The telecommunication industry is currently experiencing rapid growth on a global scale and recently in Nigeria, as a result of technological development which has enhanced the application of new information technologies and subsequently facilitated economic activities [1]. Mobile or cellular phones, ipads, ipods and android devices have become a necessity for many people globally. The ability to communicate with family, get assistance in emergencies, keep in touch with business associates, access to email are some of the reasons for the increasing importance of telecommunication equipment in developed and developing economies [2].
Mobile or cellular phones, ipads, ipods and android have gained immeasurable ground in the lives of students all over the world [3]. In many countries, half of the population use these devices and the market is growing rapidly. In 2014, the estimated global subscription was about 6.9 billion. In some parts of the world, telecommunication equipment is the most reliable or the only means of communication [4].
Closely related to the mechanism of function of telecommunication equipment is the emission of EMF by its antennae [5], classified by the International Agency for Research on Cancer as possibly carcinogenic to humans [4]. In many of the studies on EMF effects, it has been reported that people that used mobile phones, tablets, walkie-talkies, ipads, ipods, android devices for upto an hour per day for over ten years had a significantly higher risk of brain cancer, neurosis, headaches, insomnia, dizziness, an increase in stress, lower bone density, possible adverse changes in brain activity and even sub-fertility in some men [4]. It was also observed that telecommunication equipment users expose their brains to higher mean intensities [6]. In a review of 23 studies involving 37,916 people, there is evidence linking telecommunication equipment use to an increased risk of tumours, especially if the phone had been used for 10 years or more [7]. In May 2011, the World Health Organisation (WHO) [8] warned, for the first time, that telecommunication equipment may cause cancer after reviewing 21 scientific studies from 14 countries [9].
The evolution of telecommunication equipment started in the mid-1980’s with attraction of a small but reasonable number of subscribers [10]. With further development in late 1990’s, there was introduction of digital network as well as entrance of additional network providers. This in turn fuelled increase in the number of subscribers in the market [11]. It is predicted that mobile communication will become the dominant technology for telephony and other applications like internet access [12]. In 2014, the estimated global subscription was 6.9 billion and in many parts of the globe, the cell phone is the reliable or the only means of telecommunication available [3].
In Nigeria, there is an estimate of over 70 million active subscribers on record [13]. This copious use of relatively new technology brings up the question of whether there are any health implications. There are conflicting findings and reports relating to possible adverse effects on human health and this has led to some serious concerns [5]. Given the huge population of cell phone users, it is paramount to investigate, understand, evaluate and monitor any possible public health implications [14]. Therefore, with the large population of phone users, there exists the potential for health complications of epidemic proportions, indeed a causative relationship between cancer and other documented adverse effects does exist.
Telecommunication equipment is low-powered radiofrequency transmitters, which work at frequencies between 450 and 2700 MHz with peak powers ranging from 0.1 to 2 watts. The power (and hence the radiofrequency exposure to a user) drop quickly with ever-increasing distance from the cell phone [3]. Power is transmitted only when the handset is turned on [15]. Use of Telecommunication equipment (tablets, walkie-talkie, ipads, ipods, android) 30-40 cm away from their body–for example when text-messaging, browsing, or using a “hands free” device-may have a much lower dose of exposure to radiofrequency fields than someone that holds the handset against the head [16].
Young people who are quick to catch on to fads and fashionable trends and who are likely to accumulate many years of exposure to this low frequency radiation seem to be at higher risk of exposure to harmful effects of telecommunication device use. It is therefore important to understand their level of knowledge about these risks and what protective measures they employ, if any, in their day to day use of these devices. Hence, the present study was done with the aim to create awareness of the same.
Materials and Methods
A descriptive cross-sectional study was conducted from March 2017 to November 2018 to assess undergraduate students’ awareness and knowledge of the effects of EMF exposure from mobile or cellular phone use (tablets, walkie-talkie, ipads, ipods, and android), perceived susceptibility and severity of the effects of EMF exposure, perceived barriers to information on the health effects of EMF exposure, and perceived self-efficacy to mitigate the health risks associated with EMFs exposure in Enugu, south-east Nigeria.
