Musculoskeletal Health Risks Associated With Smartphone Use: A Retrospective Study from Riyadh, Saudi Arabia.

BACKGROUND: Smartphone usage has become ubiquitous in Saudi Arabia with concerns growing over its impact on musculoskeletal health. Globally, various musculoskeletal symptoms have been linked to smartphone use such as neck pain, headaches, and shoulder discomfort, often exacerbated by poor posture and prolonged screen time. METHODS: This cross-sectional study was conducted in Riyadh, Saudi Arabia, to investigate the impact of smartphone use on musculoskeletal health among adults aged 18 years and older. Participants were recruited through convenience sampling from various settings such as universities, workplaces, and public areas. Data were collected using a structured questionnaire administered both online and in paper format, covering demographic characteristics, smartphone usage behaviors, awareness of smartphone-related health effects, and the prevalence and severity of musculoskeletal symptoms. RESULTS: A total of 413 participants from Riyadh, Saudi Arabia, were surveyed to assess musculoskeletal symptoms associated with smartphone use. Demographic analysis revealed a predominantly young, single, and highly educated population, primarily Saudi nationals. Smartphone usage patterns showed extensive daily use, with over 41% using their devices for more than five hours daily. The majority were aware of smartphone-related health effects. Musculoskeletal symptoms were prevalent, notably neck pain (83.8%), arm pain (63.8%), and headaches (71.2%). The incidence of symptoms related to text neck syndrome was substantial, although awareness and diagnosis were limited. The severity of symptoms varied, with mild to moderate levels reported most frequently. CONCLUSION: This study highlights a substantial prevalence of musculoskeletal symptoms among smartphone users in Riyadh, Saudi Arabia, emphasizing the need for public health interventions to promote ergonomic practices and mitigate health risks associated with smartphone use. Future research should focus on longitudinal studies to establish causal relationships and evaluate intervention strategies aimed at reducing these symptoms effectively.

Association Between Smartphone Usage and Primary Headaches in Taif, Saudi Arabia: A Hospital-Based Study.

Background Integrating smartphones into human life has transformed various daily activities. Numerous symptoms, including headaches, have been linked to smartphone use. The excessive use of these devices raises significant health concerns. This study aimed to investigate the relationship between smartphone use and the progression, type, and severity of primary headaches, as well as the necessity for both abortive and prophylactic medications in treating such conditions. Materials and methods In this study, we utilized a cross-sectional survey involving 403 participants aged 14 years and older, all experiencing primary headaches and seeking care at three governmental hospitals in Taif, Saudi Arabia. The participants were divided into two groups based on their smartphone usage: high and low smartphone users. Data were collected through a hospital-based questionnaire administered across the three centers. Descriptive analysis and Pearson chi-square tests were conducted using IBM SPSS Statistics for Windows, Version 21 (released 2012; IBM Corp., Armonk, New York, United States). Results Of the participants, 128 (31.8%) were classified as low users, while 275 (68.2%) were identified as high users. The most frequently reported type of headache was undiagnosed headache, among 109 (27%), followed by migraine, at 86 (21.3%). Headaches were severe in 112 (40.9%) of cases and moderate in 134 (48.9%) of users. Around 62 (72.1%) of participants diagnosed with migraine reported a severe impact on their daily lives. In terms of medication usage, 166 (60.6%) of participants reported consuming zero to five pills monthly, while 52 (19%) reported taking more than 10 pills monthly. Additionally, 58 (21.2%) of participants utilized prophylactic medications. Conclusion No significant association was observed between smartphone use and the impact of headaches. Notably, pain severity was higher among low smartphone users who reported a high intake of medications. Migraine was the most severe and intense headache type. On average, the participants consumed fewer than five pills per month.

The Relationship Between Smartphone Overuse and Academic Achievement Among Undergraduate Nursing Students.

