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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 4  |  Page : 540-546

Prevalence of text neck syndrome in children and adolescents using smartphones in Erbil city


Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq

Date of Submission10-Jul-2022
Date of Acceptance03-Aug-2022
Date of Web Publication09-Jan-2023

Correspondence Address:
Areen Nimat Aziz
Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_110_22

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  Abstract 

Background: Neck and shoulder pain is a common health issue among children and teenagers in developing countries. Objective: This study aimed to identify the prevalence of text neck syndrome and its associated factors in children and adolescents. Materials and Methods: In this cross-sectional study, children and adolescents who attended primary health centers (PHCs) along with their parents were included. Four main PHCs in Erbil city in Iraqi Kurdistan in 2022 were selected for this study. Results: The prevalence of text neck pain was 69.0% among children. The level of neck disability score was 17.15 out of 21 among children. Adolescents (96.05%) those who used smartphones >3 h (83.56%), those studying secondary level (94.24%), and those with psychological, social, and physical functions and children who slept less, played fewer sports, used more computers, watched more TV, and played the game more than 3 h were more likely to have text neck syndrome. The study showed that children who spent more time on smartphones, watching TV, playing games, and those with physical and social functions had a high level of neck disability. Conclusion: This study found a high prevalence of text neck syndrome among schoolchildren in this region. The high prevalence of text neck syndrome was associated with more using smartphones and watching TV and a high prevalence of physical, psychological, and social issues.

Keywords: Children, neck pain, text neck syndrome


How to cite this article:
Aziz AN, Bakir LA. Prevalence of text neck syndrome in children and adolescents using smartphones in Erbil city. Med J Babylon 2022;19:540-6

How to cite this URL:
Aziz AN, Bakir LA. Prevalence of text neck syndrome in children and adolescents using smartphones in Erbil city. Med J Babylon [serial online] 2022 [cited 2023 Feb 6];19:540-6. Available from: https://www.medjbabylon.org/text.asp?2022/19/4/540/367320




  Introduction Top


Neck and shoulder pain is a medical condition. It is a relatively mild musculoskeletal condition mostly found among children.[1] Neck pain has become a major health issue among the general population. It has a high burden on the individuals and community.[2],[3],[4] Based on the World Health Organization (WHO), neck pain and other musculoskeletal diseases are considered to be the 4th and 10th health issues, respectively.[5]

“Text neck syndrome” has become an emerging public health issue of the twenty-first century. The clinical condition of text neck syndrome is degeneration of the cervical spinal. The text neck syndrome is caused by repeated stress of forwarding head flexion. This condition happens when someone watches screens of mobile devices and performs texting for a long time.[6] This condition is more commonly observed among adolescents because they spend several hours watching mobile phones and computers.[7] It is projected that close to 75% of the populations across the world have hand devices and use them daily. The population flexes their heads forwards when using electronic devices.[8]

It is estimated that the prevalence of neck pain in the general population is from 0.4% to 86.8%.[9] Based on the Global Burden of Disease, neck pain is one of the main factors contributing to years of disability in adolescents aged between 15 and 19 years.[10] Neck and shoulder pain are common health issues in children and teenagers in developing countries.[11],[12] The rates of neck pain are different among the general population: 3.3% in Thailand, 22.7% in Canada, 10.5% in Belgium, 22.0% in Austria, 31.8% in Spain, 66.3% in Sweden, 30.2% in Norway, and 3.5% in China.[9]

There are several epidemiological studies about risk factors, burden, and management of musculoskeletal pain in adult populations. But there is little information about the epidemiology of text neck syndrome among adolescents. Several studies have mentioned the lack of data about text neck syndrome among children and adolescents.[13],[14],[15] Children and adolescents who have persistent pain have an elevated risk of chronic pain as adults.[16],[17]

The risk factors reported in the literature for neck pain are lifestyle, psychological, physical, and social factors, and inappropriate sitting.[18],[19],[20] Neck pain in children is a risk factor for health issues during adulthood.[21],[22] Therefore, it is important to detect the prevalence of neck pain and manage it during childhood and adolescence to avoid such kinds of issues. Because this issue in childhood is associated with health profiles during adulthood, we need to identify the contributed factors to neck pain among children.[23] This study aimed to identify the prevalence of text neck syndrome and its associated factors among children and adolescents.


  Materials and Methods Top


Study design and population

The children and adolescents who attended the primary health center (PHC) along with their parents were included in this cross-sectional study. Four main PHCs in Erbil city in Iraqi Kurdistan were selected for the study purpose. The children were selected from the following four PHCs; Shadi, Birayeti, Nawrooz, and Azadi between December 2021 and March 2022.