Qualitative and quantitative techniques were used to gather data from university students. Ethical clearance was obtained from the University of Nigeria Teaching Hospital Ethical Committee (Reference No; UNTH/CSA/329/OL.5). Informed written consent was obtained from research participants before the commencement of the research.
Enugu State has a population of 3,267,837 (National Population Commission, 2006) [17]. Enugu has 23 tertiary institutions which is the highest number in eastern Nigeria. Higher institutions also consist of people from different social and geographic background which invariably confers heterogeneity and spread to the research. Administratively, Enugu State has 17 Local Government Area (LGAs).
The study population included undergraduate students of Enugu State. A random sample of 576 undergraduate students was selected from six institutions, based on one Federal University, one State University, one Private university, one Distance Learning University, one Polytechnic and one College of Education. A sample size of participants was calculated [18] and ‘n’ was calculated to be approximately 288, but a sample size of 576 undergraduate students was selected to have a better representative number of the population.
A multistage sampling technique was used to select the participants:
Stage 1: Stratification of the institutions into two categories: Universities and other tertiary institutions (Polytechnics, Colleges of Education and Monotechnics). Thus, University of Nigeria Nsukka (UNN), Enugu State University of Science and Technology (ESUT), Enugu State College of Education and Technology (ESCET), Institute of Management and Technology (IMT), Godfrey Okoye University (GOU), and National Open University of Nigeria (NOUN) were selected, respectively, in each of the categories [Table/Fig-1].
Selected institutions in Enugu State and their sample size distribution.
| Institutions in Enugu | Estimated student population | No. of faculties | Proportion of students to be selected from each institution | Number of students selected from each institution | Status |
|---|
| University of Nigeria Nsukka | 28,202 | 15 | 28202/80300×576=202.2 | 202 | Federal University |
| Enugu State University of Science and Technology | 16,236 | 7 | 16236/80300×576=117 | 117 | State University |
| Godfrey Okoye University | 2,014 | 4 | 2014/80300×576=15.4 | 15 | Private University |
| National Open University of Nigeria | 1,985 | 4 | 1985/80300×576=14.2 | 14 | Open and Distance Learning University |
| Institute of Management and Technology | 30,000 | 6 | 30000/80300×576=215.1 | 215 | Polytechnic |
| Enugu State College of Education Technology | 1,863 | 6 | 1863/80300×576=13.3 | 13 | College of Education |
| Total | 80,300 | 42 | | 576 | |
Stage 2: The selection of faculties was by simple random sampling. Three faculties were selected from each of the institutions. The basis of the choice of faculty was to get representation from different fields of study: social sciences, arts and biological/physical sciences.
The variables measured included certain socio-demographic characteristics such as age, gender, educational level, and years of cell phone usage. Other measures included awareness and knowledge, perceived susceptibility and severity, perceived barriers, perceived self-efficacy and mitigation of risk.
Measures
The major independent variables in the study were the demographic variables, predisposing factors such as levels of knowledge, awareness and all perception sub-variables. The dependent variables included practices and precautionary measures/risk reduction strategies.
A structured interviewer self-administered survey questionnaire was used to collect data from undergraduate students who used mobile phone. In addition, focus group discussions and in-depth interviews were conducted to gain qualitative understanding of perceived susceptibility, severity, barriers to the problem and perceived ability to carry out the recommended actions relating to telecommunication EMF.
Two data collection instruments were used for this study: 1) The first was the focus group discussion (FGD). The FGDs and in-depth interviews were conducted with carefully developed FGD/in-depth interview guide which contained diagnostic questions on some of the issues raised in the questionnaire study. This provides in-depth understanding on the socio-cultural risk factors of the people with respect to issues that affect the contacting of radiation from wireless telecommunication equipment. The focus group implemented was to uncover the experience, views and interpretation of events related to wireless telecommunication equipment user practices. Finding from the focus group discussions were incorporated in the development of the survey questionnaire.
2) The second was survey questionnaire. Section A covered demographic characteristics of the participants (gender, age, ethnicity, educational level, course of study, number of phones). Section B focused on knowledge and awareness of cell phone EMF effects.
