Imperial College London

Professor Mireille B Toledano

Faculty of MedicineSchool of Public Health

Mohn Chair; Population Child Health & Director-Mohn Centre



m.toledano Website




525Medical SchoolSt Mary's Campus





Publication Type

134 results found

Clark S, Alli AS, Ezzati M, Brauer M, Toledano M, Nimo J, Bedford Moses J, Baah S, Hughes A, Cavanaugh A, Agyei-Mensah S, Owusu G, Robinson B, Baumgartner J, Bennett J, Arku Ret al., 2022, Spatial modelling and inequalities of environmental noise in Accra, Ghana, Environmental Research, Vol: 214, ISSN: 0013-9351

Noise pollution is a growing environmental health concern in rapidly urbanizing sub-Saharan African (SSA) cities. However, limited city-wide data constitutes a major barrier to investigating health impacts as well as implementing environmental policy in this growing population. As such, in this first of its kind study in West Africa, we measured, modelled and predicted environmental noise across the Greater Accra Metropolitan Area (GAMA) in Ghana, and evaluated inequalities in exposures by socioeconomic factors. Specifically, we measured environmental noise at 146 locations with weekly (n = 136 locations) and yearlong monitoring (n = 10 locations). We combined these data with geospatial and meteorological predictor variables to develop high-resolution land use regression (LUR) models to predict annual average noise levels (LAeq24hr, Lden, Lday, Lnight). The final LUR models were selected with a forward stepwise procedure and performance was evaluated with cross-validation. We spatially joined model predictions with national census data to estimate population levels of, and potential socioeconomic inequalities in, noise levels at the census enumeration-area level. Variables representing road-traffic and vegetation explained the most variation in noise levels at each site. Predicted day-evening-night (Lden) noise levels were highest in the city-center (Accra Metropolis) (median: 64.0 dBA) and near major roads (median: 68.5 dBA). In the Accra Metropolis, almost the entire population lived in areas where predicted Lden and night-time noise (Lnight) surpassed World Health Organization guidelines for road-traffic noise (Lden <53; and Lnight <45). The poorest areas in Accra also had significantly higher median Lden and Lnight compared with the wealthiest ones, with a difference of ∼5 dBA. The models can support environmental epidemiological studies, burden of disease assessments, and policies and interventions that address underlying causes of noise exposure ineq

Journal article

Schmutz C, Burgler A, Ashta N, Soenksen J, Karim YB, Shen C, Smith RB, Jenkins RH, Mireku MO, Mutz J, Maes MJA, Hirst R, Chang I, Fleming C, Mussa A, Kesary D, Addison D, Maslanyj M, Toledano MB, Roosli M, Eeftens Met al., 2022, Personal radiofrequency electromagnetic field exposure of adolescents in the Greater London area in the SCAMP cohort and the association with restrictions on permitted use of mobile communication technologies at school and at home, Environmental Research, Vol: 212, ISSN: 0013-9351

Personal measurements of radiofrequency electromagnetic fields (RF-EMF) have been used in several studies to characterise personal exposure in daily life, but such data are limitedly available for adolescents, and not yet for the United Kingdom (UK). In this study, we aimed to characterise personal exposure to RF-EMF in adolescents and to study the association between exposure and rules applied at school and at home to restrict wireless communication use, likely implemented to reduce other effects of mobile technology (e.g. distraction).We measured exposure to RF-EMF for 16 common frequency bands (87.5 MHz–3.5 GHz), using portable measurement devices (ExpoM-RF), in a subsample of adolescents participating in the cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP) from Greater London (UK) (n = 188). School and home rules were assessed by questionnaire and concerned the school's availability of WiFi and mobile phone policy, and parental restrictions on permitted mobile phone use. Adolescents recorded their activities in real time using a diary app on a study smartphone, while characterizing their personal RF-EMF exposure in daily life, during different activities and times of the day.Data analysis was done for 148 adolescents from 29 schools who recorded RF-EMF data for a median duration of 47 h. The majority (74%) of adolescents spent part of their time at school during the measurement period. Median total RF-EMF exposure was 40 μW/m2 at home, 94 μW/m2 at school, and 100 μW/m2 overall. In general, restrictions at school or at home made little difference for adolescents’ measured exposure to RF-EMF, except for uplink exposure from mobile phones while at school, which was found to be significantly lower for adolescents attending schools not permitting phone use at all, compared to adolescents attending schools allowing mobile phone use during breaks. This difference was not statistically significant for total personal exposure.Total ex

Journal article

Vu TV, Stewart GB, Kitwiroon N, Lim S, Barratt B, Kelly FJ, Thompson R, Smith RB, Toledano MB, Beevers SDet al., 2022, Assessing the contributions of outdoor and indoor sources to air quality in London homes of the SCAMP cohort, Building and Environment, Vol: 222, Pages: 1-8, ISSN: 0360-1323

Given that many people typically spend the majority of their time at home, accurate measurement and modelling of the home environment is critical in estimating their exposure to air pollution. This study investigates the fate and impact on human exposure of outdoor and indoor pollutants in London homes, using a combination of sensor measurements, outdoor air pollution estimated from the CMAQ-urban model and indoor mass balance models. Averaged indoor concentrations of PM2.5, PM10 and NO2 were 14.6, 24.7 and 14.2 μg m−3 while the outdoor concentrations were 14.4, 22.6 and 21.4 μg m−3, respectively. Mean infiltration factors of particles (0.6–0.7) were higher than those of NO2 (0.4). In contrast, higher loss rates were found for NO2 (0.5–0.8 h−1) compared to those for particles (0.1–0.3 h−1). The average concentrations of PM2.5, PM10 and NO2 in kitchen environments were 22.0, 33.7 and 20.8 μg m−3, with highest hourly concentrations (437, 644 and 136 μg m−3, respectively) during cooking times (6–7 pm). Indoor sources increased the indoor concentrations of particles and NO2 by an average of 26–37% in comparison to the indoor background level without indoor sources. Outdoor and indoor air exchange plays an important role in reducing air pollution indoors by 65–86% for particles and 42–65% for NO2.