Population and sampling

The population of the study was schoolchildren studying in a primary and secondary school in Erbil city. The population had different ages and gender and socio-demographic characteristics. The sampling was performed using a non-probability technique.

The sample size was determined using the Cochran formula. The required sample size was estimated based on the estimated population made for this study. We expected that 20 children attend each PHC in a week. The total number of expected children who visited the PHC was 4160 in a year for this study. The required sample size was 352 based on the Cochran formula. But we increased the sample size to compensate for the missing information and possibly rejection. The children were included between December 2021 and March 2022.

Inclusion and exclusion criteria

The children and adolescents aged 5–15 years of both genders who attended the PHCs were included in this study. We excluded the children whose parents did not give their consent and were not included in this study. The patients with chronic diseases were excluded from the study. The researcher documented the chronic diseases by asking the students’ parents.

Data collection

The data were collected through direct interviews after obtaining verbal and written approval from the parents. A structural questionnaire was used to interview the participants. The questionnaire consists of two parts: Part 1: including sociodemographic data such as age and education and Part 2: signs and symptoms related to smartphone users such as headache, neck pain, shoulder stiffness, eyesight issues, and sleeping disturbance.

Measurement tool

The level of neck function disability was measured using the “Copenhagen Neck Functional Disability Scale.” This scale is used to measure the disability experienced by patients and individuals with neck pain. The scores obtained from this scale can be used to evaluate the changes over time. The scale has 15 items rated as yes, occasionally, or no. The following numbers are given to the items 1–5 and 13–15 (0 for yes, 1 for occasionally, and 2 for no). The negative items 6–12 were rated as 2 for yes, 1 for occasionally, and 0 for no. The numbers were added together to obtain the score of neck function disability (from 0 to 30). On this scale, the higher the score means the greater the disability.[24]

Statistical analysis

We presented the general information of children in mean (SD) or number (%). The prevalence of text neck syndrome and its effects and symptoms were determined in number and %. The association of text neck syndrome with sociodemographic characteristics was examined in a Pearson’s χ2 test. The comparisons of the level of neck disability in children with different characteristics were examined using an independent t-test or one-way analysis of variance (ANOVA) test. A P-value less than 0.05 was used to determine the significant level of difference. JMP Pro 14.3.0 was used to calculate the statistical calculations.

Ethical consideration

The research health ethics of the College of Medicine/Hawler Medical University approved the protocol of this study. In addition, we obtained approval from the Erbil Directorate of the Heath. We protected the confidentiality of the personal information, according to the instruction of the Health Ethics Committee. We obtained the written consent of parents before data collection based on the Declaration of Helsinki. The study protocol and the subject information and consent form were reviewed and approved by the Research Ethics Committee of College of Medicine/Hawler Medical University, according to document number 23 (including the number and the date on 27/06/2022) to get this approval.


  Results Top


The mean age of the children is 10.79 between 6 and 15 years. The children were males (56.25%) and females (43.75%). More than half of the children (56.25%) reported that they used smartphones for more than 3 h. The children had primary (65.25%) and secondary levels of school [34.75%; [Table 1]].
Table 1: Basic characteristics of schoolchildren

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The children reported pain in different areas and only 28.75% of them reported no pain. The children reported different effects, children’s eye symptoms, psychological effects, and social effects. We found that 50.25% of children slept 6–8 h. The children used the computer for 1–3 h (79.50%), played games for 1–3 h (89.50%), and watched TV for 1–3 h (84.0%) per day. The prevalence of text neck pain was 69.0% among children [Table 2]. The level of neck disability score was 17.15 of 21 among children in this study. The frequencies of neck disability issues were reported in [Table 3].
Table 2: Prevalence, symptoms, and effects of text neck syndrome among school children

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Table 3: Prevalence of neck disability issues among schoolchildren

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The study showed that adolescents (96.05%) who used smartphones for more than 3 h (83.56%), those studying secondary level (94.24%), and those with psychological, social, and physical dysfunctions were more likely to have text neck syndrome. The children who slept less, played fewer sports, used more computers, watched more TV, and played video games for more than 3 h were more likely to have text neck syndrome [Table 4].
Table 4: Prevalence of text neck syndrome in children with different characteristics and symptoms

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The study showed that the children who spent more time on smartphones, watching TV, video games, and those with dysfunction had high levels of neck disability [Table 5].
Table 5: Comparisons of level of neck disability in children with different characteristics

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  Discussion Top


This study found that the prevalence of text neck text syndrome is so high with a high neck disability in this region. The study showed that the high text neck syndrome is associated with being adolescents, more using smartphones, and watching more TV and computers. In addition, the children with text neck syndrome were more likely to have more adverse effects.

