumulative mobile phone call duration and RF-EMF brain and whole body dose were 0.62 and 0.67, respectively for the whole sample and 0.48 and 0.28, respectively for the sample with operator data. In linear exposure-response models an interquartile increase in cumulative operator recorded mobile phone call duration was associated with a decrease in figural memory performance score by -0.15 (95% CI: -0.33, 0.03) units. For cumulative RF-EMF brain and whole body dose corresponding decreases in figural memory scores were -0.26 (95% CI: -0.42, -0.10) and -0.40 (95% CI: -0.79, -0.01), respectively. No exposure-response associations were observed for sending text messages and duration of gaming, which produces tiny RF-EMF emissions.
CONCLUSIONS: A change in memory performance over one year was negatively associated with cumulative duration of wireless phone use and more strongly with RF-EMF dose. This may indicate that RF-EMF exposure affects memory performance.
... From a public health point of view potential effects of chronic exposure are more relevant, which needs to be investigated with epidemiological studies. So far there has only been one community-based epidemiological study investigating effects of mobile phone use on adolescents' memory. Abramson et al. (2009) showed in a cross-sectional analysis of 317 seventh grade students from Australia that mobile phone use was associated with faster and less accurate response on a number of tasks involving the memory. Since similar associations were found in relation to the number of SMS (short text messages), which produces negligible RF-EMF exposure, they speculated that these behaviours may have been learned through the frequent use of a mobile phone and may not be the consequence of mobile phone radiation. In a follow-up investigation one year later, in 236 of these students, an increase in mobile phone use was associated with a reduction in response time in one out of three tests involving the memory (Thomas et al., 2010). This study relied on self-reported mobile phone use only, which has been shown to be inaccurate. Adolescents tend to substantially overestimate their amount of mobile phone use (Aydin et al., 2011; Inyang et al., 2009).
Regular mobile phone use may affect adolescents in various ways. Thus, the main challenge for research consists in differentiating between RF-EMF radiation effects and other non-RF-EMF related effects from mobile phone use. For instance, frequent texting or gaming on a mobile phone may facilitate cognitive processes (Abramson et al., 2009). It was also observed, that calling and sending texts during night was associated with poor perceived health symptoms such as tiredness, rapid exhaustibility, headache and physical ill-being (Schoeni et al., 2015; Van den Bulck, 2007). Other studies showed that frequent mobile phone use was associated with anxiety (Jenaro et al., 2007), unhealthy lifestyle (Ezoe et al., 2009), depression (Yen et al., 2009) and psychological distress (Beranuy et al., 2009). Thus, to address RF-EMF effects of wireless communication devices, the development of a RF-EMF dose measure, which incorporates all exposure relevant factors, is inevitable.
Memory performance was assessed with a standardized, computerized cognitive test battery (IST, Intelligenz-Struktur-Test 2000R (Liepmann et al., 2006)). Verbal and figural memory was measured with the subtest of the IST. In the verbal memory task, word groups have to be memorized in one minute time. After 1 min the study participants give an account of the word groups that have been memorized. In total 10 points can be achieved by remembering the correct word groups. In the figural memory task, pairwise symbols have to be memorized in one minute time. After 1 min one part of the pairwise symbols is shown and the matching part has to be found. A total of 13 points can be achieved. For both the verbal and figural tests, 2 min is given to complete the test. Memory performance is considered as the right number of remembered word groups or symbols, respectively. For the statistical analyses of verbal and figural memory the continuous test score values
were used as outcome. Every test was conducted once at baseline and once at follow-up investigation.
In this study we considered objectively recorded data on mobile phone use collected from the Swiss mobile phone operators as well as self-reported data on wireless communication devices usage obtained from a written questionnaire referring to the 6 months period prior to each examination. In terms of RF-EMF related exposure measures we inquired about call duration with own or any other mobile phone (referred to as duration mobile phone calls), call duration with cordless (fixed line) phone and duration of data traffic on the mobile phone, e. g. for surfing and streaming. The duration of gaming on computers and TV and number of all kind of text messages (SMS, WhatsApp etc.) are not, or only marginally relevant for RF-EMF exposure and were thus inquired to be used as negative exposure control variables in the analyses.