Journal article

Girela Serrano BM, Spiers A, Ruotong L, Gangadia S, Toledano MB, Di Simplicio Met al., 2022, Impact of mobile phones and wireless devices use on children and adolescents´ mental health: a systematic review, European Child and Adolescent Psychiatry: official journal of the European Society for Child and Adolescent Psychiatry, ISSN: 1018-8827

Growing use of mobiles phones (MP) and other wireless devices (WD) has raised concerns about their possible effects on children and adolescents’ wellbeing. Understanding whether these technologies affect children and adolescents’ mental health in positive or detrimental ways has become more urgent following further increase in use since the COVID-19 outbreak. To review the empirical evidence on associations between use of MP/WD and mental health in children and adolescents. A systematic review of literature was carried out on Medline, Embase and PsycINFO for studies published prior to July 15th 2019, PROSPERO ID: CRD42019146750. 25 observational studies published between January 1st 2011 and 2019 were reviewed (ten were cohort studies, 15 were cross-sectional). Overall estimated participant mean age and proportion female were 14.6 years and 47%, respectively. Substantial between-study heterogeneity in design and measurement of MP/WD usage and mental health outcomes limited our ability to infer general conclusions. Observed effects differed depending on time and type of MP/WD usage. We found suggestive but limited evidence that greater use of MP/WD may be associated with poorer mental health in children and adolescents. Risk of bias was rated as ‘high’ for 16 studies, ‘moderate’ for five studies and ‘low’ for four studies. More high-quality longitudinal studies and mechanistic research are needed to clarify the role of sleep and of type of MP/WD use (e.g. social media) on mental health trajectories in children and adolescents.

Journal article

Filippi R, Ceccolini A, Booth E, Shen C, Thomas MSC, Toledano MB, Dumontheil Iet al., 2022, Modulatory effects of SES and multilinguistic experience on cognitive development: a longitudinal data analysis of multilingual and monolingual adolescents from the SCAMP cohort, International Journal of Bilingual Education and Bilingualism, Pages: 1-18, ISSN: 1367-0050

Previous research has shown that cognitive development is sensitive to socio-economic status (SES) and multilinguistic experiences. However, these effects are difficult to disentangle and SES may modulate the effects of multilingualism. The present study used data from a large cohort of pupils who took part in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) at ages 11–12 (T1) and 13–15 years old (T2). Cognitive measures were derived from tasks of cognitive flexibility, verbal, spatial and visuo-spatial working memory, speech processing and non-verbal reasoning. Using SES information collected through questionnaires (school type, level of deprivation, parental education and occupation), the sample was clustered into high/medium/low SES groups. Comparisons focused on 517 monolingual and 329 multilingual pupils in the high/low SES groups. Having controlled for multiple comparisons, the results indicated a significant beneficial effect of bilingualism in measures of working memory, visuo-spatial processing and non-verbal reasoning. These effects were present in both high and low SES individuals and sustained at both times of development, with a particularly significant improvement of working memory abilities in low SES bilinguals at T2 as compared to monolingual peers. Theoretical and practical implications of these findings are considered and guidance for educators is discussed.

Journal article

Thompson R, Toledano M, Dewa L, Fisher HL, Kabba Z, Hussain Tet al., 2022, Adolescents’ thoughts and feelings about the local and global environment: a qualitative interview study, Child and Adolescent Mental Health, Vol: 27, Pages: 4-13, ISSN: 1475-357X

BackgroundDespite a recent increase in engagement with environmental issues among young people, their impact upon adolescent mental health and wellbeing is not yet fully understood. Therefore, this study aimed to explore adolescents' thoughts and feelings about current environmental issues.MethodsSemi-structured interviews were conducted with a convenience sample of 15 UK-based adolescents aged 14–18 years (66.7% female). Transcripts were inductively thematically analysed by the interviewing researcher and two adolescent co-researchers, with priority given to the co-researchers' impressions to strengthen interpretations of the personal experiences of the interviewees.ResultsSix themes were identified: the local environment, efficacy, challenging emotions, information, hindrances and perceptions of the future. The local environment was found to affect adolescents positively and negatively. Factors including greenspace and fresh air had a positive impact, and factors including noise and litter had a negative impact. Most participants reported feeling disempowered to personally influence environmental problems but were engaged with them and felt that trying to make a difference was beneficial for their wellbeing. Adolescents largely reported negative expectations about the environment’s future.ConclusionThe UK adolescents interviewed appeared to be very engaged and emotionally affected by a perceived lack of care towards the environment, locally and globally. It is therefore imperative to amplify young people’s voices and involve them in influencing environmental policy, for the benefit of young people and the planet. Further research should quantify the extent to which environmental issues affect young people's mental health and identify factors that could prevent or alleviate distress.