The studies conducted in other regions of the world have reported different prevalence rates of text neck syndrome. The low-income countries have reported a prevalence similar to our study. For example, one of these studies reported that the prevalence of text neck syndrome is between 35.8% and 30.9% for neck and shoulder pain, respectively, over a month. It is lower than the prevalence reported in the current study. The main difference between our study and their study is that they reported different sociodemographic factors related to neck syndrome. They reported that the factors associated with the severity of text neck syndrome were very high: desk height, backward seat pan inclination, forward seat pan inclination, difficulty in viewing the board, too much homework, and rapid upper limbs assessment.[25] A study from Saudi Arabia reported the high prevalence as 68.1% including mild (49.5%), moderate (16.1%), and severe neck disabilities (2.6%). They reported that high neck disability among the population is highly associated with smartphone use.[26] Similar prevalence rates of text neck have been reported in other studies as well.[6],[7],[27],[28]

The text neck syndrome is a common health issue among children. In agreement with the current study, Fares et al.[6] reported that factors related to neck pain are watching television and using smartphones, strong flexion of the neck during studying, sitting, and using other smart devices.

The natural course of neck pain among children aged 9–12 years was evaluated and followed up for 4 years by a study. At baseline, 1756 schoolchildren filled out the questionnaire about musculoskeletal pain symptoms, psychological symptoms, and physical activity frequency. The re-evaluation was performed following 1 and 4 years. They mentioned that 24% reported no neck pain, 71% reported fluctuating, and 5% reported persistent weekly neck pain at the following-up time. The persistent course of neck pain was observed among children with weekly musculoskeletal and/or other physical and psychological symptoms at baseline. They concluded that the neck pain among children fluctuated mostly. But accompanied with other musculoskeletal symptoms and/or markers of psychological stress increases the risk of neck pain toward the persistent course.[29]

Further, sleeping hours has a significant impact on neck pain among children. The effects of sleep posture on neck muscle activity have been reported in other studies as well. For example, a study recruited 20 healthy persons in three different supine positions, including both hands at the sides, both hands on the chest, and the dominant hand on the forehead. They measured the activities of scalene and upper trapezius muscles bilaterally using surface electromyography. They reported that upper trapezius and scalene muscle activity on the right side is significantly higher in the supine position with the dominant hand in the forehand position. Therefore, sleeping posture affects neck and shoulder musculoskeletal pain.[30] In addition, inadequate sleeping hours and low-sleep quality have been shown to act as independent risk factor for neck and low back pain.[31]

The current study showed that text neck syndrome is a risk factor for eye symptoms. Children with neck pain had a strained eye, a common symptom in the eye during text neck syndrome. In contrast, patients with dry eyes were impacted by text neck syndrome, and they felt pain while they closed or opened their eyes. Some patients had dry and strained eyes, whereas others had neck pain. This symptom was available in children with neck pain and another musculoskeletal disease. Patients with no eye symptoms also had neck pain. But compared with other patients, their pain was minor. Most patients with eye symptoms experience more than 3 h of playing games, watching TV, and using smartphones daily. So, this affects their eyes immediately.

Other studies have reported similar health issues related to neck pain. For instance, a study reported that the children had flawed flexion of their back and neck during studying and/or using smartphones, tablets, and computers. Importantly, 21% reported eye symptoms and their parents reported the alteration in the psychological and social behavior of their children.[6] Text neck syndrome is a common issue among teens and adolescents who spend more time on smartphones.[32] It is projected that 75% of the world’s population spends hours daily on smart devices.[8] In our study, 56.25% of the children who participated in this study reported that they spend more than 3 h daily on smartphones. When children use smartphones, they tilt their heads over reading and texting on smartphones or handling devices estimated between 1825 and 2555 h a year. Excessive stress is found in the cervical spine area.[33]

Limitations

The findings of this study must be interpreted in the inherence of the study design and sampling technique as we could not collect the sample from the school due to daily work of the researchers in PHCs. However, it can present a fraction of the population studying in school.


  Conclusions Top


This study found a high prevalence of text neck syndrome among schoolchildren in this region. The high prevalence of text neck syndrome was associated with using more smartphones and watching TV and had a high prevalence of physical, psychological, and social issues. It is recommended that the children’s use of smartphones and TV be limited to a few hours to alleviate the physical, psychological, and social-related issues.

Acknowledgments

We would like to present our deep thanks to the participants and parents of the children.

Financial support and sponsorship

No funding was received for this study.

Conflicts of interest

The authors do not claim any conflict of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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