Validation of self-reported cellular phone use

The effects of radiofrequency exposure on male fertility and adverse reproductive outcomes: A protocol for two systematic reviews of human observational studies with meta-analysis

BACKGROUND

The World Health Organization (WHO) is bringing together evidence on radiofrequency electromagnetic field (RF-EMF) exposure in relation to health outcomes, previously identified as priorities for evaluation by experts in the field, to inform exposure guidelines. A suite of systematic reviews are being undertaken by a network of topic experts and methodologists in order to collect, assess and synthesise data relevant to these guidelines. Here, we present the protocol for the systematic review on the effect of exposure to RF on adverse reproductive outcomes (human observational studies), also referred to as Systematic Review (SR) 3 within the series of systematic reviews currently being commissioned.

OBJECTIVES

Following the WHO handbook for guideline development and the COSTER conduct guidelines, we will systematically review the effect of RF-EMF exposure on both male fertility (SR3A) and adverse pregnancy outcomes (SR3B) in human observational studies. Herein we adhere to the PRISMA-P reporting guidelines.

DATA SOURCES

We will conduct a broad search for potentially relevant records relevant for both reviews within the following bibliographic databases: MEDLINE; Embase; and EMF Portal. We will also conduct searches of grey literature through relevant databases and organisational websites. RF-EMF experts will also be consulted. We will hand search citation and reference lists of included study records.

STUDY ELIGIBILITY CRITERIA

We will include quantitative human observational studies on the effect of RF-EMF exposure: (in SR3A) in adult male participants on infertility, sperm morphology, concentration or total sperm count or motility; and (in SR3B) in preconception adults or pregnant women on preterm birth, small for gestational age (associated with intrauterine growth restriction), miscarriage, stillbirth and congenital anomalies.

STUDY APPRAISAL AND SYNTHESIS METHODS

Titles, abstracts and then full texts will be screened in blinded duplicate against eligibility criteria with input from a third reviewer as required. Data extraction from included studies will be completed by two reviewers as will risk of bias assessment using the Office of Health Assessment and Translation (OHAT) tool. If appropriate we will undertake meta-analysis to pool effect measures and explore heterogeneity using sub-group analyses or meta-regression as feasible. We will conduct sensitivity analysis to assess the impact of any assumptions made throughout the review process. The OHAT methodology, based on the GRADE guidelines for evidence assessment, will be used to evaluate the certainty of evidence per outcome and to conclude the level of evidence of a health effect.

CONCLUSION

This manuscript details the protocols for two systematic reviews. The aims of publishing details of both protocols are to: pre-specify their scope and methods; reduce the impact of reviewer bias; promote transparency and replicability; and improve the review process.

PROSPERO REGISTRATION

CRD42021265401 (SR3A), CRD42021266268 (SR3B).

Exposure to Radiofrequency Electromagnetic Field in the High-Frequency Band and Cognitive Function in Children and Adolescents: A Literature Review

With increasing use of mobile phones, exposure to radiofrequency electromagnetic field (RF-EMF) in the high-frequency band associated with mobile phones has become a public concern, with potentially adverse effects on cognitive function in children and adolescents. However, findings regarding the relation of RF-EMF and cognitive function in children and adolescents have been inconsistent due to a number of study design-related factors, such as types of exposure and outcome measures, age of participants, and the era of study conduction. The present literature review focused on these possible factors that could explain this inconsistency. This review identified 12 eligible studies (participants ages 4 to 17 years) and extracted a total 477 relations. In total, 86% of the extracted relations were not statistically significant; in the remaining 14%, a negative relation between RF-EMF and cognitive performance was detected under limited conditions: when (1) RF-EMF was assessed using objective measurement not subjective measurement (i.e., questionnaire), (2) participants were relatively older (12 years and above) and had greater opportunity of exposure to RF-EMF, and (3) the collection of cognitive function data was conducted after 2012. Given that 86% of the extracted relations in this analysis were not statistically significant, the interpretation should be approached with caution due to the possibility of the 14% of significant relationships, extracted in this review, representing chance findings.

Uncertainty Analysis of Mobile Phone Use and Its Effect on Cognitive Function: The Application of Monte Carlo Simulation in a Cohort of Australian Primary School Children

Previous epidemiological studies on health effects of radiation exposure from mobile phones have produced inconsistent results. This may be due to experimental difficulties and various sources of uncertainty, such as statistical variability, measurement errors, and model uncertainty. An analytical technique known as the Monte Carlo simulation provides an additional approach to analysis by addressing uncertainty in model inputs using error probability distributions, rather than point-source data. The aim of this investigation was to demonstrate using Monte Carlo simulation of data from the ExPOSURE (Examination of Psychological Outcomes in Students using Radiofrequency dEvices) study to quantify uncertainty in the output of the model. Data were collected twice, approximately one year apart (between 2011 and 2013) for 412 primary school participants in Australia. Monte Carlo simulation was used to estimate output uncertainty in the model due to uncertainties in the call exposure data. Multiple linear regression models evaluated associations between mobile phone calls with cognitive function and found weak evidence of an association. Similar to previous longitudinal analysis, associations were found for the Go/No Go and Groton maze learning tasks, and a Stroop time ratio. However, with the introduction of uncertainty analysis, the results were closer to the null hypothesis.

Cell phone use and risk of thyroid cancer: a population-based case-control study in Connecticut

PURPOSE

This study aims to investigate the association between cell phone use and thyroid cancer.

METHODS

A population-based case-control study was conducted in Connecticut between 2010 and 2011 including 462 histologically confirmed thyroid cancer cases and 498 population-based controls. Multivariate unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between cell phone use and thyroid cancer.

RESULTS

Cell phone use was not associated with thyroid cancer (OR: 1.05, 95% CI: 0.74-1.48). A suggestive increase in risk of thyroid microcarcinoma (tumor size ≤10 mm) was observed for long-term and more frequent users. Compared with cell phone nonusers, several groups had nonstatistically significantly increased risk of thyroid microcarcinoma: individuals who had used a cell phone >15 years (OR: 1.29, 95% CI: 0.83-2.00), who had used a cell phone >2 hours per day (OR: 1.40, 95% CI: 0.83-2.35), who had the most cumulative use hours (OR: 1.58, 95% CI: 0.98-2.54), and who had the most cumulative calls (OR: 1.20, 95% CI: 0.78-1.84).