Introduction Nowadays, college students highly depend on smartphones on a daily basis because it is found to be practical and useful to manage and organize most of their daily basic activities. However, this raises a concern about the negative influence of smartphone overuse on their academic achievement and well-being. Relatively, multiple studies have reported negative impacts associated with smartphone overuse on different aspects like sleep patterns, body energy, eating habits, and academic achievements. Objective This cross-sectional study examines the relationship between smartphone overuse and academic achievement among 133 undergraduate nursing students at King Saud bin Abdulaziz University for Health Science in the Kingdom of Saudi Arabia. Method Demographic data was collected and the Smartphone Addiction Scale-Short Version (SAS-SV) was used to collect other data. Results The statistics showed an overuse of smartphones among the students as half of them (50.4%) reported checking their smartphones 1-10 times per hour. Additionally, most of the participants reported that they use their smartphones regularly (97.7%) and 90.2% of them use monthly data plans. Furthermore, 75.9% of students reported using their phones during class, either for note-taking or searching. Conclusion The findings did not show a significant association between academic achievement and smartphone overuse because a high percentage of the participants reported using their phones mostly for educational purposes.

Nomophobia and Its Association with Depression, Anxiety and Stress (DASS Scale), among Young Adults in Greece.

Smartphones with their numerous applications have become essential daily equipment, prompting scientific research to deal with the impact of their use on psychosocial health. Under this spectrum, the aim of the present cross-sectional study was to examine the association between nomophobia and the negative emotional states of depression, anxiety, and stress, in relation to self-esteem and sociodemographic data, among the young adult population. The study sample consisted of 1408 young adults aged 18-25 years, participating on a voluntary basis with an online anonymous questionnaire. Data were collected through the "Nomophobia Questionnaire (NMP-Q)", "Depression Anxiety Stress Scales-short form (DASS-21)", and Rosenberg Self-Esteem Scale (RSES). The questionnaire also included socio-demographic characteristics and smartphone use variables. Data analysis showed that women were identified with severe depression and stress to a greater extent than men (63.3% vs. 55.1% for depression and 18.1% vs. 13.8% for stress scale). With respect to nomophobia, participants with severe levels of nomophobia also exhibited severe levels of negative emotional states in all DASS components, i.e., 40.6% in depression, 73.7% in anxiety, and 32.7% in stress (all p values < 0.001). Participants with severe levels of depression and anxiety were very often checking their phone and used it in all daily activities. Moreover, correlation analysis revealed that self-esteem had a moderating effect on the relationship between nomophobia and DASS, a fact that modifies the association between the involved variables: stronger relationships appeared between nomophobia and DASS components in individuals with normal/high self-esteem than in individuals with low self-esteem.

Relationship between Anxiety and Problematic Smartphone Use in First-Year Junior High School Students: Moderated Mediation Effects of Physical Activity and School Adjustment.

BACKGROUND AND AIMS: Despite previous research identifying anxiety as a risk factor for problematic smartphone use among students, the mediating and moderating mechanisms underlying the relationship between the two aforementioned variables are poorly understood. This study aims to explore the relationship between anxiety and problematic smartphone use among first-year junior high school students, together with the mediating effects of school adjustment and the moderating effects of physical activity on the mentioned relationship. METHOD: This study was conducted using a Web-based self-report questionnaire survey with data collected from 445 first-year junior high school students in Jinan City, Shandong Province. Mediation and moderation analyses were performed using the PROCESS macro in SPSS. RESULTS: The results showed that anxiety predicted problematic smartphone use not only directly but also indirectly via school adjustment. School adjustment played a partial mediating role in the relationship between anxiety and problematic smartphone use. Physical activity also played a moderating role in the relationship between anxiety and school adjustment. CONCLUSION: school adjustment and physical activity may be important variables in the relationship between anxiety and problematic smartphone use.

Increased psychological distress among young people before and during the fifth wave of COVID-19 after two years of pandemic in Hong Kong: a 6-month longitudinal study.