Journal article

Thompson R, Smith RB, Bou Karim Y, Shen C, Drummond K, Teng C, Toledano MBet al., 2022, Noise pollution and human cognition: An updated systematic review and meta-analysis of recent evidence, Environment International, Vol: 158, Pages: 1-27, ISSN: 0160-4120

BackgroundThis systematic review provides a comprehensive synthesis of recent epidemiological evidence that environmental noise negatively impacts human cognition.MethodsWe update a prior review with recent publications (PROSPERO CRD42019151923). The strength of evidence for associations was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. We also conducted random-effects meta-analyses where suitable.Results16 studies were identified and reviewed in tandem with 32 studies previously reviewed by Clark & Paunovic (2018). A meta-analysis from 3 studies found that reading comprehension scores in quiet classrooms were 0.80 (95% confidence interval: 0.40; 1.20) points higher than children in noisier classrooms. Meta-analysis of the impact of 1 dB (dB) increase in environmental noise on reading and language abilities gave a pooled beta coefficient of −0.11(95% confidence interval: −0.32; 0.10). A meta-analysis of Odds Ratios (OR) from 3 studies found higher odds of cognitive impairment in people aged 45 + with higher residential noise exposure (OR 1.40, 95% CI: 1.18;1.61). After qualitative synthesis of remaining studies, there was high quality evidence for an association between environmental noise and cognitive impairment in middle-to-older adults, moderate quality evidence for an association between aircraft noise and reading and language in children, and moderate quality evidence against an association between aircraft noise and executive functioning in children. Generally the literature was supportive for other cognitive outcomes, but with low or very low-quality evidence.DiscussionThe evidence so far suggests that noise exposure is associated with cognition, but more good quality research using standardised methodology is required to corroborate these results and to allow for precise risk estimation by larger meta-analyses. There is also a need for more research with older teenagers and young-to

Journal article

Kenny RPW, Millar EB, Adesanya A, Richmond C, Beyer F, Calderon C, Rankin J, Toledano M, Feychting M, Pearce MS, Craig D, Pearson Fet al., 2021, 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, Environment International, Vol: 158, ISSN: 0160-4120

BackgroundThe 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.ObjectivesFollowing 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 sourcesWe 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 criteriaWe 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 methodsTitles, abstracts and then full texts will be screened in blinded duplicate against eligibility cr

Journal article

Rashid T, Bennett J, Paciorek C, Doyle Y, Pearson-Stuttard J, Flaxman S, Fecht D, Toledano M, Li G, Daby H, Johnson E, Davies B, Ezzati Met al., 2021, Life expectancy and risk of death in 6,791 English communities from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data, The Lancet Public Health, Vol: 6, Pages: e805-e816, ISSN: 2468-2667

Background: There is limited data with high spatial granularity on how mortality and longevity have changed in English communities. We estimated trends from 2002 to 2019 in life expectancy and probabilities of death at different ages for all 6,791 English middle-layer super output areas (MSOAs).Methods: We used de-identified data for all deaths in England from 2002 to 2019 with information on age, sex and MSOA of residence, and population counts by age, sex and MSOA. We used a Bayesian hierarchical model to obtain estimates of age-specific death rates by sharing information across age groups, MSOAs and years. We used life table methods to calculate life expectancy at birth and probabilities of death in different ages by sex and MSOA.Results: In 2002-2006 and 2006-2010, the vast majority of MSOAs experienced a life expectancy increase for both sexes. In 2010-2014, female life expectancy decreased in 351 (5%) of MSOAs. By 2014-2019, the number of MSOAs with declining life expectancy was 1,270 (19%) for women and 784 (12%) for men. The life expectancy increase from 2002 to 2019 was smaller where life expectancy had been lower in 2002, mostly northern urban MSOAs, and larger where life expectancy had been higher in 2002, mostly MSOAs in and around London. As a result of these trends, the gap between the 1st and 99th percentiles of MSOA life expectancy for women increased from 10.7 (95% credible interval 10.4-10.9) in 2002 to reach 14.2 (13.9-14.5) years in 2019, and from 11.5 (11.3-11.7) years to 13.6 (13.4-13.9) years for men. Interpretation: In many English communities, life expectancy declined in the years prior to the Covid-19 pandemic. To ensure that this trend does not continue there is a need for pro-equity economic and social policies, and greater investment on public health and healthcare.

Journal article

Fernandes GS, Spiers A, Vaidya N, Zhang Y, Sharma E, Holla B, Heron J, Hickman M, Murthy P, Chakrabarti A, Basu D, Subodh BN, Singh L, Singh R, Kalyanram K, Kartik K, Kumaran K, Krishnaveni G, Kuriyan R, Kurpad S, Barker GJ, Bharath RD, Desrivieres S, Purushottam M, Orfanos DP, Toledano MB, Schumann G, Benegal Vet al., 2021, Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort, BMC Public Health, Vol: 21, ISSN: 1471-2458

Background: Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such assubstance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.Methods: Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in Indiawas used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse ChildhoodExperiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smokingand Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysisexplained the associations between ACEs and substance misuse with adjustments for confounders such as sex andfamily structure.Results: 1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, malesreport more of every individual childhood adversity and are more likely to report misusing substances comparedwith females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5–11.7) and collective levelACEs (adj OR 6.6, 95% CI 1.4–31.1) show associations with substance misuse whilst in young adults, child level ACEssuch as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1–3.5).Conclusion: ACEs such as abuse and domestic violence are strongly associated with substance misuse, mostcommonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACEresilience programmes and ‘trauma-informed’ approaches to tackling longer-term impact of ACEs in India.Funding: Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and theIndian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