The questionnaire has been attached as an [Appendix].
Section C was on cell phone use. Section D was tailored to the component of the HBM framework. The health believe model entails, perceived susceptibility to EMF risks, perceived severity, perceived barrier and perceived benefits of adhering to precautions [19].
The Likert scale format with four response categories was used to elicit responses to the questions in the perception domain. The Telecommunication equipment Problem Usage Scale was reviewed and relevant sections adapted for this study [20]. The validity of the contents of the questionnaire and FGD was strengthened through review of literature and structured based on the objectives identified for the study and conceptual framework of the HBM. Furthermore, review of the instrument by colleagues was extensively undertaken to provide face validity. The reliability of the result of the questionnaire was ensured by assuring respondents that their status will be anonymous giving them freedom to answer the questions sincerely. The questions were in simple clear English language to avoid ambiguity.
Data Collection
a. Quantitative data
A uniform set of questionnaire was administered to undergraduate students from six selected tertiary institutions. The questionnaire sought information on the socio-demographic (background) characteristics of the respondents, knowledge and awareness, perceived susceptibility and severity, perceived barriers, perceived self-efficacy and mitigation of risk (HBM Frame work).
To ensure uniformity in the interpretation of concepts and recording of responses, the questionnaire was administered on one on one basis interviews with all the respondents. For this purpose, field assistants were recruited and trained for three days on the objectives and methods of the study.
b. Qualitative data
FGDs were conducted with 6-8 persons in a group in their classroom by the researcher and trained research assistants. The discussion was held with undergraduate males and females for 10 minutes and a note-taker was on hand to record important non-verbal expressions and reactions to issues raised by the facilitators of the FGDs. A total of twelve FGDs for six tertiary institutions were conducted in all (two per category of discussants and ensured information).
Statistical Analysis
Data analysis was conducted using the statistical package SPSS version 14. Computation involved frequency distributions, summaries of descriptive statistics, p-value of the Chi-square test and Correlation coefficient (2-tailed) at 0.05 level of significance was measured.
Results
A total of 576 undergraduate students from six tertiary institutions in Enugu State, Eastern Nigeria were recruited for the study. Out of 576 respondents, 82.2% carried their telecommunication equipment close to the body. Also, significant number of the respondents understood the meaning of EMF as a wave (34.1%), transmission of energy through space or material medium (34.8%) but about 6.1% of respondents still believed that EMF is a dangerous spell from evil spirit.
This study showed that 93.4% of the respondents were relatively addicted to their telecommunication equipment. It also showed that majority (46.5%) of the respondents had one telecommunication equipment. The study showed a higher percentage of 53.5% having more than one telecommunication equipment which translates to more exposure. Majority of the respondents 14.7% got the information about radiation from the internet and minority from health professional house visit (1.0%) and general practioners (6.5%).
A total of 576 undergraduate students were recruited for the study, 43.2% were males and 56.8% were females. The majority (84.2%) of the respondents were singles. A total of 91.3% of the respondents were Christians, 4.9% Muslims and 3.8% Traditional practitioners [Table/Fig-2].
Socio demographic characteristics.
| Factors | N | % |
|---|
| Gender |
| Female | 327 | 57% |
| Male | 249 | 43% |
| Age group |
| Less than 15 years | 2 | 0.3% |
| 15-18 years | 110 | 19.1% |
| 19-24 years | 351 | 60.9% |
| 25-30 years | 85 | 14.8% |
| 31-35 years | 27 | 4.7% |
| Above 35 years | 1 | 0.2% |
| Marital status |
| Single | 485 | 84.2% |
| Married | 78 | 13.5% |
| Divorce | 10 | 1.7% |
| Separated | 3 | .5% |
| Religion |
| Christianity | 526 | 91.3% |
| Islam | 28 | 4.9% |
| Traditional | 22 | 3.8% |
In the study, out of 576 respondents recruited, 23.1% used their telecommunication equipment for less than 30 minutes daily while 17% used it for 30-60 minutes, 15.5% for 61-90 minutes. As much as 44.4% used theirs for more than 90 minutes daily [Table/Fig-3] while relatively less (40.1%) do significant texting, which is safer.