CONCLUSIONS

This study found no significant association between cell phone use and thyroid cancer. A suggestive elevated risk of thyroid microcarcinoma associated with long-term and more frequent uses warrants further investigation.

Correctness of Self-Reported Task Durations: A Systematic Review

Objectives

Duration of tasks in a job is an essential interest in occupational epidemiology. Such duration is frequently measured using self-reports, which may, however, be associated with both bias and random errors. The present systematic literature review examines the correctness of self-reported durations of tasks, i.e. the extent to which they differ from more valid reference data due to either systematic or random errors, and factors influencing this correctness, with particular emphasis on the assessment of exposures of relevance to musculoskeletal disorders.

Methods

The search for relevant studies included the databases ISI Web of Science, MEDLINE, EBSCO HOST, Proquest, and Psycnet.

Results

Thirty-two articles were identified; of which, 23 examined occupational tasks and 9 examined non-occupational tasks. Agreement between self-reports and a more correct reference was reported for, in total, 182 tasks. Average proportional errors were, for most tasks, between -50% (i.e. underestimations) and +100%, with a dominance of overestimations; 22% of all results considered overestimations of 100% or more. For 15% of the 182 reported tasks, the mean difference between the self-reported and the reference duration value was <5%, and 20% of the 182 mean differences were between 5 and 20%. In general, respondents were able to correctly distinguish tasks of a longer duration from shorter tasks, even though the actual durations were not correct. A number of factors associated with the task per se appeared to influence agreement between self-reports and reference data, including type of task, true task duration, task pattern across time (continuous versus discontinuous), and whether the addressed task is composed of subtasks. The musculoskeletal health status of the respondent did not have a clear effect on the ability to correctly report task durations. Studies differed in key design characteristics and detail of information reported, which hampers a formal aggregation of results.

Conclusions

The correctness of self-reported task durations is, at the best, moderate at the individual level, and this may present a significant problem when using self-reports in task-based assessment of individual job exposures. However, average self-reports at the group level appear reasonably correct and may thus be a viable method in studies addressing, for instance, the relative occurrence of tasks in a production system. Due to the disparity of studies, definite conclusions on the quantitative effect on agreement of different modifiers are not justified, and we encourage future studies specifically devoted to understanding and controlling sources of bias in self-reported task durations. We also encourage studies developing decision support for when to apply or avoid self-reports to measure task durations, depending on study purpose and occupational setting.

Radiofrequency Electromagnetic Radiation and Memory Performance: Sources of Uncertainty in Epidemiological Cohort Studies

Uncertainty in experimental studies of exposure to radiation from mobile phones has in the past only been framed within the context of statistical variability. It is now becoming more apparent to researchers that epistemic or reducible uncertainties can also affect the total error in results. These uncertainties are derived from a wide range of sources including human error, such as data transcription, model structure, measurement and linguistic errors in communication. The issue of epistemic uncertainty is reviewed and interpreted in the context of the MoRPhEUS, ExPOSURE and HERMES cohort studies which investigate the effect of radiofrequency electromagnetic radiation from mobile phones on memory performance. Research into this field has found inconsistent results due to limitations from a range of epistemic sources. Potential analytic approaches are suggested based on quantification of epistemic error using Monte Carlo simulation. It is recommended that future studies investigating the relationship between radiofrequency electromagnetic radiation and memory performance pay more attention to treatment of epistemic uncertainties as well as further research into improving exposure assessment. Use of directed acyclic graphs is also encouraged to display the assumed covariate relationship.

Long-term recall accuracy for mobile phone calls in young Japanese people: A follow-up validation study using software-modified phones

This study examined changes in recall accuracy for mobile phone calls over a long period. Japanese students' actual call statuses were monitored for 1 month using software-modified phones (SMPs). Three face-to-face interviews were conducted to obtain information regarding self-reported call status during the monitoring period: first interview: immediately after the monitoring period; second interview: after 10-12 months; third interview: after 48-55 months. Using the SMP records as the "gold standard", phone call recall accuracy was assessed for each interview. Data for 94 participants were analyzed. The number of calls made was underestimated considerably and the duration of calls was overestimated slightly in all interviews. Agreement between self-report and SMP records regarding the number of calls, duration of calls and laterality (i.e., use of the dominant ear while making calls) gradually deteriorated with the increase in the interval following the monitoring period (number of calls: first interview: Pearson's r=0.641, third interview: 0.396; duration of calls: first interview: Pearson's r=0.763, third interview: 0.356; laterality: first interview: weighted-κ=0.677, third interview: 0.448). Thus, recall accuracy for mobile phone calls would be consistently imperfect over a long period, and the results of related epidemiological studies should be interpreted carefully.

Mapping of radio frequency electromagnetic field exposure levels in outdoor environment and comparing with reference levels for general public health

In this study, radio frequency electromagnetic field exposure levels were measured on the main streets in the city center of Diyarbakır, Turkey. Measured electric field levels were plotted on satellite imagery of Diyarbakır and were compared with exposure guidelines published by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Exposure measurements were performed in dense urban, urban and suburban areas each day for 7 consecutive days. The measurement system consisted of high precision and portable spectrum analyzer, three-axis electric field antenna, connection cable and a laptop which was used to record the measurement samples as a data logger. The highest exposure levels were detected for two places, which are called Diclekent and Batıkent. It was observed that the highest instantaneous electric field strength value for Batıkent was 7.18 V/m and for Diclekent was 5.81 V/m. It was statistically determined that the main contributor band to the total exposure levels was Universal Mobile Telecommunications System band. Finally, it was concluded that all measured exposure levels were lower than the reference levels recommended by ICNIRP for general public health.