Journal article

Patjamontri S, Spiers ADV, Smith RB, Shen C, Adaway J, Keevil BG, Toledano MB, Ahmed Fet al., 2021, Salivary sex steroids as markers of puberty in boys during late childhood and adolescence, European Society for Paediatric Endocrinology

Introduction: Salivary androgens represent a non-invasive marker of puberty that may have utility in population studies as well as in the clinical arena.Objectives: To establish normal reference values of salivary androgens using LC-MS/MS and demonstrate the correlations between salivary androgens and pubertal development in boys.Methods: School-based adolescent cohort study with two time points for collecting saliva samples two years apart. Five androgens (Testosterone;T, androstenedione; A4, 17-hydroxyprogesterone; 17-OHP, 11-ketotestosterone; 11-KT and 11β-hydroxyandrostenedione; 11OHA4 were analyzed in saliva samples using LC-MS/MS. In addition, self-reported assessment of puberty through the Pubertal Development Scale (PDS) was also collected at both time points. Receiver-operating characteristic (ROC) curves were used to determine the areas under the curves (AUCs), of each androgen as a predictor of self-reported voice maturation.Results: A total of 1,166 saliva samples were available from 929 boys aged between 11-16 years at either baseline or follow up or both time points with the median age of 12.3 yrs (range 11.3-13.2) and 14.3 yrs (range 13.4-15.8) at baseline and follow up time point, respectively. Median salivary T increased from 7 pmol/l (10th,90th centile, 5, 41) in participants aged 11-12 yrs to 122 pmol/l (21.6, 267.4) in participants aged 15-16 yrs and median salivary A4 increased from 53 pmol/l (26.2, 92.0) in participants aged 11-12 yrs to 144 pmol/l (50.7, 241.2) in participants aged 15-16 yrs. In a subgroup analysis of 147 saliva samples that were collected within 90 days before or after PDS, salivary T and A4 concentrations showed the highest correspondence with self-reported voice-breaking (One-way ANOVA P < 0.005). ROC curve analysis showed that a salivary testosterone of 82.7 pmol/l and a salivary A4 of 113.4 pmol/l provided a sensitivity of 77% and 74%, respectively and a specificity of 76% and 74%, respectively. Salivary T concent


Patjamontri S, Spiers A, Smith RB, Shen C, Adaway J, Keevil BG, Toledano MB, Ahmed SFet al., 2021, Salivary sex steroids as markers of puberty in boys during late childhood and adolescence, 59th Annual Meeting of the European Society for Paediatric Endocrinology - 2021, Publisher: KARGER, Pages: 366-366, ISSN: 1663-2818

Conference paper

Maes MJA, Pirani M, Booth ER, Shen C, Milligan B, Jones KE, Toledano MBet al., 2021, Benefit of woodland and other natural environments for adolescents' cognition and mental health, Nature Sustainability, Vol: 4, Pages: 851-858, ISSN: 2398-9629

Epidemiological studies have established positive associations of urban nature with cognitive development and mental health. However, why specifically these health benefits are received remains unclear, especially in adolescents. We used longitudinal data in a cohort of 3,568 adolescents aged 9 to 15 years at 31 schools across London, UK, to examine the associations between natural-environment types and adolescents’ cognitive development, mental health and overall well-being. We characterized natural-environment types in three tiers, where natural space was distinguished into green and blue space, and green space was further distinguished into woodland and grassland. We showed that, after adjusting for other confounding variables, higher daily exposure to woodland, but not grassland, was associated with higher scores for cognitive development and a lower risk of emotional and behavioural problems for adolescents. A similar but smaller effect was seen for green space, but not blue space, with higher scores for cognitive development. Our results suggest that urban planning decisions to optimize ecosystem benefits linked to cognitive development and mental health should carefully consider the type of natural environment included.

Journal article

Shen C, Dumontheil I, Thomas M, Röösli M, Elliott P, Toledano Met al., 2021, Digital technology use and BMI: evidence from a cross-sectional analysis of an adolescent cohort study, Journal of Medical Internet Research, Vol: 23, Pages: 1-16, ISSN: 1438-8871

Background:The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep.Objective:This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents.Methods:We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep.Results:Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted β=.30, 95% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95% CI 1.09-2.34), compared with low use (≤30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6% to 17.8%) by an indirect effect.Conclusions:We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, sugg

Journal article

Clark S, Alli A, Nathvani R, Hughes A, Ezzati M, Brauer M, Toledano M, Baumgartner J, Bennett J, Nimo J, Bedford Moses J, Baah S, Agyei-Mensah S, Owusu G, Croft B, Arku Ret al., 2021, Space-time characterization of community noise and sound sources in Accra, Ghana, Scientific Reports, Vol: 11, Pages: 1-14, ISSN: 2045-2322

Urban noise pollution is an emerging public health concern in growing cities in sub-Saharan Africa (SSA), but the sound environment in SSA cities is understudied. We leveraged a large-scale measurement campaign to characterize the spatial and temporal patterns of measured sound levels and sound sources in Accra, Ghana. We measured sound levels and recorded audio clips at 146 representative locations, involving 7-days (136 locations) and 1-year measurements between 2019 and 2020. We calculated metrics of noise levels and intermittency and analyzed audio recordings using a pre-trained neural network to identify sources. Commercial, business, and industrial areas and areas near major roads had the highest median daily sound levels (LAeq24hr: 69 dBA and 72 dBA) and the lowest percentage of intermittent sound; the vice-versa was found for peri urban areas. Road-transport sounds dominated the overall sound environment but mixtures of other sound sources, including animals, human speech, and outdoor music, dominated in various locations and at different times. Environmental noise levels in Accra exceeded both international and national health-based guidelines. Detailed information on the acoustical environmental quality (including sound levels and types) in Accra may guide environmental policy formulation and evaluation to improve the health of urban residents.