Daily telecommunication equipment use by institution.
| How can you rate your daily telecommunication equipment use | Institution | Total |
|---|
| ESUT | IMT | UNN | ESCET | GOU | NOUN |
|---|
| Less than 30 min% within institution | 17.9% | 29.8% | 15.3% | 23.1% | 66.7% | 28.6% | 23.1% |
| 30-60 min% within institution | 23.9% | 12.6% | 15.3% | 23.1% | 20% | 42.9% | 17% |
| 61-90 min% within institution | 18.8% | 12.1% | 18.3% | 15.4% | 6.7% | 7.1% | 15.5% |
| More than 90 min% within institution | 39.3% | 45.6% | 51.0% | 38.5% | 6.7% | 21.4% | 44.4% |
| Total | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
About 50% of respondents had used their phone for more than 2 years [Table/Fig-4].
Percentage of duration the respondents had been using telecommunication equipment.
| Percentage of duration the respondents have been using telecommunication equipments | Institution | Total |
|---|
| ESUT | IMT | UNN | ESCET | GOU | NOUN |
|---|
| Less than one month% within institution | 0.9% | 6.5% | 1% | Nil | 6.7% | 14.3% | 3.5% |
| 1 month-1 year% within institution | 41% | 61.4% | 42.1% | 23.1% | 40% | Nil | 47.60% |
| 2-4 years% within institution | 25.6% | 14.4% | 14.4% | 30.8% | 6.7% | 42.9% | 17.5% |
| 5-7 years% within institution | 16.2% | 9.3% | 6.9% | 23.1% | 13.3% | 14.3% | 10.4% |
| 8-10 years% within institution | 16.2% | 5.6% | 35.6% | Nil | 33.3% | 21.4% | 19.3% |
| More than 10 years% within institution | Nil | 2.8% | Nil | 23.1% | Nil | 7.1% | 1.7% |
| Total | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
It was observed that majority used their telecommunication equipment in full bar (60%) [Table/Fig-5].
Analysis of signal strength of telecommunication equipment used by the respondents
| Signal strength of telecommunication equipment used by the respondent | Percentage (%) |
|---|
| Full (Four) bars | 60% |
| Three bars | 24% |
| Two bars | 11.3% |
| One bars | 4.7% |
| Zero bar | Nil |
| Total | 100% |
About 46% of respondents were concerned about the radiation effects from their telecommunication equipment [Table/Fig-6].
How worried in getting radiation from their telecommunication equipment.
| How worried in getting radiation from their telecommunication equipment? | Institution | Total |
|---|
| ESUT | IMT | UNN | ESCET | GOU | NOUN |
|---|
| Very much worried% within institution | 52.1% | 56.3% | 30.2% | 46.2% | 46.7% | 50% | 45.7% |
| A little worried% within institution | 33.3% | 34% | 34.7% | 30.8% | 40% | 21.4% | 33.9% |
| Not worried at all% within institution | 14.5% | 9.8% | 35.1% | 23.1% | 13.3% | 28.6% | 20.5% |
| Total | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
There was a significant relationship between student’s perception and pattern of EMF and their gender [Table/Fig-7].
Relationship between Students’ Perceptions of EMF and their gender using Chi-square test.