BACKGROUND: Despite over two years of COVID-19 worldwide, the outbreak of the Omicron variant has given rise to an unprecedented surge of infection with diverse lockdown measures implemented globally. Whether the emergence of a new wave of COVID-19 could further affect mental health in the population after nearly two years of the pandemic remains to be addressed. Furthermore, whether changes in smartphone overuse behaviours and physical activity - both of which are particularly relevant to young people - would together contribute to changes in distress symptoms during this wave of COVID-19 was also examined. METHODS: A total of 248 young people from an ongoing household-based epidemiological study in Hong Kong who completed their baseline assessments prior to the Omicron variant outbreak, i.e., fifth wave of COVID-19 (July-November 2021), were invited for a 6-month follow-up study during this wave of infection (January-April 2022) (mean age = 19.7 years, SD = 2.7; 58.9% females). At both time points, levels of global distress symptoms, perceived stress, smartphone overuse, frequency of engagement in vigorous physical activity, and other potential risk and protective factors were assessed. RESULTS: The proportion of young people presenting moderate-to-severe distress (6-item Kessler Psychological Distress Scale ≥ 5) significantly increased from 45.6 to 54.4% during the fifth wave of COVID-19 (p < 0.010). Significantly increased levels of smartphone overuse and reduced days of vigorous physical activity were also observed during the fifth wave. Notably, increased smartphone overuse and reduced physical activity both additively and interactively contributed to elevated distress at 6 months, even after accounting for demographic characteristics, psychiatric history, childhood adversity, as well as baseline distress symptoms, resilience, and recent personal stressors. CONCLUSIONS: The findings suggest that the emergence of a new wave of COVID-19, specifically the Omicron outbreak, can further aggravate mental distress even after a protracted period of the pandemic. Awareness of the dynamic nature of COVID-19 is necessitated to address the pressing mental health needs of populations. Supporting young people in healthier patterns of smartphone use and physical activity can be helpful.

Dose-response analysis of smartphone usage and self-reported sleep quality: a systematic review and meta-analysis of observational studies.

STUDY OBJECTIVES: Several studies have recently reported on the association between smartphone usage and self-reported sleep quality. However, no systematic review or meta-analysis has yet been performed. We aimed to analyze the association between smartphone usage time and self-reported sleep quality. METHODS: We searched for articles published up to January 13, 2022, using the Embase and Medline databases. All observational studies were eligible for inclusion. The Newcastle-Ottawa scale was used to evaluate the risk of bias within studies. We used restricted cubic spline analysis to perform a dose-response analysis. RESULTS: Seventeen studies with a total of 36,485 participants were included. The pooled odds ratio was 2.28 (confidence interval [CI]: 1.81-2.89; P < .001) and heterogeneity was 80%. In the dose-response analysis conducted on 5 studies, the regression coefficient between daily smartphone usage time (hours/day) and poor sleep quality was 1.042 (1.027-1.058), which confirmed a significantly positive association. CONCLUSIONS: Smartphone overuse was closely associated with poor self-reported sleep quality, sleep deprivation, and sleep latency prolongation. Further studies using a more structured method and high-quality evidence (cohort or case-control) should be conducted. SYSTEMATIC REVIEW REGISTRATION: CRD42022303371. CITATION: Chu Y, Oh Y, Gwon M, et al. Dose-response analysis of smartphone usage and self-reported sleep quality: a systematic review and meta-analysis of observational studies. J Clin Sleep Med. 2023;19(3):621-630.

Prevalence of Upper Limb Musculoskeletal Disorders and Their Association with Smartphone Addiction and Smartphone Usage among University Students in the Kingdom of Saudi Arabia during the COVID-19 Pandemic-A Cross-Sectional Study.

This study aimed to investigate the prevalence of upper limb musculoskeletal disorders (MSDs) and their association with smartphone addiction and smartphone usage among university students in the Kingdom of Saudi Arabia during the COVID-19 pandemic. A total of 313 university students aged 18 years and older who owned a smartphone and used it during the preceding 12 months participated in this cross-sectional study. The prevalence of upper limb MSDs, smartphone addiction/overuse, and levels of physical activity were recorded using the standardized Nordic musculoskeletal questionnaire, the smartphone addiction scale (short version), and the international physical activity questionnaire (short form), respectively. Data collection was performed on campus between March and May 2021. Binary logistic regression was used to determine the association between the prevalence of upper limb MSDs and smartphone addiction/overuse and levels of physical activity. The 12-month prevalence of MSDs of the shoulder, elbow, and wrist/hand regions due to smartphone use among participants was found to be 20.13%, 5.11%, and 13.42%, respectively. Shoulder (odds ratio (OR) = 11.39, 95% confidence interval (CI) = 4.64−27.94, p < 0.001), elbow (OR = 15.38, 95% CI = 1.92−123.26, p = 0.01), and wrist/hand MSDs (OR = 7.65, 95% CI = 2.75−21.22, p < 0.001) were more prevalent among participants who were categorized as having smartphone addiction/overuse measures. Promoting awareness about the healthy use of smartphones, including postural education and decreasing screen time, is necessary to reduce smartphone-related MSDs.