Journal article

Bruton J, Jones K, Jenkins R, Davies B, Ward H, Toledano Met al., 2020, Enabling participation of Black and Minority Ethnic (BME) and seldom-heard communities in health research: A case study from the SCAMP adolescent cohort study, Research for All, Vol: 4, Pages: 207-219, ISSN: 2399-8121

Aim: To investigate barriers and facilitators to BME parental consent for children’s involvement in data-sharing aspects of study on mobile phone and wireless device use (SCAMP). To co-produce solutions to increase participation. Methods: Focus groups, telephone interviews, community event, PPI Café; symposium with public, participants and researchers. Results: Barriers were concerns about the research, practical constraints, poor communication. Facilitators were value of research, benefits to others. Solutions to increase participation were community support and clear, simple communication. Overall, trust in the research and the researchers was a key focus of enabling participation.Sharing recommendations: Symposium generated ideas about improving participation including tailoring participant information, engaging with local advocates, involving people in research design and delivery.Key words: Seldom heard, BME, research participation, co-production, PPI, parental consent

Journal article

Clark S, Alli AS, Brauer M, Ezzati M, Baumgartner J, Toledano M, Hughes A, Nimo J, Moses J, Terkpertey S, Vallarino J, Agyei-Mensah S, Agyemang E, Nathvani R, Muller E, Bennett J, Wang J, Beddows A, Kelly F, Barratt B, Beevers S, Arku Ret al., 2020, High-resolution spatiotemporal measurement of air and environmental noise pollution in sub-Saharan African cities: Pathways to Equitable Health Cities Study protocol for Accra, Ghana, BMJ Open, Vol: 10, ISSN: 2044-6055

Introduction: Air and noise pollution are emerging environmental health hazards in African cities, with potentially complex spatial and temporal patterns. Limited local data is a barrier to the formulation and evaluation of policies to reduce air and noise pollution. Methods and analysis: We designed a year-long measurement campaign to characterize air and noise pollution and their sources at high-resolution within the Greater Accra Metropolitan Area, Ghana. Our design utilizes a combination of fixed (year-long, n = 10) and rotating (week-long, n = ~130) sites, selected to represent a range of land uses and source influences (e.g. background, road-traffic, commercial, industrial, and residential areas, and various neighbourhood socioeconomic classes). We will collect data on fine particulate matter (PM2.5), nitrogen oxides (NOx), weather variables, sound (noise level and audio) along with street-level time-lapse images. We deploy low-cost, low-power, lightweight monitoring devices that are robust, socially unobtrusive, and able to function in the Sub-Saharan African (SSA) climate. We will use state-of-the-art methods, including spatial statistics, deep/machine learning, and processed-based emissions modelling, to capture highly resolved temporal and spatial variations in pollution levels across Accra and to identify their potential sources. This protocol can serve as a prototype for other SSA cities. Ethics and dissemination: This environmental study was deemed exempt from full ethics review at Imperial College London and the University of Massachusetts Amherst; it was approved by the University of Ghana Ethics Committee. This protocol is designed to be implementable in SSA cities to map environmental pollution to inform urban planning decisions to reduce health harming exposures to air and noise pollution. It will be disseminated through local stakeholder engagement (public and private sectors), peer-reviewed publications, contribution to policy documents, media, a

Journal article

Zhang Y, Elliott P, Toledano M, Schumann Get al., 2020, The Consortium on Vulnerability to Externalising Disorders and Addictions (c-VEDA): an accelerated longitudinal cohort of children and adolescents in India, Molecular Psychiatry, Vol: 25, Pages: 1618-1630, ISSN: 1359-4184

The global burden of disease attributable to externalising disorders such as alcohol misusecalls urgently for effective prevention and intervention. As our current knowledge is mainlyderived from high-income countries such in Europe and North-America, it is difficult toaddress the wider socio-cultural, psychosocial context, and genetic factors in which risk andresilience are embedded in low- and medium-income countries. c-VEDA was established asthe first and largest India-based multi-site cohort investigating the vulnerabilities for thedevelopment of externalising disorders, addictions, and other mental health problems. Usinga harmonised data collection plan coordinated with multiple cohorts in China, USA, andEurope, baseline data were collected from 7 study sites between November 2016 and May2019. 9010 participants between the ages of 6 and 23 were assessed during this time, amongstwhich 1278 participants underwent more intensive assessments including MRI scans. Bothwaves of follow-ups have started according to the accelerated cohort structure with plannedmissingness design. Here we present descriptive statistics on several key domains ofassessments, and the full baseline dataset will be made accessible for researchers outside theconsortium in September 2019. More details can be found on our website [].