Informed consent to obtain objectively recorded mobile phone use data from the mobile phone operators was given by 234 out of 439 study participants and their parents. This included duration of each call and on which network (GSM or UMTS) it started, number of SMS (text messages) sent per day and amount of volume of data traffic (MB/day). Data were obtained for up to 18 months, 6 months before baseline until follow-up investigation.
A particular strength of this study is the longitudinal design. To the best of our knowledge this is the first longitudinal study on memory performance in adolescents using not only mobile phone call duration as an exposure proxy, but calculating RF-EMF dose measures derived from objectively recorded operator data and propagation modelling. Compared to a cross-sectional design where changes over time cannot be assessed andwhere reverse causality is of concern, longitudinal studies allow for more robust conclusions.
.. Most relevant contributors for the brain dose are calls on the GSM network (on average 93.3% for the whole sample based on self-reported data and 58.7% for the sample with operator data using operator recorded information) followed by calls with the cordless phones (4.2% and 21.0%, respectively). For the whole body dose, calls on the GSM network (on average 66.9% for the whole sample and 19.5% for the sample with operator data), the use of computer/laptop/tablet connected to WLAN (12.0% and 29.1%, respectively) and data traffic on mobile phones over WLAN (8.1% and 22.3%, respectively) counted for the most part. Less important for the dose measures were exposure from radio and TV broadcast transmitters (brain dose: 0.1% and 0.4%, respectively; whole body dose: 0.3% and 0.9%, respectively) and mobile phone base stations (brain dose: 0.6% and 3.5%, respectively; whole body dose: 2.0% and 4.8%, respectively).
... media usage measures which are not, or only marginally associated with RF-EMF were not associated with figural memory performance (e.g. sending text messages, playing games, and duration/volume of data traffic on the mobile phone). On the other hand, mobile and cordless phone use,which involves RF-EMF exposure, tended to be negatively correlated, although not statistically significant, whereas the dose measures were significantly correlated in many models. The relative high correlation between dose measures and self-reported and objectively recorded mobile phone call duration respectively, limits the possibility to disentangle effects due to RF-EMF exposure or due to other factors associated with mobile phone use.
Since we found stronger associations between RF-EMF doses and figural memory but not verbal memory, one could speculate that this might be due to different brain areas involved in the verbal and figural memory tasks. The type of information being processed determines the brain activity during encoding and retrieval and as a consequence brain activity patterns during figural memory tasks differ fromthose observed during verbal memory tasks. During figural memory processes, encoding elicits bilateral prefrontal activity and retrieval increases the activity in bilateral or right-sided temporal regions and in bilateral prefrontal regions (Beason-Held et al., 2005; Roland and Gulyas, 1995; Wagner et al., 1998). During verbal encoding increases in prefrontal and temporal brain activity in the left hemisphere can be seen (Heun et al., 2000; Iidaka et al., 2000; Reber et al., 2002; Strandberg et al 2011) and during verbal retrieval the activity in bilateral or rightsided prefrontal regions, bilateral or left-sided temporal regions and the anterior cingulate are increased (Beason-Held et al., 2005; Buckner et al., 1998; Cabeza et al., 1997). Stronger overall effects observed for figural memory processes predominantly involving the right hemisphere compared to the verbal memory tasks mostly involving the left hemisphere is compatible with the fact that 81.2% of the study participants reported at follow-up to mainly use mobile phones on the right side but only 18.8% on the left side or with no laterality preference. Strikingly, our laterality analyses indicated indeed stronger associations for right side users for the figural memory task whereas the reverse pattern was seen for the verbal task. However, the sample size of the laterality analysis was small for the subgroup with left side or no side preference for mobile phone use (n= 80).
We considered a number of potential confounders and adjusted model estimates were relatively similar to the crude model estimates, which indicates that confounding seems not to have a substantial impact on the results. Nevertheless, we cannot exclude that we have missed a relevant confounder ....
The observed striking pattern with more consistent associations for RF-EMF dose measures compared to usage measures and no indications of associations for negative control exposure variables may indicate that RF-EMF exposure affects the figural memory of adolescents. However, given the complex correlation structure for various exposure measures and the uncertainty in the RF-EMF dose calculation, the observed associations need to be interpreted with caution.