Cyberbullying has emerged as a societal issue, and the majority of the research examining cyberbullying perpetration samples adolescent and/or emerging adult populations. A paucity of empirical attention has focused on young children (aged 8-10) regarding their cyberbullying frequency and predictors. The current study sampled 142 US youth aged 8-10 years and assessed their cyberbullying perpetration rate and cellular phone ownership. Results indicated that (a) older participants were more likely to cyberbully than their younger peers; (b) higher rates of cyberbullying were found for youth who already owned a cellular phone; and (c) an interaction between participant age and cellular phone ownership was found, suggesting that cyberbullying was highest for only the 10-year-old group who owned a cellular phone. These findings have implications for (a) parents, school administrators, health care providers, and anyone else interested in better understanding the predictors of cyberbullying perpetration; (b) intervention specialists focused on reducing cyberbullying in youth; and (c) a researcher interested in understanding the basic theoretical underpinnings of cyberbullying. Based on these findings, we recommend that (a) cyberbullying interventions be administered to youth as early as elementary school; (b) parents/guardians carefully consider the positive and negative consequences of youth cellular phone usage; and (c) increased communication between youth and parents/guardians concerning youth cellular phone activities.

Purpose The purpose of the study is to determine if instructional videos detailing the use of smartphone accessibility features may be used to improve quality of life and comfort with phone usage among patients with severe glaucoma. Design The design of the present study is an interventional case series. Methods The patients with vision loss due to severe glaucoma were recruited from one institution. Two surveys were completed to provide baseline data: one detailed their current use of smartphone accessibility features, and the other provided survey was the EuroQol 5 Dimension 5 Level (EQ-5D-5L) (EuroQol Group, Rotterdam, Netherlands), which is used to assess the quality of life. Then, the patients were shown a brief video with instructions on configuring the use of voice-over, magnification, and zoom functions, along with other features. To conclude, the patients completed the same surveys either at follow-up visits or by phone calls. Results Fifteen patients were recruited to participate in the study. At baseline, the participants used a median of one accessibility feature, with the most common feature being \"text sizing/bolding.\" At follow-up, the participants averaged the gain of use of one accessibility feature and reported a decrease in text messaging visual limitation, although these findings did not reach statistical significance. Overall, the quality of life, as measured by the EQ-5D-5L, demonstrated a non-statistically significant increase of six points. Conclusions Despite the lack of statistical significance, our results indicate that providing instructional videos may benefit the patients\' ability to navigate on their smartphones. Incorporating links or Quick Response (QR) codes to these instructional videos provides an opportunity to improve the quality of life at no additional risk to the patient. Further studies are needed with an increased population to investigate for any significance of our findings.

BACKGROUND: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message-based mobile health (mHealth) technology. Numerous SMS text message-based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa.
OBJECTIVE: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message-based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda.
METHODS: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message-based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system.
RESULTS: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system.
CONCLUSIONS: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions.

In the 1990s, the Institute of Electrical and Electronics Engineers (IEEE) restricted its risk assessment for human exposure to radiofrequency radiation (RFR) in seven ways: (1) Inappropriate focus on heat, ignoring sub-thermal effects. (2) Reliance on exposure experiments performed over very short times. (3) Overlooking time/amplitude characteristics of RFR signals. (4) Ignoring carcinogenicity, hypersensitivity, and other health conditions connected with RFR. (5) Measuring cellphone Specific Absorption Rates (SAR) at arbitrary distances from the head. (6) Averaging SAR doses at volumetric/mass scales irrelevant to health. (7) Using unrealistic simulations for cell phone SAR estimations. Low-cost software and hardware modifications are proposed here for cellular phone RFR exposure mitigation: (1) inhibiting RFR emissions in contact with the body, (2) use of antenna patterns reducing the Percent of Power absorbed in the Head (PPHead) and body and increasing the Percent of Power Radiated for communications (PPR), and (3) automated protocol-based reductions of the number of RFR emissions, their duration, or integrated dose. These inexpensive measures do not fundamentally alter cell phone functions or communications quality. A health threat is scientifically documented at many levels and acknowledged by industries. Yet mitigation of RFR exposures to users does not appear as a priority with most cell phone manufacturers.