Impact of smartphone overuse on 1-year severe depressive symptoms and momentary negative affect: Longitudinal and experience sampling findings from a representative epidemiological youth sample in Hong Kong.

Smartphone overuse can have detrimental impacts on youth mental health. How it may be longitudinally associated with depressive symptoms and functioning, and with daily momentary affect, remains to be investigated. A total of 3,033 young people were consecutively recruited from a large-scale epidemiological youth mental health study in Hong Kong. A subsample (n = 936) was followed-up after 1 year, with experience sampling data collected from 177 participants. Separate multivariable logistic regression models were applied to examine the prospective associations between smartphone overuse and depressive symptoms, with multilevel models fitted to examine its associations with momentary affect. The prevalence of smartphone overuse in the Hong Kong youth population was 29.3%. Smartphone overuse was significantly associated with more depressive symptoms and functional impairments both cross-sectionally and longitudinally. The associations between smartphone overuse and 1-year depressive symptoms were significant, even when accounting for baseline symptoms, social media use, and other risk and protective factors. Baseline depressive symptoms, in contrast, were not associated with 1-year smartphone overuse after adjusting for baseline smartphone overuse. Smartphone overuse was also significantly associated with higher levels of momentary negative affect, even when accounting for depressive symptoms. Strategies to mitigate the impact of smartphone overuse can have important long-term implications.

Perspectives and Experiences of Smartphone Overuse among University Students in Umm Al-Qura University (UQU), Saudi Arabia: A Qualitative Analysis.

Smartphone overuse and addiction is a growing concern worldwide. However, there are limited studies about smartphone addiction and its impacts on university students in Saudi Arabia. This qualitative study aimed to elicit students' and university staff's perspectives and experiences about smartphone overuse/addiction in Umm Al-Qura University (UQU), Saudi Arabia. Fifteen undergraduate students and 18 university staff (13 lecturers and five professionals) were recruited for the purpose of this study. The study data were collected using semi-structured interviews and analysed using thematic analysis. The qualitative data comprising 33 participants (students and staff) identified four major themes including the perception of smartphone use; causes of smartphone overuse; negative impacts of smartphone overuse; and strategies to reduce the overuse of smartphone. The overall findings confirmed that students and staff alike held both positive and negative perceptions about using a smartphone. Potential factors leading to smartphone overuse included personal factors (extended free time and low self-confidence, irresponsibility/escaping certain social gatherings/passing the time); smartphone factors (reasonable price, attractive advertisements (ads), and engaging smartphone Apps); and social factors (social pressure and fear of losing a connection). The main negative impacts of smartphone overuse were found to be related to low academic productivity, poor physical health (body pain, lack of sleep, and low exercise), compromised mental well-being (stress and negative emotions), and decreased socialisation (social isolation and a reduction in face-to-face communication). Our findings suggested that awareness campaigns about smartphone overuse, promoting family and social events, encouraging physical activities, and limiting internet use can reduce smartphone usage among university students. This finding has significant implications for decision-makers.

Mind-Wandering Mediates the Associations Between Neuroticism and Conscientiousness, and Tendencies Towards Smartphone Use Disorder.