Total recall in the SCAMP cohort: Validation of self-reported mobile phone use in the smartphone era

Mobile phone use, predominantly smartphones, is almost ubiquitous amongst both adults and children. However adults and children have different usage patterns. A major challenge with research on mobile phone use is the reliability of self-reported phone activity for accurate exposure assessment. We investigated the agreement between self-reported mobile phone use data and objective mobile operator traffic data in a subset of adolescents aged 11-12 years participating in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) cohort. We examined self-reported mobile phone use, including call frequency, cumulative call time duration and text messages sent among adolescents from SCAMP and matched these data with records provided by mobile network operators (n = 350). The extent of agreement between self-reported mobile phone use and mobile operator traffic data use was evaluated using Cohen's weighted Kappa (ĸ) statistics. Sensitivity and specificity of self-reported low (< 1 call/day, ≤ 5min of call/day or ≤ 5 text messages sent/day) and high (≥ 11 calls/day, > 30min of call/day or ≥ 11 text messages sent /day) use were estimated. Agreement between self-reported mobile phone use and mobile operator traffic data was highest for the duration spent talking on mobile phones per day on weekdays (38.9%) and weekends (29.4%) compared to frequency of calls and number of text messages sent. Adolescents overestimated their mobile phone use during weekends compared to weekdays. Analysis of agreement showed little difference overall between the sexes and socio-economic groups. Weighted kappa between self-reported and mobile operator traffic data for call frequency during weekdays was κ = 0.12, 95% CI 0.06-0.18. Of the three modes of mobile phone use measured in the questionnaire, call frequency was the most sensitive for low mobile phone users on weekdays and weekends (77.1, 95% CI: 69.3-83.7 and 72.0, 95% CI: 65.0-78.4, respectively). Specificity was moderate to high for high users with the highest for call frequency during weekdays (98.4, 95% CI: 96.4-99.5). Despite differential agreement between adolescents' self-reported mobile phone use and mobile operator traffic data, our findings demonstrate that self-reported usage adequately distinguishes between high and low use. The greater use of mobile smartphones over Wi-Fi networks by adolescents, as opposed to mobile phone networks, means operator data are not the gold standard for exposure assessment in this age group. This has important implications for epidemiologic research on the health effects of mobile phone use in adolescents.

An international prospective cohort study of mobile phone users and health (COSMOS): Factors affecting validity of self-reported mobile phone use

This study investigates validity of self-reported mobile phone use in a subset of 75 993 adults from the COSMOS cohort study. Agreement between self-reported and operator-derived mobile call frequency and duration for a 3-month period was assessed using Cohen's weighted Kappa (κ). Sensitivity and specificity of both self-reported high (≥10 calls/day or ≥4h/week) and low (≤6 calls/week or <30min/week) mobile phone use were calculated, as compared to operator data. For users of one mobile phone, agreement was fair for call frequency (κ=0.35, 95% CI: 0.35, 0.36) and moderate for call duration (κ=0.50, 95% CI: 0.49, 0.50). Self-reported low call frequency and duration demonstrated high sensitivity (87% and 76% respectively), but for high call frequency and duration sensitivity was lower (38% and 56% respectively), reflecting a tendency for greater underestimation than overestimation. Validity of self-reported mobile phone use was lower in women, younger age groups and those reporting symptoms during/shortly after using a mobile phone. This study highlights the ongoing value of using self-report data to measure mobile phone use. Furthermore, compared to continuous scale estimates used by previous studies, categorical response options used in COSMOS appear to improve validity considerably, most likely by preventing unrealistically high estimates from being reported.

Use of mobile and cordless phones and change in cognitive function: a prospective cohort analysis of Australian primary school children

BACKGROUND

Some previous studies have suggested an association between children's use of mobile phones (MPs)/cordless phones (CPs) and development of cognitive function. We evaluated possible longitudinal associations between the use of MPs and CPs in a cohort of primary school children and effects on their cognitive function.

METHODS

Data on children's socio-demographics, use of MPs and CPs, and cognitive function were collected at baseline (2010-2012) and follow-up (2012-2013). Cognitive outcomes were evaluated with the CogHealth™ test battery and Stroop Color-Word test. The change in the number of MP/CP voice calls weekly from baseline to follow-up was dichotomized: "an increase in calls" or a "decrease/no change in calls". Multiple linear regression analyses, adjusting for confounders and clustering by school, were performed to evaluate the associations between the change in cognitive outcomes and change in MP and CP exposures.

RESULTS

Of 412 children, a larger proportion of them used a CP (76% at baseline and follow-up), compared to a MP (31% at baseline and 43% at follow-up). Of 26 comparisons of changes in cognitive outcomes, four demonstrated significant associations. The increase in MP usage was associated with larger reduction in response time for response inhibition, smaller reduction in the number of total errors for spatial problem solving and larger increase in response time for a Stroop interference task. Except for the smaller reduction in detection task accuracy, the increase in CP usage had no effect on the changes in cognitive outcomes.

CONCLUSION

Our study shows that a larger proportion of children used CPs compared to MPs. We found limited evidence that change in the use of MPs or CPs in primary school children was associated with change in cognitive function.

Recall accuracy of mobile phone calls among Japanese young people

This study aimed to elucidate the recall accuracy of mobile phone calls among young people using new software-modified phone (SMP) technology. A total of 198 Japanese students aged between 10 and 24 years were instructed to use a SMP for 1 month to record their actual call statuses. Ten to 12 months after this period, face-to-face interviews were conducted to obtain the self-reported call statuses during the monitoring period. Using the SMP record as the gold standard of validation, the recall accuracy of phone calls was evaluated. A total of 19% of the participants (34/177) misclassified their laterality (i.e., the dominant side of ear used while making calls), with the level of agreement being moderate (κ-statistics, 0.449). The level of agreement between the self-reports and SMP records was relatively good for the duration of calls (Pearson's r, 0.620), as compared with the number of calls (Pearson's r, 0.561). The recall was prone to small systematic and large random errors for both the number and duration of calls. Such a large random recall error for the amount of calls and misclassification of laterality suggest that the results of epidemiological studies of mobile phone use based on self-assessment should be interpreted cautiously.

Validation of objective records and misreporting of personal radio use in a cohort of British Police forces (the Airwave Health Monitoring Study)

BACKGROUND

Terrestrial Trunked Radio (TETRA) is a digital communication system progressively adopted by Police Forces in Great Britain since 2001. In 2000, the UK Independent Expert Group on Mobile Phones suggested that exposure to TETRA-like signal modulation might have adverse effects on health. The Airwave Health Monitoring Study was established to investigate possible long-term effects of TETRA use on health. This requires estimation of TETRA use among Police Force employees participating in the study.

METHODS

We investigated TETRA usage among 42,112 Police officers and staff. An algorithm was created to link each personal radio user to his/her objective radio usage records for the 26,035 participants with available data. We linked 16,577 personal radio users to their objective radio usage records and compared self-reported usage with data from the TETRA operator for those individuals.