There is growing interest in using information and communication technologies (ICTs) to improve access to mental health services for youth experiencing homelessness (YEH); however, limited efforts have been made to synthesize this literature.
This study aimed to review the research on the use of ICTs to provide mental health services and interventions for YEH.
We used a scoping review methodology following the Arksey and O\'Malley framework and guidelines from the Joanna Briggs Institute Manual for Evidence Synthesis. The results are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A systematic search was conducted from 2005 to 2021 in MEDLINE, Embase, CINAHL, PsycInfo, Cochrane, Web of Science, and Maestro and in ProQuest Thesis and Dissertations, Papyrus, Homeless Hub, and Google Scholar for gray literature. Studies were included if participants\' mean age was between 13 and 29 years, youth with mental health issues were experiencing homelessness or living in a shelter, ICTs were used as a means of intervention, and the study provided a description of the technology. The exclusion criteria were technology that did not allow for interaction (eg, television) and languages other than French or English. The data were analyzed using descriptive statistics and qualitative approaches. Two reviewers were involved in the screening and data extraction process in consultation with a third reviewer. The data were summarized in tables and by narrative synthesis.
From the 2153 abstracts and titles screened, 12 were included in the analysis. The most common types of ICTs used were communication technologies (eg, phone, video, and SMS text messages) and mobile apps. The intervention goals varied widely across studies; the most common goal was reducing risky behaviors, followed by addressing cognitive functioning, providing emotional support, providing vital resources, and reducing anxiety. Most studies (9/11, 82%) focused on the feasibility of interventions. Almost all studies reported high levels of acceptability (8/9, 89%) and moderate to high frequency of use (5/6, 83%). The principal challenges were related to technical problems such as the need to replace phones, issues with data services, and phone charging.
Our results indicate the emerging role of ICTs in the delivery of mental health services to YEH and that there is a high level of acceptability based on early feasibility studies. However, our results should be interpreted cautiously, considering the limited number of studies included in the analysis and the elevated levels of dropout. There is a need to advance efficacy and effectiveness research in this area with larger and longer studies.
RR2-10.1136/bmjopen-2022-061313.

BACKGROUND: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly.
OBJECTIVE: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app.
METHODS: We evaluated the original and redesigned iMHere modules-MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants\' dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred.
RESULTS: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules.
CONCLUSIONS: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles.

Introduction: Youth are among the fastest growing subset of the homeless population. Youth experiencing homelessness (YEH) face multiple barriers in accessing health information and health care services. As such, they may best be reached through information and communication technologies (ICTs); however, limited efforts have been made to synthesize literature on this topic. In this paper, we review studies on access and use of ICTs among YEH. We also discuss the implications of the review for healthcare. Methods: Using scoping review methodology, we searched four databases (Medline, Embase, PsycInfo, and CINAHL) for studies published between 2005 and 2019, screening 1,927 titles and abstracts. Results: We identified 19 articles reporting on studies with YEH between the ages of 12-30, the majority of which were published in the USA. On average, more than half of the samples owned smartphones, used social media, and accessed the internet weekly to search for housing, employment, health information, and to communicate with family, peers, and health workers; however, many youths faced barriers to sustaining their access to technology. Benefits of using ICTs were connecting with home-based peers, family, and case workers, which was associated with a reduction in substance use, risky sexual health behaviors, and severity of mental health symptoms. Connecting with negative, street-based social ties was identified as the most common risk factor to using ICTs due to its association with engaging in risky sex behaviors and substance abuse. Discussion: This review supports the advancement of research and practice on using ICTs to deliver public health information and health services to YEH, while also considering the health-related risks, benefits, and barriers that YEH face when accessing ICTs.