Mounting evidence suggests that smartphone overuse/smartphone use disorder (SmUD) is associated with negative affectivity. Given a large number of smartphone users worldwide (currently about 4.7 billion) and the fact that many individuals carry their smartphones around 24/7, it is of high importance to better understand the phenomenon of smartphone overuse. Based on the interaction of person-affect-cognition-execution (I-PACE) model, we investigated the links between SmUD and the personality traits, neuroticism and conscientiousness, which represent two vulnerability factors robustly linked to SmUD according to a recent meta-analysis. Beyond that, we tested the effects of mind-wandering (MW) and fear of missing out (FoMO) in the relation between individual differences in personality and tendencies towards SmUD. The effective sample comprised 414 study participants (151 men and 263 women, age M = 33.6, SD = 13.5). By applying a structural equation modeling (SEM) technique, we observed that the associations of higher neuroticism and lower conscientiousness with higher levels of SmUD were mediated by higher scores in mind-wandering. These novel findings can help to understand the associations between personality and SmUD in more detail.

Prevalence and Associated Factors of Problematic Smartphone Use During the COVID-19 Pandemic: A Bangladeshi Study.

BACKGROUND: Problematic smartphone use (PSU) has been increasing hastily in recent decades, and it has become inseparable during the COVID-19 pandemic, especially among the students who are at risk of problematic smartphone use. Therefore, the present study aimed to investigate the prevalence and associated factors of PSU during the COVID-19 pandemic among the Bangladeshi students. METHODS: A total of 601 Bangladeshi students were recruited through an online-based cross-sectional survey that was conducted between October 7 and November 2, 2020. The survey collected information related to socio-demographics, behavioral health, internet use behaviors, depression, anxiety, and PSU. Independent samples t-test and one-way ANOVA were performed to present the relationship between the studied variables and PSU. Multiple linear regression analysis was also used for investigating the explanatory power of the predictive models for PSU. RESULTS: Surprisingly, about 86.9% of the students scored to be problematic smartphone users (≥21 out of a total 36 based on the Smartphone Application-Based Addiction Scale). In addition, medical students, engaging in a relationship, performing less physical activity, longer duration of internet use, some sorts of internet use purpose (eg, messaging, watching videos, using social media), depression, and anxiety were significantly associated with higher scores of PSU. After adjusting all the studied variables, the final model explained a 31.3% variance predicting PSU. CONCLUSION: The present study is one of the first approaches to assess the prevalence of PSU among the Bangladeshi students during the COVID-19 pandemic, whereas the addiction level was superfluous (and this may be due to more online engagement related to the pandemic). Thus, the study recommended strategies or policies related to the students' risk-reducing and healthy use of smartphones.

Association of smartphone overuse with depression, anxiety, and other addictive behaviors: A nationwide community sample of Korean adults.

Smartphone is one of the essential items. However, it may negatively affect a user's mental health when it is overused. The study aimed to investigate associations of smartphone overuse with depression, anxiety, and the relationship with other addictive behaviors and disorders. A total of 2,509 subjects were randomly selected through a one-person-per-household method. Smartphone Overuse Screening Questionnaire (SOS-Q) and the Korean version of the Composite International Diagnostic Interview (K-CIDI) were used. Linear regression and Pearson correlation analyses were performed to evaluate associations of smartphone overuse with depression, anxiety, and relationship with other addictive psychiatric disorders respectively. Among 2509 participants, 138 (14.76%) demonstrated smartphone overuse. Participants who used their smartphones for more than three hours a week were more likely to be single and females compared to those who used their smartphones for less than three hours a week. Smartphone overuse showed significant associations with depression, anxiety disorder, and a significant relationship with internet and game overuse, alcohol dependence, and nicotine dependence disorder. Internet-related behavior showed the strongest relationship with smartphone overuse. Although the sample size was adequate, a large number of subjects did not complete the questionnaire. People with psychiatric disorders should be advised to use smartphones in moderation.

Effect of Smartphone on Hand Performance and Strength in the Healthy Population.

The study aimed to determine the interactive effects of smartphone use on hand grip strength as well as functional hand performance in young people. The evolution of technology smartphone has become our necessity. It has made our lifestyle more comfortable in the form of browsing the internet, important conversation, and source of entertainment. However, it has negatively impacted our lifestyle too. Smartphone consumption among the young population has become broadly popular for different purposes aside from communication including playing games as well as internet browsing. The main complications associated with the increase in the use of smartphones results in weakness of the hand as well as wrist. High levels of smartphone use diminished hand grip strengths as well as and hand function leading to decreased hand grip strength in their dominant hand.