| Responses to questionnaire | Gender | Total |
|---|
| Male | Female |
|---|
| Perception and Pattern of EMF | Strongly disagree | Count | Nil | 92 | 92 |
| Expected count | 52.2 | 39.8 | 92 |
| % within gender | Nil | 36.9% | 16% |
| Disagree | Count | 1 | 104 | 105 |
| Expected count | 59.6 | 45.4 | 105 |
| % within gender | 0.3% | 41.8 | 18.2 |
| Neutral | Count | 95 | 44 | 139 |
| Expected count | 78.9 | 60.1 | 139 |
| % within gender | 29.1% | 17.7% | 24.1% |
| Agree | Count | 151 | 9 | 160 |
| Expected count | 90.8 | 69.2 | 160 |
| % within gender | 46.2% | 3.6% | 27.8% |
| Strongly agree | Count | 80 | Nil | 80 |
| Expected count | 45.4 | 34.6 | 80 |
| % within gender | 24.5% | Nil | 13.9% |
| Total | | Count | 327 | 249 | 576 |
| Expected count | 327 | 249 | 576 |
| % within gender | 100% | 100% | 100% |
| Analysis | Value | df | p-value |
|---|
| Pearson Chi-square | 414.820a | 4 | <0.001 |
| Likelihood ratio | 533.787 | 4 | <0.001 |
| Linear-by-linear association | 365.569 | 1 | <0.001 |
| N of valid cases | 576 | | |
a0 cells (.0%) have expected count less than 5. The minimum expected count is 34.58
In the study, there was a significant relationship between perception of EMF risks and students’ level in school (p=0.003). This implies that perception of EMF risks varies with the year of study, which may be explained by increased exposure to information with longer stay in school [Table/Fig-8].
Relationship between students perception of EMF risk and students level in school (Year of study).
| Perception of EMF risk and students level | Level (Year of study) | Total |
|---|
| 100 level | 200 level | 300 level | 400 level |
|---|
| Strongly disagree % within level | 14.3% | 17.9% | 10.5% | 24.8% | 16% |
| Disagree % within level | 14.3% | 21.4% | 18.4% | 17.8% | 18.2% |
| Neutral % within level | 21.4% | 17.9% | 23.8% | 25.7% | 24.1% |
| Agree % within level | 42.9% | 28.6% | 29.2% | 24.3% | 27.8% |
| Strongly agree % within level | 7.1% | 14.3% | 18.1% | 7.4% | 13.9% |
| Total | 100% | 100% | 100% | 100% | 100% |
p=0.003
The faculty of medical lab and health administration/mgt had the highest level of awareness while Biological sciences had the least level of awareness [Table/Fig-9].
Chi-square test for relationship between Awareness and Faculty (Discipline of study).
| How much do you know about telecommunication equipment radiation? | | Faculty | Total |
|---|
| Biological sciences | Political science and Business admin | Medical lab and Health admin/Mgt | Accounting and library education | Social sciences | Law |
|---|
| Nothing At All | 22.2% | 15.3% | 7.4% | 7.7% | Nil | 7.1% | 13.2% |
| A little | 38.5% | 42.3% | 37.1% | 61.5% | 66.7% | 42.9% | 40.8% |
| Neutral | 12.8% | 7.9% | 11.4% | 23.1% | 20.0% | 35.7% | 11.5% |
| Much | 18.8% | 18.1% | 17.3% | 7.7% | 6.7% | 7.1% | 17.2% |
| Very much | 7.7% | 16.3% | 26.7% | Nil | 6.7% | 7.1% | 17.4% |
| Total | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
p=0.0001
The correlation coefficient is 0.806 and the p-value <0.05 shows that there is a high positive relationship between risk reduction strategies and level of awareness among students [Table/Fig-10].
Correlation between risk reduction strategies and level of awareness among students.
| Correlations |
|---|
| Self efficacy 2 | Level of awarness of EMF |
|---|
| Self efficacy 2 | Pearson correlation | 1 | 0.806** |
| p-value | | <0.001 |
| N | 576 | 576 |
| Level of awarness of EMF | Pearson correlation | 0.806** | 1 |
| p-value | <0.001 | |
| N | 576 | 576 |
**Correlation is significant at the 0.01 level (2-tailed)
Discussion
With increased use of telecommunication equipment in the developing countries like Nigeria, there is a great concern over the adverse effects of the EMF. This becomes particularly worrisome because all the respondents in the study possessed at least one telecommunication equipment. This also supports the NCC data that there are 145 million active subscriptions in Nigeria with a population of 190 million [13]. A similar study done in Saudi Arabia [9] shows that 77% had one telecommunication equipment as 23% had more than one. In contrast, the study showed a higher percentage of 53.5% having more than one telecommunication equipment which translates to more exposure.
