Smartphone use health outcomes in children and adolescents: A systematic review of behavioral, developmental, and environmental risk pathways

Table 12 Summary of studies evaluating radiofrequency electromagnetic field exposure and health outcomes in children and young people

Ref.	Design	Population/age	Exposure metric	Outcome (s)	Key findings	Primary bias considerations	Risk of bias (JBI)
Moon[97], 2020	Narrative review	Children (various ages)	Environmental RF-EMF (mobile phones, WiFi, base stations)	Carcinogenicity, neurodevelopmental, and biological effects	RF-EMF is classified by IARC as Group 2B (possible carcinogen). No confirmed causal pediatric harm; precautionary approach recommended due to biological uncertainty	As a narrative review, it is prone to selection bias compared to systematic reviews; however, it accurately synthesizes IARC and WHO positions	Moderate to high
Castaño-Vinyals et al[98], 2022 (MOBI-Kids)	Multinational case-control (14 countries)	899 cases, 1910 controls; age 10-24 years	Cumulative call time, number of calls, years since first use, modeled cumulative RF energy at tumor site	Neuroepithelial brain tumors (mainly glioma)	No increased risk with higher exposure. ORs did not increase with cumulative use; some inverse trends likely due to recall bias. Small risk increase cannot be entirely excluded	Robust multinational design with sophisticated RF-energy modeling. Recall bias is a noted limitation common to retrospective case-controls	Low
Elliott et al[99], 2010	National case-control (registry-linked)	1397 cancer cases (0-4 years), 5588 controls	Distance to base stations, modeled RF power density at birth address	All cancers, CNS tumors, leukemia, NHL	No association between prenatal base-station RF exposure and early childhood cancer. ORs = 1.0 across exposure categories	High-quality registry-linked study; used objective distance to base stations, eliminating recall bias for exposure	Low
Durusoy et al[105], 2017	Cross-sectional survey	2150 high school students	Mobile phone use characteristics (calls/day, duration, texts/day, nighttime proximity); measured school EMF levels	Headache, fatigue, sleep disturbance, concentration difficulties	Mobile phone use associated with headache (OR = 1.90), fatigue (OR = 1.78), sleep disturbance (OR = 1.53); dose-response observed. No association with measured school EMF levels	Large sample size; however, symptoms (headache, fatigue) and exposure characteristics were entirely self-reported	Moderate
Edelstyn and Oldershaw[100], 2002	Randomized experimental	38 adults (young)	30-minute exposure to 900 MHz mobile phone vs sham	Attention, processing speed	No deficits observed; transient facilitation in select attentional tasks	Controlled and blinded; however, the sample size is small and the exposure duration was limited to 30 minutes	Low to moderate
Mortazavi et al[101], 2012	Randomized experimental	160 university students (18-31 years)	10-minute real vs sham exposure (high SAR handset)	Visual reaction time	Significant reduction (faster reaction time) after real exposure; no impairment demonstrated	Well-controlled randomized trial with a larger sample for an experimental neurophysiology study	Low
Sauter et al[102], 2011	Randomized crossover	30 young male adults (mean 25 years)	7 hours 15 minutes exposure to GSM 900, WCDMA, or sham	Attention, working memory	No consistent cognitive effects after correction for multiple testing; time-of-day effects significant	Robust crossover design (participants served as their own controls); accounted for multiple testing corrections	Low
Terao et al[103], 2006	Double-blind crossover	16 adults	30-minute pulsed EMF vs sham	Visuo-motor reaction time, movement time	No significant short-term effects on visuo-motor processing	High internal validity due to double-blinding and counterbalanced crossover design	Low
Inomata-Terada et al[104], 2007	Experimental neurophysiology	10 adults (+ 2 MS patients)	30-minute mobile phone EMF exposure	Motor evoked potentials (TMS), intracortical inhibition	No detectable short-term effects on motor cortical excitability or GABAergic inhibition	Small sample size (n = 10) limits power to detect subtle effects, though the neurophysiological methods (TMS) are highly precise	Moderate

Risk of Bias assessment has been performed using the Joanna Briggs Institute checklist for analytical cross-sectional studies and ergonomic assessments. JBI: Joanna Briggs Institute; IARC: International Agency for Research on Cancer; WHO: World Health Organization; TMS: Transcranial magnetic stimulation; MS: Multiple sclerosis; RF-EMF: Radiofrequency electromagnetic field; RE: Radiofrequency; EMF: Electromagnetic field; OR: Odds ratio; CNS: Central nervous system.