Journal article

Jenkins R, Shen C, Dumontheil I, Thomas MSC, Elliott P, Roosli M, Toledano Met al., 2020, Social networking site use in young adolescents: association with health-related quality of life and behavioural difficulties, Computers in Human Behavior, Vol: 109, Pages: 1-10, ISSN: 0747-5632

Despite Social Networking Sites (SNS) having a minimum age of 13, younger adolescents are using them. In this study, we examine self-reported overall SNS use and SNS use if awake at night in relation to Health-Related Quality of Life (HRQOL, measured by KIDSCREEN-10) and behaviour (measured by Strengths and DifficultiesQuestionnaire, SDQ) in 5229 adolescents aged 11–12 in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) cohort. Two-thirds of the study population used SNS. Weekday and weekend SNS use on mobile phones and other devices was significantly associated with lower HRQOL in females (all p-values for linear trend < 0.01) but not males. Using SNS if awake at night was also significantly associated with lower HRQOL in females (adjustedβ-coefficient - 2.20 (95% CI - 3.18, - 1.22)). Higher SNS use on mobile phones and other devices was associated with increased behavioural difficulties in both genders (p-value for trend < 0.001). Similarly, SNS useif awake at night was associated with greater behavioural difficulties (adjusted β-coefficient 2.54 (95% CI 2.09, 2.98)). We recommend further longitudinal research in this area in order have a better understanding of the direction of relationships between SNS and wellbeing and behaviour in adolescents.

Journal article

Maes MJA, Jones KE, Toledano MB, Milligan Bet al., 2020, Accounting for natural capital has cross-cutting relevance for UK public sector decision-making, Ecosystem Services: science, policy and pratice, Vol: 44, Pages: 1-6, ISSN: 2212-0416

Countries have made a range of international commitments to compile and use natural capital accounts. While processes and methods for compiling natural capital accounts are now well defined, mainstreaming natural capital accounting (NCA) across public sector decision-making remains a practical challenge. This raises the question: which domains of public sector decision-making are important for a phased introduction of NCA? Here, we address a subset of this evidence gap through systematic analysis of the policy-relevance of natural capital accounts in the United Kingdom (UK). We identify 85 UK public sector bodies whose activities can affect the extent or condition of natural capital assets, and 60 bodies whose policy objectives are qualitatively contingent on natural capital stocks or services. For each of these 60 public sector bodies natural capital management (1) is a core policy priority, (2) impacts on policy objectives by regulating natural hazards, or (3) provides ecosystem goods and services that support policy objectives concerning health and well-being. Our findings highlight the considerable cross-cutting relevance of natural capital for public sector decision-making, and the need to account for natural capital in policy domains beyond those focused narrowly on environmental policy and management, e.g. through coordination structures that feature cross-departmental representation.

Journal article

Tettamanti G, Auvinen A, Åkerstedt T, Kojo K, Ahlbom A, Heinävaara S, Elliott P, Schüz J, Deltour I, Kromhout H, Toledano MB, Poulsen AH, Johansen C, Vermeulen R, Feychting M, Hillert L, COSMOS Study Groupet al., 2020, Long-term effect of mobile phone use on sleep quality: results from the cohort study of mobile phone use and health (COSMOS), Environment International, Vol: 140, Pages: 1-9, ISSN: 0160-4120

BACKGROUND: Effects of radiofrequency electromagnetic field exposure (RF-EMF) from mobile phone use on sleep quality has mainly been investigated in cross-sectional studies. The few previous prospective cohort studies found no or inconsistent associations, but had limited statistical power and short follow-up. In this large prospective cohort study, our aim was to estimate the effect of RF-EMF from mobile phone use on different sleep outcomes. MATERIALS AND METHODS: The study included Swedish (n = 21,049) and Finnish (n = 3120) participants enrolled in the Cohort Study of Mobile Phone Use and Health (COSMOS) with information about operator-recorded mobile phone use at baseline and sleep outcomes both at baseline and at the 4-year follow-up. Sleep disturbance, sleep adequacy, daytime somnolence, sleep latency, and insomnia were assessed using the Medical Outcome Study (MOS) sleep questionnaire. RESULTS: Operator-recorded mobile phone use at baseline was not associated with most of the sleep outcomes. For insomnia, an odds ratio (OR) of 1.24, 95% CI 1.03-1.51 was observed in the highest decile of mobile phone call-time (>258 min/week). With weights assigned to call-time to account for the lower RF-EMF exposure from Universal Mobile Telecommunications Service (UMTS, 3G) than from Global System for Mobile Communications (GSM, 2G) the OR was 1.09 (95% CI 0.89-1.33) in the highest call-time decile. CONCLUSION: Insomnia was slightly more common among mobile phone users in the highest call-time category, but adjustment for the considerably lower RF-EMF exposure from the UMTS than the GSM network suggests that this association is likely due to other factors associated with mobile phone use than RF-EMF. No association was observed for other sleep outcomes. In conclusion, findings from this study do not support the hypothesis that RF-EMF from mobile phone use has long-term effects on sleep quality.