RESULTS

For weekly usage, the correlation between self-reported and operator-derived personal radio usage was r=0.69 for number and r=0.59 for the duration of calls. Compared with objective data, participants under-reported the number of calls and over-reported the duration of calls by a factor of around 4 and 1.6 respectively. Correlations were lower and bias higher when looking at daily usage.

CONCLUSION

Where both objective and self-reported information were available, our study showed substantial misreporting in self-reported TETRA usage. Successful linkage of large numbers of TETRA users to objective data on their personal radios will allow objective assessment of TETRA radio usage for these participants and development of algorithms to correct bias in self-reported data for the remainder.

Development of a Brief Multicultural Version of the Test of Mobile Phone Dependence (TMDbrief) Questionnaire

The Test of Mobile Phone Dependence (TMD) questionnaire (Chóliz, 2012) evaluates the main features of mobile phone dependence: tolerance, abstinence syndrome, impaired impulse control, associated problems, excessive use, etc.

OBJECTIVE

The objective of this study was to develop a multicultural version of the TMD (TMDbrief) adapted to suit the novel communication tools of smartphones.

PROCEDURE

In this study, the TMD was completed by 2,028 young respondents in six distinct world regions: Southern Europe, Northwest Europe, South-America, Mesoamerica, Pakistan, and India.

RESULTS

Psychometric analysis of the reliability of the instrument and factor analysis were performed to adapt the TMDbrief for use in these regions. Differences among regions with respect to TMD Mobile Phone Dependence scores were obtained.

CONCLUSION

A brief questionnaire for the evaluation of mobile phone addiction in cross-cultural studies was successfully developed.

Using software-modified smartphones to validate self-reported mobile phone use in young people: A pilot study

A newly developed smartphone application was piloted to characterize and validate mobile phone use in young people. Twenty-six volunteers (mean age 17.3 years) from France, Spain, and the Netherlands used a software-modified smartphone for 4 weeks; the application installed on the phone recorded number and duration of calls, data use, laterality, hands-free device usage, and communication system used for both voice calls and data transfer. Upon returning the phone, participants estimated their mobile phone use during those 4 weeks via an interviewer-administered questionnaire. Results indicated that participants on average underestimated the number of calls they made, while they overestimated total call duration. Participants held the phone for about 90% of total call time near the head, mainly on the side of the head they reported as dominant. Some limitations were encountered when comparing reported and recorded data use and speaker use. When applied in a larger sample, information recorded by the smartphone application will be very useful to improve radiofrequency (RF) exposure modeling from mobile phones to be used in epidemiological research.

A validity study of self-reported daily texting frequency, cell phone characteristics, and texting styles among young adults

Background

Texting is associated with adverse health effects including musculoskeletal disorders, sleep disturbances, and traffic crashes. Many studies have relied on self-reported texting frequency, yet the validity of self-reports is unknown. Our objective was to provide some of the first data on the validity of self-reported texting frequency, cell phone characteristics including input device (e.g. touchscreen), key configuration (e.g., QWERTY), and texting styles including phone orientation (e.g., horizontal) and hands holding the phone while texting.

Methods

Data were collected using a self-administered questionnaire and observation of a texting task among college students ages 18 to 24. To gauge agreement between self-reported and phone bill-derived categorical number of daily text messages sent, we calculated percent of agreement, Spearman correlation coefficient, and a linear weighted kappa statistic. For agreement between self-reported and observed cell phone characteristics and texting styles we calculated percentages of agreement. We used chi-square tests to detect significant differences (α = 0.05) by gender and study protocol.

Results

There were 106 participants; 87 of which had complete data for texting frequency analyses. Among these 87, there was 26% (95% CI: 21–31) agreement between self-reported and phone bill-derived number of daily text messages sent with a Spearman’s rho of 0.48 and a weighted kappa of 0.17 (95% CI: 0.06-0.27). Among those who did not accurately report the number of daily texts sent, 81% overestimated this number. Among the full sample (n = 106), there was high agreement between self-reported and observed texting input device (96%, 95% CI: 91–99), key configuration (89%, 95% CI: 81–94), and phone orientation while texting (93%, 95% CI: 86–97). No differences were found by gender or study protocol among any items.

Conclusions

While young adults correctly reported their cell phone’s characteristics and phone orientation while texting, most incorrectly estimated the number of daily text messages they sent. This suggests that while self-reported texting frequency may be useful for studies where relative ordering is adequate, it should not be used in epidemiologic studies to identify a risk threshold. For these studies, it is recommended that a less biased measure, such as a cell phone bill, be utilized.

Validation of self-reported start year of mobile phone use in a Swedish case-control study on radiofrequency fields and acoustic neuroma risk

The possible effect of radiofrequency exposure from mobile phones on tumor risk has been studied since the late 1990s. Yet, empirical information about recall of the start of mobile phone use among adult cases and controls has never been reported. Limited knowledge about recall errors hampers interpretations of the epidemiological evidence. We used network operator data to validate the self-reported start year of mobile phone use in a case-control study of mobile phone use and acoustic neuroma risk. The answers of 96 (29%) cases and 111 (22%) controls could be included in the validation. The larger proportion of cases reflects a more complete and detailed reporting of subscription history. Misclassification was substantial, with large random errors, small systematic errors, and no significant differences between cases and controls. The average difference between self-reported and operator start year was -0.62 (95% confidence interval: -1.42, 0.17) years for cases and -0.71 (-1.50, 0.07) years for controls, standard deviations were 3.92 and 4.17 years, respectively. Agreement between self-reported and operator-recorded data categorized into short, intermediate and long-term use was moderate (kappa statistic: 0.42). Should an association exist, dilution of risk estimates and distortion of exposure-response patterns for time since first mobile phone use could result from the large random errors in self-reported start year. Retrospective collection of operator data likely leads to a selection of "good reporters", with a higher proportion of cases. Thus, differential recall cannot be entirely excluded.

Mobile phone use and brain tumours in the CERENAT case-control study

The carcinogenic effect of radiofrequency electromagnetic fields in humans remains controversial. However, it has been suggested that they could be involved in the aetiology of some types of brain tumours.

OBJECTIVES

The objective was to analyse the association between mobile phone exposure and primary central nervous system tumours (gliomas and meningiomas) in adults.