Relationship between bruxism and smartphone overuse in young adults.

OBJECTIVE: To evaluate the possible relationship between bruxism and smartphone overuse and assess the potential role of anxiety and depression in this relationship. The null hypothesis was that there was no significant difference between sleep bruxism (SB) and/or awake bruxism (AB) and non-bruxers in the level of smartphone overuse, anxiety, and depression. METHODS: In total, 167 dental students were included in this study. They were evaluated using the American Academy of Sleep Medicine (AASM) criteria, Smartphone Addiction Scale (SAS), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI). T-test and chi-square test were used to compare the means and percentages between groups. RESULTS: A higher percentage of sleep bruxers were high smartphone users (60.3%) compared to non-SBs (44.2%). The frequencies of high smartphone users among participants with high anxiety and depression were higher than those with low anxiety and depression. CONCLUSION: SB and high smartphone use were positively associated.

The Relationship between Mother's Smartphone Addiction and Children's Smartphone Usage.

OBJECTIVE: As smartphone use is becoming more common, the age of initial exposure to devices is becoming younger. Young children's screen use is influenced by various factors; it is more directly dependent on family environment than school-aged children. Our study aimed to examine the effect of mother's smartphone addition on their child's smartphone use. METHODS: Participants were from the Kids Cohort for Understanding of internet addiction Risk factors in early childhood (K-CURE) study. Adult smartphone addiction self-diagnosis scale was used to evaluate smartphone addiction degree of mother. Child's smartphone use was assessed by parental questionnaire. Using logistic regression analysis, we examine the association between mother's smartphone addiction and child's smartphone use. RESULTS: After adjusting for other factors, mother's smartphone addiction is related with early smartphone exposure of children. Highrisk group's children was exposed to smartphone earlier than low risk group (adjusted OR, 0.418; p=0.021). Contrary to expectation, there is no correlation between mother's smartphone addiction and child's smartphone use time. CONCLUSION: Our study explain that mother's smartphone addiction can affect early smartphone exposure on children. Based on our findings, further study might explore the effect of early smartphone exposure on children.

Excessive Smartphone Use and Self-Esteem Among Adults With Internet Gaming Disorder: Quantitative Survey Study.

BACKGROUND: Smartphone overuse can harm individual health and well-being. Although several studies have explored the relationship between problematic or excessive smartphone use and mental health, much less is known about effects on self-esteem, which is essential in having a healthy life, among adults with mental health disorders, including internet gaming disorder. Furthermore, given that smartphone usage differs by gender, little is known about gender differences in the relationship between smartphone overuse and self-esteem. OBJECTIVE: The objective of this study was to assess self-esteem among individuals with mental health disorders and explore the relationship with excessive smartphone use. METHODS: Participants were selected based on their responses to the internet gaming disorder assessment, which includes 9 items developed based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria, from among a Korean cohort of smartphone users aged 20-40 years, resulting in a sample of 189 participants (men:120, women: 69). The Rosenberg self-esteem scale and the Korean smartphone addiction proneness scale were utilized to assess the outcome self-esteem with excessive smartphone use as the primary independent variable. Guided by the Bowlby attachment theory and prior studies, we selected several covariates. Generalized linear regression analyses, as well as subgroup analyses by gender, were performed. RESULTS: Among adults with internet gaming disorder, the average Korean smartphone addiction proneness scale score was significantly higher in women than that in men (41.30 vs. 37.94; P=.001), and excessive smartphone use was significantly more prevalent in women than it was in men (30.43% vs. 20.83%; P=.02). Our findings from the generalized linear regression analyses indicated that an increase in Korean smartphone addiction proneness scale score had a negative relationship with self-esteem among those with internet gaming disorder (ß=-0.18, P=.001). Furthermore, our interaction models showed that, among those with internet gaming disorder, more men than women had lower self-esteem associated with an increase in Korean smartphone addiction proneness scale score and a high degree of smartphone overuse (ß=-0.19, P=.004; ß=-3.73, P<.001). CONCLUSIONS: Excessive smartphone use was found to be adversely associated with self-esteem among young and middle-aged adults with internet gaming disorder; notably, more men than women were negatively influenced (regarding self-esteem) by smartphone overuse. Based on our findings, more efforts should be made to reduce excessive or problematic smartphone use by considering developing public health interventions or policy, particularly among those with mental health disorders such as internet gaming disorder.