Mobile health (mHealth)-hand-held technologies to address health priorities-has significant potential to answer the growing need for patient chronic illness self-care interventions. Previous reviews examined mHealth effect on patient outcomes. None have a detailed examination and mapping of specific technology features to targeted health outcomes. Examine recent chronic illness mHealth self-care interventions; map the study descriptors, mHealth technology features, and study outcomes. (1) Information extracted from PubMed, CINAHL, and Web of Science databases for clinical outcomes studies published 2010-January 2020; and (2) realist synthesis techniques for within and across case analysis. From 652 records, 32 studies were examined. Median study duration was 19.5 weeks. Median sample size was 62 participants. About 47% of interventions used solely patient input versus digital input; 50% sent tailored messages versus generic messages; 22% augmented the intervention with human interaction. Studies with positive clinical outcomes had higher use of digital input. Software descriptions were lacking. Most studies built interventions: only two incorporated target audience participation in development. We recommend researchers provide sufficient system description detail. Future research includes: data input characteristics; impact of augmentation with human interaction on outcomes; and development decisions.

We investigated whether cellular phone use was associated with increased risk of tumors using a meta-analysis of case-control studies. PubMed and EMBASE were searched from inception to July 2018. The primary outcome was the risk of tumors by cellular phone use, which was measured by pooling each odds ratio (OR) and its 95% confidence interval (CI). In a meta-analysis of 46 case-control studies, compared with never or rarely having used a cellular phone, regular use was not associated with tumor risk in the random-effects meta-analysis. However, in the subgroup meta-analysis by research group, there was a statistically significant positive association (harmful effect) in the Hardell et al. studies (OR, 1.15-95% CI, 1.00 to 1.33- n = 10), a statistically significant negative association (beneficial effect) in the INTERPHONE-related studies (case-control studies from 13 countries coordinated by the International Agency for Research on Cancer (IARC); (OR, 0.81-95% CI, 0.75 to 0.89-n = 9), and no statistically significant association in other research groups\' studies. Further, cellular phone use with cumulative call time more than 1000 h statistically significantly increased the risk of tumors. This comprehensive meta-analysis of case-control studies found evidence that linked cellular phone use to increased tumor risk.

Introduction Orthopaedic surgeons choose to manage communication with their patients outside of official visits and interactions in a variety of ways, with some choosing to provide their personal cell phone number in order to provide patients with direct accessibility. The objective of this prospective study is to explore to what extent patients utilize the cell phone numbers of orthopaedic surgeons in the immediate period after it is provided to them. Methods Seven fellowship-trained orthopaedic surgeons from five different subspecialties in a single private, multi-site group each provided his/her personal cell phone number to 30 consecutive patients. The surgeon\'s phone number was written down on a business card, and the surgeons themselves provided the card to the patient. Phone calls and voice mail messages received in the 30 days following the patient receiving the phone number were recorded, and the reasons for these calls were categorized as being \"appropriate\" (e.g. acute postoperative issues, unclear instructions) or \"inappropriate\" (e.g. administrative issues, medication refills, advanced imaging-related inquires). Results Two-hundred seven patients with an average age of 51.5 years were provided cell phone numbers. During the 30 days following administration of cell phone numbers to each patient, 21 patients (10.1%) made calls to their surgeons, for an average of 0.15 calls per patient. Six patients (2.9%) called their surgeons more than once. Seventeen calls (54.8%) were deemed appropriate, while 14 calls (45.2%) were inappropriate. Logistic regression analysis did not reveal patient age, sex, type of visit, or surgeon subspecialty to be independently associated with calling. Conclusion Our study has demonstrated a low rate of patient utilization of surgeon cell phone number when provided to them. If surgeons choose to provide their cell phone number to patients, we recommend specifying appropriate reasons to call in order to maximize the effectiveness of this communication method.