METHODS

CERENAT is a multicenter case-control study carried out in four areas in France in 2004-2006. Data about mobile phone use were collected through a detailed questionnaire delivered in a face-to-face manner. Conditional logistic regression for matched sets was used to estimate adjusted ORs and 95% CIs.

RESULTS

A total of 253 gliomas, 194 meningiomas and 892 matched controls selected from the local electoral rolls were analysed. No association with brain tumours was observed when comparing regular mobile phone users with non-users (OR=1.24; 95% CI 0.86 to 1.77 for gliomas, OR=0.90; 95% CI 0.61 to 1.34 for meningiomas). However, the positive association was statistically significant in the heaviest users when considering life-long cumulative duration (≥896 h, OR=2.89; 95% CI 1.41 to 5.93 for gliomas; OR=2.57; 95% CI 1.02 to 6.44 for meningiomas) and number of calls for gliomas (≥18,360 calls, OR=2.10, 95% CI 1.03 to 4.31). Risks were higher for gliomas, temporal tumours, occupational and urban mobile phone use.

CONCLUSIONS

These additional data support previous findings concerning a possible association between heavy mobile phone use and brain tumours.

Vestibular schwannoma and cell-phones. Results, limits and perspectives of clinical studies

The widespread development of cell-phones entails novel user exposure to electromagnetic fields. Health impact is a public health issue and a source of anxiety in the population. Some clinical studies reported an association between cell and cordless phone use and vestibular schwannoma; others found none. A systematic review was performed of all published clinical studies (cohort, registry, case-control and validation studies), with analysis of results, to determine the nature of the association and the level of evidence. Cohort studies were inconclusive due to short exposure durations and poor representativeness. Registry studies showed no correlation between evolution of cell-phone use and incidence of vestibular schwannoma. Case-control studies reported contradictory results, with methodological flaws. Only a small number of subjects were included in long-term studies (>10 years), and these failed to demonstrate any indisputable causal relationship. Exposure assessment methods were debatable, and long-term assessment was lacking. An on-going prospective study should determine any major effect of electromagnetic fields; schwannoma being a rare pathology, absence of association will be difficult to prove. No clinical association has been demonstrated between cell and cordless phone use and vestibular schwannoma. Existing studies are limited by their retrospective assessment of exposure.

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.

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.

Validation of exposure assessment and assessment of recruitment methods for a prospective cohort study of mobile phone users (COSMOS) in Finland: a pilot study

BACKGROUND

The aim of the study was to evaluate the agreement between self-reported and operator-derived estimates of call time based on a three-month monitoring period, as well as the consistency of mobile phone use over time. Alternative approaches to improve participation in a cohort study of mobile phone users were also compared.

METHODS

A total of 5,400 subjects were identified from network operators' subscriber databases for recruitment to the pilot study. Operator and questionnaire data were used to quantify mobile phone use. Operator data were available for a subset of the subjects for a three-month period in three consecutive years. We also evaluated the effect of the length of the questionnaire and one- or two-phase recruitment on participation.

RESULTS

The average response rate for both questionnaires and recruitment procedures was 12%. The response rate was not affected by the length of the questionnaire or the recruitment method.Operator data were available for 83% of the participants for 2007, the first study year. The agreement between self-reported and operator-derived call times decreased with the level of use among intermediate and heavy mobile phone users. During 2007-2009, mobile phone use increased fairly constantly over time.

CONCLUSIONS

The agreement between self-reported mobile phone use and operator databases was moderate and overestimation of the call time by participants was common. A prospective cohort study would be feasible in Finland, although the potentially low participation rate would increase the resources required for recruitment.

The impact of exposure to radio frequency electromagnetic fields on chronic well-being in young people--a cross-sectional study based on personal dosimetry

A possible influence of radio frequency electromagnetic field (RF EMF) exposure on health outcomes was investigated in various studies. The main problem of previous studies was exposure assessment. The aim of our study was the investigation of a possible association between RF EMF and chronic well-being in young persons using personal dosimetry. 3022 children and adolescents were randomly selected from the population registries of four Bavarian cities in Germany (participation 52%). Personal interview data on chronic symptoms, socio-demographic characteristics and potential confounders were collected. A 24-h radio frequency exposure profile was generated using a personal dosimeter. Exposure levels over waking hours were expressed as mean percentage of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) reference level. Half of the children and nearly every adolescent owned a mobile phone which was used only for short durations per day. Measured exposure was far below the current ICNIRP reference levels. The most reported chronic symptom in children and adolescents was fatigue. No statistically significant association between measured exposure and chronic symptoms was observed. Our results do not indicate an association between measured exposure to RF EMF and chronic well-being in children and adolescents. Prospective studies investigating potential long-term effects of RF EMF are necessary to confirm our results.

Predictors of mobile telephone use and exposure analysis in Australian adolescents

AIM

Australian adolescents are increasingly using mobile telephones (MP) while the debate on MP safety persists. This group is not generally engaged in full-time employment, suggesting that their MP use is not work related. We investigated possible predictors of MP use in young people.

METHODS

We assessed exposure to radiofrequency energy from MP by means of a self-administered questionnaire adapted from INTERPHONE--an international case-control study of adult brain, head and neck tumours. We investigated possible determinants of MP use in adolescent Australians using self-reported number of incoming and outgoing voice calls as exposure metric.

RESULTS

There is a high prevalence of MP use amongst Australian adolescents (94%). Males were significantly younger than females at age of first uptake of MP (P= 0.02). Participants without siblings were significantly younger at age of first uptake. Personality traits were associated with regular MP usage: higher psychoticism scores were associated with regular use (IRR = 1.06, P= 0.03); there was a tendency for students with higher extraversion scores to report more MP use. Parental socio-economic status was associated with MP use, but parents who expressed moderate/high level concerns about possible health risks of use were more likely to have children who used MP (OR = 4.06, P= 0.05).

CONCLUSIONS

Almost all adolescent Australians use MP, but regular exposure was associated with personality traits. Parental socio-economic status and perceived health risks of MP use were also associated with use of phones. Longitudinal studies are needed to assess the predictors of mobile phone use in the long term.

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.