Journal article

Piel F, Fecht D, Hodgson S, Blangiardo M, Toledano M, Hansell A, Elliott Pet al., 2020, Small-area methods for investigation of environment and health, International Journal of Epidemiology, Vol: 49, Pages: 686-699, ISSN: 1464-3685

Small-area studies offer a powerful epidemiological approach to study disease patterns at the population level and assess health risks posed by environmental pollutants. They involve a public health investigation on a geographic scale (e.g. neighbourhood) with overlay of health, environmental, demographic and potential confounder data. Recent methodological advances, including Bayesian approaches, combined with fast growing computational capabilities permit more informative analyses than previously possible, including the incorporation of data at different scales, from satellites to individual-level survey information. Better data availability has widened the scope and utility of small-area studies, but also led to greater complexity, including choice of optimal study area size and extent, duration of study periods, range of covariates and confounders to be considered, and dealing with uncertainty. The availability of data from large, well-phenotyped cohorts such as UK Biobank enables the use of mixed-level study designs and the triangulation of evidence on environmental risks from small-area and individual-level studies, therefore improving causal inference, including use of linked biomarker and -omics data. As a result, there are now improved opportunities to investigate the impacts of environmental risk factors on human health, particularly for the surveillance and prevention of non-communicable diseases.

Journal article

Toledano MB, Shaddick G, de Hoogh C, Fecht D, Freni Sterrantino A, Matthews J, Wright M, Gulliver J, Elliott Pet al., 2020, Electric field and air ion exposures near high voltage overhead power lines and adult cancers: a case control study across England and Wales, International Journal of Epidemiology, Vol: 49, Pages: i57-i66, ISSN: 0300-5771

Background: Various mechanisms have been postulated to explain how electric fields emitted by high voltage overhead power lines, and the charged ions they produce, might be associated with possible adult cancer risk but this has not previously been systematically explored in large scale epidemiologic research. Methods: We investigated risks of adult cancers in relation to modelled air ion density (per cm3) within 600m (focusing analysis on mouth, lung, respiratory) and calculated electric field within 25m (focusing analysis on non-melanoma skin) of high voltage overhead power lines in England and Wales, 1974-2008. Results: With adjustment for age, sex, deprivation and rurality, odds ratios (OR) in the highest fifth of net air ion density (0.504-1) compared with the lowest (0-0.1879) ranged from 0.94 (95% CI 0.82 – 1.08) for mouth cancers to 1.03 (95% CI 0.97 -1.09) for respiratory system cancers, with no trends in risk. The pattern of cancer risk was similar using corona ion estimates from an alternative model proposed by others. For keratinocyte carcinoma, adjusted OR in the highest (1.06 - 4.11 kV/m) compared with the lowest (<0.70 kV/m) thirds of electric field strength was 1.23 (95% CI 0.65-2.34) with no trend in risk. Conclusions: Our results do not provide evidence to support hypotheses that air ion density or electric fields in the vicinity of power lines are associated with cancer risk in adults.

Journal article

Smith RB, Beevers SD, Gulliver J, Dajnak D, Fecht D, Blangiardo M, Douglass M, Hansell AL, Anderson HR, Kelly F, Toledano MBet al., 2020, Impacts of air pollution and noise on risk of preterm birth and stillbirth in London, Environment International, Vol: 134, ISSN: 0160-4120

BackgroundEvidence for associations between ambient air pollution and preterm birth and stillbirth is inconsistent. Road traffic produces both air pollutants and noise, but few studies have examined these co-exposures together and none to date with all-cause or cause-specific stillbirths.ObjectivesTo analyse the relationship between long-term exposure to air pollution and noise at address level during pregnancy and risk of preterm birth and stillbirth.MethodsThe study population comprised 581,774 live and still births in the Greater London area, 2006–2010. Outcomes were preterm birth (<37 completed weeks gestation), all-cause stillbirth and cause-specific stillbirth. Exposures during pregnancy to particulate matter with diameter <2.5 μm (PM2.5) and <10 μm (PM10), ozone (O3), primary traffic air pollutants (nitrogen dioxide, nitrogen oxides, PM2.5 from traffic exhaust and traffic non-exhaust), and road traffic noise were estimated based on maternal address at birth.ResultsAn interquartile range increase in O3 exposure was associated with elevated risk of preterm birth (OR 1.15 95% CI: 1.11, 1.18, for both Trimester 1 and 2), all-cause stillbirth (Trimester 1 OR 1.17 95% CI: 1.07, 1.27; Trimester 2 OR 1.20 95% CI: 1.09, 1.32) and asphyxia-related stillbirth (Trimester 1 OR 1.22 95% CI: 1.01, 1.49). Odds ratios with the other air pollutant exposures examined were null or <1, except for primary traffic non-exhaust related PM2.5, which was associated with 3% increased odds of preterm birth (Trimester 1) and 7% increased odds stillbirth (Trimester 1 and 2) when adjusted for O3. Elevated risk of preterm birth was associated with increasing road traffic noise, but only after adjustment for certain air pollutant exposures.DiscussionOur findings suggest that exposure to higher levels of O3 and primary traffic non-exhaust related PM2.5 during pregnancy may increase risk of preterm birth and stillbirth; and a possible relationship between long-term traff

Journal article

Parkes B, Hansell AL, Ghosh RE, Douglas P, Fecht D, Wellesley D, Kurinczuk JJ, Rankin J, de Hoogh K, Fuller GW, Elliott P, Toledano MBet al., 2020, Risk of congenital anomalies near municipal waste incinerators in England and Scotland, Retrospective population-based cohort study, Vol: 134, ISSN: 0160-4120