Factors Influencing the Smartphone Usage Behavior of Pedestrians: Observational Study on "Spanish Smombies".

BACKGROUND: Smartphone addiction has become a reality accepted by all. Some previous studies have shown that the use of smartphones on public roads while walking is very common among the young population. The term "smombie" or smartphone zombie has been coined for this behavior. Such behavior causes a reduction in the attention given to other pedestrians and drivers and may result in accidents or collisions. However, there are no precise data about how many people use the phone while they are walking on the street. Smartphone usage habits are evolving rapidly, and more in-depth information is required, particularly about how users interact with their devices while walking: traditional phone conversations (phone close to the ear), voice chats (phone in front of the head), waiting for notifications (phone in hand), text chats (user touching the screen), etc. This in-depth information may be useful for carrying out specific preventive actions in both the education field (raising awareness about the risks) and in the infrastructure field (redesigning the cities to increase safety). OBJECTIVE: This study aimed to gather information about pedestrians' smartphone usage and to identify population groups wherein interventions should be focused to prevent accidents. The main hypothesis was that gender, age, and city area can significantly influence the smartphone usage of the pedestrians while walking. METHODS: An observational study of pedestrians in the street was carried out in Elche, a medium-sized Spanish city of 230,000 inhabitants. The following data were gathered: gender, age group, location, and type of smartphone interaction. A specific smartphone app was developed to acquire data with high reliability. The statistical significance of each variable was evaluated using chi-squared tests, and Cramér's V statistic was used to measure the effect sizes. Observer agreement was checked by the Cohen kappa analysis. RESULTS: The behavior of 3301 pedestrians was analyzed, of which 1770 (53.6%) were females. As expected, the effect of the main variables studied was statistically significant, although with a small effect size: gender (P<.001, V=0.12), age (P<.001, V=0.18), and city area (P<.001, V=0.16). The phone in hand or "holding" behavior was particularly dependent on gender for all age groups (P<.001, V=0.09) and to a greater extent in young people (P<.001, V=0.16). Approximately 39.7% (222/559) of the young women observed showed "holding" or "smombie" behavior, and they comprised the highest proportion among all age and gender groups. CONCLUSIONS: An in-depth analysis of smartphone usage while walking revealed that certain population groups (especially young women) have a high risk of being involved in accidents due to smartphone usage. Interventions aimed at reducing the risk of falls and collisions should be focused in these groups.

Evaluating hand performance and strength in children with high rates of smartphone usage: an observational study.

[Purpose] This study investigated the interaction effects between the levels of smartphone use and hand dominance on handgrip, pinch strengths, and functional hand performance in children. [Participants and Methods] A total of 60 children aged between 9 and 15 were assigned into two groups: Group A (high-frequency smartphone users) and Group B (low-frequency smartphone users). Use levels were determined according to the smartphone addiction scale-short version. A hand dynamometer and pinch gauge were used to measure handgrip and pinch strength respectively. Functions of the upper extremity and hand were scored using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire. [Results] Group A participants had reduced measurements in hand grip and pinch strength, especially in the dominant hand. However, Quick Disabilities of the Arm, Shoulder, and Hand scores indicated that hand function was decreased in the dominant hand whether the child was a high- or low-frequency smartphone user. [Conclusion] Results indicated that high levels of smartphone use diminished hand and pinch-grip strengths as well as and hand function. That is, hand and pinch-grip strengths were reduced in the dominant hands of high-frequency smartphone users. However, hand functions were affected in the dominant hands among both high and low-level smartphone users.