Validity of self-reported occupational noise exposure

In all epidemiological studies the validity of self-reported questionnaire data is an important issue as the exposure assessment based on such data is a major source of bias in the risk estimation. A validation study was conducted based on a case-control study including 94 acoustic neuroma cases and 191 matched controls from the German Interphone Study to investigate the level of agreement between self-reported occupational noise exposure and a job-exposure-matrix (JEM) on noise exposure derived from a lifetime occupation calendar. The JEM was generated based on measurement data collected in the literature for various occupations. Level of agreement was investigated by using sensitivity, specificity, kappa coefficient and the Youden-Index. The receiver operating characteristics curve yielded an optimal cut point of 80 decibel(Acoustic) (dB(A)) to dichotomize noise exposure, displaying a moderate agreement between self-reported exposure and the JEM-based exposure (kappa of 0.53) that was slightly higher for cases than controls (kappas of 0.62 and 0.48). The agreement was only slightly lower if the longest held job or the last held job were used instead of the loudest job of the lifetime job history. The cut point of 80 dB(A) corresponds with regulations for workers safety with a recommendation to wear noise protection. The good levels of agreement between self-reported high occupational noise exposure compared with JEM-data, together with no substantial differences between cases and controls, suggest that self-reported data on occupational noise exposure is a valid exposure metric. Noise exposure appears to be appropriate if only exposure information on the last or the longest held job is available.

How well do adolescents recall use of mobile telephones? Results of a validation study

BACKGROUND

In the last decade mobile telephone use has become more widespread among children. Concerns expressed about possible health risks have led to epidemiological studies investigating adverse health outcomes associated with mobile telephone use. Most epidemiological studies have relied on self reported questionnaire responses to determine individual exposure. We sought to validate the accuracy of self reported adolescent mobile telephone use.

METHODS

Participants were recruited from year 7 secondary school students in Melbourne, Australia. Adolescent recall of mobile telephone use was assessed using a self administered questionnaire which asked about number and average duration of calls per week. Validation of self reports was undertaken using Software Modified Phones (SMPs) which logged exposure details such as number and duration of calls.

RESULTS

A total of 59 adolescents participated (39% boys, 61% girls). Overall a modest but significant rank correlation was found between self and validated number of voice calls (rho = 0.3, P = 0.04) with a sensitivity of 57% and specificity of 66%. Agreement between SMP measured and self reported duration of calls was poorer (rho = 0.1, P = 0.37). Participants whose parents belonged to the 4th socioeconomic stratum recalled mobile phone use better than others (rho = 0.6, P = 0.01).

CONCLUSION

Adolescent recall of mobile telephone use was only modestly accurate. Caution is warranted in interpreting results of epidemiological studies investigating health effects of mobile phone use in this age group.

Recall bias in the assessment of exposure to mobile phones

Most studies of mobile phone use are case-control studies that rely on participants' reports of past phone use for their exposure assessment. Differential errors in recalled phone use are a major concern in such studies. INTERPHONE, a multinational case-control study of brain tumour risk and mobile phone use, included validation studies to quantify such errors and evaluate the potential for recall bias. Mobile phone records of 212 cases and 296 controls were collected from network operators in three INTERPHONE countries over an average of 2 years, and compared with mobile phone use reported at interview. The ratio of reported to recorded phone use was analysed as measure of agreement. Mean ratios were virtually the same for cases and controls: both underestimated number of calls by a factor of 0.81 and overestimated call duration by a factor of 1.4. For cases, but not controls, ratios increased with increasing time before the interview; however, these trends were based on few subjects with long-term data. Ratios increased by level of use. Random recall errors were large. In conclusion, there was little evidence for differential recall errors overall or in recent time periods. However, apparent overestimation by cases in more distant time periods could cause positive bias in estimates of disease risk associated with mobile phone use.

Mobile phone use and risk of uveal melanoma: results of the risk factors for uveal melanoma case-control study

We recently reported an increased risk of uveal melanoma among mobile phone users. Here, we present the results of a case–control study that assessed the association between mobile phone use and risk of uveal melanoma. We recruited 459 uveal melanoma case patients at the University of Duisburg-Essen and matched 455 case patients with 827 population control subjects, 133 with 180 ophthalmologist control subjects, and 187 with 187 sibling control subjects. We used a questionnaire to assess mobile phone use and estimated odds ratios (ORs) and 95% confidence intervals (95% CIs) of risk for uveal melanoma using conditional logistic regression. Risk of uveal melanoma was not associated with regular mobile phone use (OR = 0.7, 95% CI = 0.5 to 1.0 vs population control subjects; OR = 1.1, 95% CI = 0.6 to 2.3 vs ophthalmologist control subjects; and OR = 1.2, 95% CI = 0.5 to 2.6 vs sibling control subjects), and we observed no trend for cumulative measures of exposure. We did not corroborate our previous results that showed an increased risk of uveal melanoma among regular mobile phone users.

Comparison of measuring instruments for radiofrequency radiation from mobile telephones in epidemiological studies: implications for exposure assessment

The debate on mobile telephone safety continues. Most epidemiological studies investigating health effects of radiofrequency (RF) radiation emitted by mobile phone handsets have been criticised for poor exposure assessment. Most of these studies relied on the historical reconstruction of participants' phone use by questionnaires. Such exposure assessment methods are prone to recall bias resulting in misclassification that may lead to conflicting conclusions. Although there have been some studies using software-modified phones (SMP) for exposure assessment in the literature, until now there is no published work on the use of hardware modified phones (HMPs) or RF dosimeters for studies of mobile phones and health outcomes. We reviewed existing literature on mobile phone epidemiology with particular attention to exposure assessment methods used. Owing to the inherent limitations of these assessment methods, we suggest that the use of HMPs may show promise for more accurate exposure assessment of RF radiation from mobile phones.

Exposure modeling of high-frequency electromagnetic fields

We developed a geospatial model that calculates ambient high-frequency electromagnetic field (HF-EMF) strengths of stationary transmission installations such as mobile phone base stations and broadcast transmitters with high spatial resolution in the order of 1 m. The model considers the location and transmission patterns of the transmitters, the three-dimensional topography, and shielding effects by buildings. The aim of the present study was to assess the suitability of the model for exposure monitoring and for epidemiological research. We modeled time-averaged HF-EMF strengths for an urban area in the city of Basel as well as for a rural area (Bubendorf). To compare modeling with measurements, we selected 20 outdoor measurement sites in Basel and 18 sites in Bubendorf. We calculated Pearson's correlation coefficients between modeling and measurements. Chance-corrected agreement was evaluated by weighted Cohen's kappa statistics for three exposure categories. Correlation between measurements and modeling of the total HF-EMF strength was 0.67 (95% confidence interval (CI): 0.33-0.86) in the city of Basel and 0.77 (95% CI: 0.46-0.91) in the rural area. In both regions, kappa coefficients between measurements and modeling were 0.63 and 0.77 for the total HF-EMF strengths and for all mobile phone frequency bands. First evaluation of our geospatial model yielded substantial agreement between modeling and measurements. However, before the model can be applied for future epidemiologic research, additional validation studies focusing on indoor values are needed to improve model validity.