Interestingly, majority of respondents (about 93.9%) got the proper definition of EMF while few 6.1% believe it to be a spell from evil spirit. This higher level of knowledge may not be unconnected to the high level of education of the respondents compared to the general public. Majority of the respondents 14.7% got the information about radiation from the internet and minority from health professional house visit (1.0%) and general practitioners (6.5%). This implies that the respondents’ information might be wrong because the major source (internet) does not create room for interactions and questions unlike the information obtained directly from health professionals’ visit and general practioners whereby the respondents would be opportune to interact and also ask question on one on one basis.
This result showed a higher percentage 59.9% use their telecommunication equipment for making calls as against 40.1% that do more of texting. It therefore implies that there is high exposure to EMF because in texting the phone is about 15 cm away from the body unlike phone calls in which there is close contact to the body.
This study showed that 93.4% of the respondents were relatively addicted to their telecommunication equipment because they claimed they can’t do without their telecommunication equipment and they spent at least 90 minutes on calls daily. This is more than the study by Khan MM in which 27.5% were addicted to their telecommunication equipment [21].
The duration of the use of telecommunication equipment was much higher in our respondent that is 44.4% for more than 90 minutes as against 5% in Saudi Arabian medical students [9]. The more usage by the respondents in this study may be due to a wider cross section of students as against only medical students in Saudi Arabian who by reason of their course of study should be exposed to more health related information.
About half of the respondents have had telecommunication equipment for less than 1 year while just less than 50% have had it for 2-10 years. This is relatively small compared to that of the study done by Huber R et al., in which 75% of the children between 7-15 years already own telecommunication equipment [22]. This invariably translates to less exposure for our respondents.
About 60% of the respondents make use of their telecommunication equipment when signal strength is the strongest (Full Bar). This means that since signal strength is inversely proportional to emissions, a greater part of the respondents are relatively safe from EMF effects. It is alarming to note that up to 54% of the respondents showed little or no concern about the radiation effects of telecommunication equipment in spite of their high level of education compared to the general population. This implies that a lot of awareness needs to be inculcated.
The study also showed that there was a significant relationship between students’ perception and pattern of EMF and their gender. This is particularly important because Sandrini L et al., observed that the specific absorption rate (WBA-SAR) of female is more than that of the male because of a thicker subcutaneous fat layer [23].
The study showed high positive correlation coefficient(r) relationship between risk reduction strategies and level of awareness among students (0.806 and the p-value <0.05), awareness of susceptibility of effects of EMF (0.950 and the p-value <0.05.) and awareness of severity (0.931 and the p-value <0.05). This implies that with improved education on adverse health effects of telecommunication equipment, respondents are more likely to take steps to mitigates of risk.
For the HBM perceived susceptibility and perceived benefit, the study showed that the overall mean rating of the respondents with regards to perceived susceptibility is (2.97) and perceived benefit (2.9395) is below the criterion mean of 3.0. This implies that most of the respondents do not perceive themselves as being susceptible to radiation as well as perceived benefit.
The significant correlation between level of awareness and risk reduction strategies among students implies that there is willingness to change behaviour to reduce risk of EMF exposure. Therefore, effort should be made by all stake holders to properly educate the populace so as to mitigate the risk as shown by this study.
Limitation(s)
The study was carried out among the educated class who by inference are exposed to more information; their response may not give a true picture of the general population that are illiterates.
Conclusion(s)
Undergraduate students are one of the active users of telecommunication equipment with all the students having at least one form or the other. Even though they have higher level of education exposure compared to the general population, they still show little or no concern about the radiation effects. The situation is made worse by their high level of addiction which translates to more exposure. This implies that there is a lot of awareness that needs to be created. The HBM is therefore an ideal model to evaluate and manage radiation risk associated with use of EMF equipment. Its recommended to carry out a similar research on telecommunication equipment producers and wireless network providers and compare with the view from the present study for a more comprehensive evaluation.
a0 cells (.0%) have expected count less than 5. The minimum expected count is 34.58p=0.003p=0.0001**Correlation is significant at the 0.01 level (2-tailed)