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.

Mobile phone use and risk of glioma in 5 North European countries

Public concern has been expressed about the possible adverse health effects of mobile telephones, mainly related to intracranial tumors. We conducted a population-based case-control study to investigate the relationship between mobile phone use and risk of glioma among 1,522 glioma patients and 3,301 controls. We found no evidence of increased risk of glioma related to regular mobile phone use (odds ratio, OR = 0.78, 95% confidence interval, CI: 0.68, 0.91). No significant association was found across categories with duration of use, years since first use, cumulative number of calls or cumulative hours of use. When the linear trend was examined, the OR for cumulative hours of mobile phone use was 1.006 (1.002, 1.010) per 100 hr, but no such relationship was found for the years of use or the number of calls. We found no increased risks when analogue and digital phones were analyzed separately. For more than 10 years of mobile phone use reported on the side of the head where the tumor was located, an increased OR of borderline statistical significance (OR = 1.39, 95% CI 1.01, 1.92, p trend 0.04) was found, whereas similar use on the opposite side of the head resulted in an OR of 0.98 (95% CI 0.71, 1.37). Although our results overall do not indicate an increased risk of glioma in relation to mobile phone use, the possible risk in the most heavily exposed part of the brain with long-term use needs to be explored further before firm conclusions can be drawn.

Radio frequency exposure in mobile phone users: implications for exposure assessment in epidemiological studies

The majority of epidemiological studies investigating correlations between long-term low-level radiofrequency (RF) exposure from mobile phones and health endpoints have followed a case-control design, requiring reconstruction of individual RF exposure. To date, these have employed 'time of use' as an exposure surrogate from questionnaire information or billing records. The present study demonstrates such an approach may not account for variability in mobile phone transmit power, which can be roughly correlated with RF exposure. This variability exists (a) during a single call, (b) between separate calls, (c) between averaged values from individuals within a local study group and (d) between average values from groups in different geographical locations. The present data also suggest an age-related influence on talk time, as well as significant inaccuracy (45-60%) in recalling 'time of use'. Evolving technology and changing use behaviours may add additional complexities. Collectively, these data suggest efforts to identify dose response and statistical correlations between mobile phone use and subtle health endpoints may be significantly challenged.

Cellular Telephone Use and Cancer Risk: Update of a Nationwide Danish Cohort

BACKGROUND

The widespread use of cellular telephones has heightened concerns about possible adverse health effects. The objective of this study was to investigate cancer risk among Danish cellular telephone users who were followed for up to 21 years.

METHODS

This study is an extended follow-up of a large nationwide cohort of 420,095 persons whose first cellular telephone subscription was between 1982 and 1995 and who were followed through 2002 for cancer incidence. Standardized incidence ratios (SIRs) were calculated by dividing the number of observed cancer cases in the cohort by the number expected in the Danish population.

RESULTS

A total of 14,249 cancers were observed (SIR = 0.95; 95% confidence interval [CI] = 0.93 to 0.97) for men and women combined. Cellular telephone use was not associated with increased risk for brain tumors (SIR = 0.97), acoustic neuromas (SIR = 0.73), salivary gland tumors (SIR = 0.77), eye tumors (SIR = 0.96), or leukemias (SIR = 1.00). Among long-term subscribers of 10 years or more, cellular telephone use was not associated with increased risk for brain tumors (SIR = 0.66, 95% CI = 0.44 to 0.95), and there was no trend with time since first subscription. The risk for smoking-related cancers was decreased among men (SIR = 0.88, 95% CI = 0.86 to 0.91) but increased among women (SIR = 1.11, 95% CI = 1.02 to 1.21). Additional data on income and smoking prevalence, primarily among men, indicated that cellular telephone users who started subscriptions in the mid-1980s appeared to have a higher income and to smoke less than the general population.

CONCLUSIONS

We found no evidence for an association between tumor risk and cellular telephone use among either short-term or long-term users. Moreover, the narrow confidence intervals provide evidence that any large association of risk of cancer and cellular telephone use can be excluded.

Epidemiological risk assessment of mobile phones and cancer: where can we improve?

This paper aims to provide an overview of factors affecting the validity of epidemiological studies on health effects of mobile phone use. A qualitative review of published studies is presented, covering both risk assessment and exposure assessment. Considerable random error is likely to have occurred in studies carried out so far, primarily related to exposure assessment. Self-reported use of mobile phone appears to be imprecise. The relationship between the amount of mobile phone use and the radio-frequency field is unclear. Several factors affect the strength of the radio-frequency field emitted by the phone, and accommodating their effect has the potential to improve exposure assessment. The major opportunity to improve the quality of evidence is, however, through prospective studies. The major limitation of epidemiological studies addressing the health effects of mobile phone use is related to exposure assessment. These limitations are inherent in case-control studies. Quality of evidence can be improved by conducting prospective cohort studies.

Cellular telephones and non-Hodgkin lymphoma

Dramatic increase in hand-held cellular telephone use since the 1980s and excess risk of lymphoproliferative malignancies associated with radio-frequency radiation (RFR) exposures in epidemiological and experimental studies motivated assessment of cellular telephones within a comprehensive US case-control investigation of non-Hodgkin lymphoma (NHL). A questionnaire ascertained cellular telephone use in 551 NHL cases and 462 frequency-matched population controls. Compared to persons who had never used cellular telephones, risks were not increased among individuals whose lifetime use was fewer than 10 (odds ratio (OR) = 0.9, 95% confidence intervals (CI): 0.6, 1.3), 10-100 (OR = 1.0, 95 % CI: 0.7, 1.5) or more than 100 times (e.g., regular users, OR = 0.9, 95% CI: 0.6, 1.4). Among regular users compared to those who had never used hand-held cellular telephones, risks of NHL were not significantly associated with minutes per week, duration, cumulative lifetime or year of first use, although NHL was non-significantly higher in men who used cellular telephones for more than 8 years. Little evidence linked use of cellular telephones with total, diffuse large B-cell lymphoma or follicular NHL. These findings must be interpreted in the context of less than 5% of the population reporting duration of use of 6 or more years or lifetime cumulative use of 200 or more hours.

Validation of short term recall of mobile phone use for the Interphone study

AIM

To validate short term recall of mobile phone use within Interphone, an international collaborative case control study of tumours of the brain, acoustic nerve, and salivary glands related to mobile telephone use.

METHODS

Mobile phone use of 672 volunteers in 11 countries was recorded by operators or through the use of software modified phones, and compared to use recalled six months later using the Interphone study questionnaire. Agreement between recalled and actual phone use was analysed using both categorical and continuous measures of number and duration of phone calls.

RESULTS

Correlations between recalled and actual phone use were moderate to high (ranging from 0.5 to 0.8 across countries) and of the same order for number and duration of calls. The kappa statistic demonstrated fair to moderate agreement for both number and duration of calls (weighted kappa ranging from 0.20 to 0.60 across countries). On average, subjects underestimated the number of calls per month (geometric mean ratio of recalled to actual = 0.92, 95% CI 0.85 to 0.99), whereas duration of calls was overestimated (geometric mean ratio = 1.42, 95% CI 1.29 to 1.56). The ratio of recalled to actual use increased with level of use, showing underestimation in light users and overestimation in heavy users. There was substantial heterogeneity in this ratio between countries. Inter-individual variation was also large, and increased with level of use.

CONCLUSIONS

Volunteer subjects recalled their recent phone use with moderate systematic error and substantial random error. This large random error can be expected to reduce the power of the Interphone study to detect an increase in risk of brain, acoustic nerve, and parotid gland tumours with increasing mobile phone use, if one exists.

Cellular phones, cordless phones, and the risks of glioma and meningioma (Interphone Study Group, Germany)

The widespread use of cellular telephones has generated concern about possible adverse health effects, particularly brain tumors. In this population-based case-control study carried out in three regions of Germany, all incident cases of glioma and meningioma among patients aged 30-69 years were ascertained during 2000-2003. Controls matched on age, gender, and region were randomly drawn from population registries. In total, 366 glioma cases, 381 meningioma cases, and 1,494 controls were interviewed. Overall use of a cellular phone was not associated with brain tumor risk; the respective odds ratios were 0.98 (95% confidence interval (CI): 0.74, 1.29) for glioma and 0.84 (95% CI: 0.62, 1.13) for meningioma. Among persons who had used cellular phones for 10 or more years, increased risk was found for glioma (odds ratio = 2.20, 95% CI: 0.94, 5.11) but not for meningioma (odds ratio = 1.09, 95% CI: 0.35, 3.37). No excess of temporal glioma (p = 0.41) or meningioma (p = 0.43) was observed in cellular phone users as compared with nonusers. Cordless phone use was not related to either glioma risk or meningioma risk. In conclusion, no overall increased risk of glioma or meningioma was observed among these cellular phone users; however, for long-term cellular phone users, results need to be confirmed before firm conclusions can be drawn.

Assessment of radiofrequency exposure from cellular telephone daily use in an epidemiological study: German Validation study of the international case-control study of cancers of the brain--INTERPHONE-Study

OBJECTIVE

The objective of the study is to validate self-reported cellular phone use information by comparing it with the cumulative emitted power and duration of calls measured by software-modified cellular phones (SMP). The information was obtained using a questionnaire developed for the international case-control study on the risk of the use of mobile phones in tumours of the brain or salivary gland (INTERPHONE-study).

METHOD

The study was conducted in Bielefeld, Germany. Volunteers were asked to use SMPs instead of their own cellular phones for a period of 1 month. The SMP recorded the power emitted by the mobile phone handset during each base station contact. Information on cellular phone use for the same time period from traffic records of the network providers and from face-to-face interviews with the participants 3 months after the SMP use was assessed. Pearson's correlation coefficients and linear regression models were used to analyse the association between information from the interview and from the SMP.

RESULTS

In total, 1757 personal mobile phone calls were recorded for 45 persons by SMP and traffic records. The correlation between the self-reported information about the number and the duration of calls with the cumulative power of calls was 0.50 (P<0.01) and 0.48 (P<0.01), respectively. Almost 23% of the variance of the cumulative power was explained by either the number or the cumulative duration of calls. After inclusion of possible confounding factors in the regression model, the variance increased to 26%. Minor confounding factors were "network provider", "contract form", and "cellular phone model".

DISCUSSION

The number of calls alone is a sufficient parameter to estimate the cumulative power emitted by the handset of a cellular telephone. The cumulative power emitted by these phones is only associated with number of calls but not with possible confounding factors. Using the mobile phone while driving, mainly in cities, or mainly in rural areas is not associated with the recorded cumulative power in the SMP.

Assessment of potential effects of the electromagnetic fields of mobile phones on hearing

Background

Mobile phones have become indispensable as communication tools; however, to date there is only a limited knowledge about interaction between electromagnetic fields (EMF) emitted by mobile phones and auditory function. The aim of the study was to assess potential changes in hearing function as a consequence of exposure to low-intensity EMF's produced by mobile phones at frequencies of 900 and 1800 MHz.

Methods

The within-subject study was performed on thirty volunteers (age 18–30 years) with normal hearing to assess possible acute effect of EMF. Participants attended two sessions: genuine and sham exposure of EMF. Hearing threshold levels (HTL) on pure tone audiometry (PTA) and transient evoked otoacoustic emissions (TEOAE's) were recorded before and immediately after 10 min of genuine and/or sham exposure of mobile phone EMF. The administration of genuine or sham exposure was double blind and counterbalanced in order.

Results

Statistical analysis revealed no significant differences in the mean HTLs of PTA and mean shifts of TEOAE's before and after genuine and/or sham mobile phone EMF 10 min exposure. The data collected showed that average TEOAE levels (averaged across a frequency range) changed less than 2.5 dB between pre- and post-, genuine and sham exposure. The greatest individual change was 10 dB, with a decrease in level from pre- to post- real exposure.

Conclusion

It could be concluded that a 10-min close exposure of EMFs emitted from a mobile phone had no immediate after-effect on measurements of HTL of PTA and TEOAEs in young human subjects and no measurable hearing deterioration was detected in our study.