Background: Few studies have investigated congenital anomalies in relation to municipal waste incinerators (MWIs) and results are inconclusive. Objectives: To conduct a national investigation into the risk of congenital anomalies in babies born to mothers living within 10 km of an MWI associated with: i) modelled concentrations of PM10 as a proxy for MWI emissions more generally and; ii) proximity of residential postcode to nearest MWI, in areas in England and Scotland that are covered by a congenital anomaly register. Methods: Retrospective population-based cohort study within 10 km of 10 MWIs in England and Scotland operating between 2003 and 2010. Exposure was proximity to MWI and log of daily mean modelled ground-level particulate matter ≤10 μm diameter (PM10) concentrations. Results: Analysis included 219,486 births, stillbirths and terminations of pregnancy for fetal anomaly of which 5154 were cases of congenital anomalies. Fully adjusted odds ratio (OR) per doubling in PM10 was: 1·00 (95% CI 0·98–1·02) for all congenital anomalies; 0·99 (0·97–1·01) for all congenital anomalies excluding chromosomal anomalies. For every 1 km closer to an MWI adjusted OR was: 1·02 (1·00–1·04) for all congenital anomalies combined; 1·02 (1·00–1·04) for all congenital anomalies excluding chromosomal anomalies; and, for specific anomaly groups, 1·04 (1·01–1·08) for congenital heart defect sand 1·07 (1·02–1·12) for genital anomalies. Discussion: We found no increased risk of congenital anomalies in relation to modelled PM10 emissions, but there were small excess risks associated with congenital heart defects and genital anomalies in proximity to MWIs. These latter findings may well reflect incomplete control for confounding, but a possible causal effect cannot be excluded.

Journal article

Auvinen A, Feychting M, Ahlbom A, Hillert L, Elliott P, Schuz J, Kromhout H, Toledano MB, Johansen C, Poulsen AH, Vermeulen R, Heinavaara S, Kojo K, Tettamanti G, COSMOS Study Groupet al., 2019, Headache, tinnitus and hearing loss in the international Cohort Study of Mobile Phone Use and Health (COSMOS) in Sweden and Finland, International Journal of Epidemiology, Vol: 48, Pages: 1567-1579, ISSN: 1464-3685

BackgroundMobile phone use and exposure to radiofrequency electromagnetic fields (RF-EMF) from it have been associated with symptoms in some studies, but the studies have shortcomings and their findings are inconsistent. We conducted a prospective cohort study to assess the association between amount of mobile phone use at baseline and frequency of headache, tinnitus or hearing loss at 4-year follow-up.MethodsThe participants had mobile phone subscriptions with major mobile phone network operators in Sweden (n = 21 049) and Finland (n = 3120), gave consent for obtaining their mobile phone call data from operator records at baseline, and filled in both baseline and follow-up questionnaires on symptoms, potential confounders and further characteristics of their mobile phone use.ResultsThe participants with the highest decile of recorded call-time (average call-time >276 min per week) at baseline showed a weak, suggestive increased frequency of weekly headaches at 4-year follow-up (adjusted odds ratio 1.13, 95% confidence interval 0.95–1.34). There was no obvious gradient of weekly headache with increasing call-time (P trend 0.06). The association of headache with call-time was stronger for the Universal Mobile Telecommunications System (UMTS) network than older Global System for Mobile Telecommunications (GSM) technology, despite the latter involving higher exposure to RF-EMF. Tinnitus and hearing loss showed no association with call-time.ConclusionsPeople using mobile phones most extensively for making or receiving calls at baseline reported weekly headaches slightly more frequently at follow-up than other users, but this finding largely disappeared after adjustment for confounders and was not related to call-time in GSM with higher RF-EMF exposure. Tinnitus and hearing loss were not associated with amount of call-time.

Journal article

Freni Sterrantino A, Elliott P, Blangiardo M, Hansell A, Ghosh R, Toledano M, Fecht Det al., 2019, Bayesian spatial modelling for quasi-experimental designs: an interrupted time series study of the opening of Municipal Waste Incinerators in relation to infant mortality and sex ratio, Environment International, Vol: 128, Pages: 109-115, ISSN: 0160-4120

BackgroundThere is limited evidence on potential health risks from Municipal Waste Incinerators (MWIs), and previous studies on birth outcomes show inconsistent results. Here, we evaluate whether the opening of MWIs is associated with infant mortality and sex ratio in the surrounding areas, extending the Interrupted Time Series (ITS) methodological approach to account for spatial dependencies at the small area level.MethodsWe specified a Bayesian hierarchical model to investigate the annual risks of infant mortality and sex-ratio (female relative to male) within 10 km of eight MWIs in England and Wales, during the period 1996–2012. We included comparative areas matched one-to-one of similar size and area characteristics.ResultsDuring the study period, infant mortality rates decreased overall by 2.5% per year in England. The opening of an incinerator in the MWI area was associated with −8 deaths per 100,000 infants (95% CI −62, 40) and with a difference in sex ratio of −0.004 (95% CI −0.02, 0.01), comparing the period after opening with that before, corrected for before-after trends in the comparator areas.ConclusionOur method is suitable for the analysis of quasi-experimental time series studies in the presence of spatial structure and when there are global time trends in the outcome variable. Based on our approach, we do not find evidence of an association of MWI opening with changes in risks of infant mortality or sex ratio in comparison with control areas.

Journal article

Toledano M, Mukherjee S, Howell J, Westaby D, Khan S, Bilton D, Simmonds Net al., 2019, The emerging burden of liver disease in cystic fibrosis patients: a UK nationwide study, PLoS ONE, Vol: 14, ISSN: 1932-6203

ObjectiveCystic fibrosis associated liver disease (CFLD) is the third largest cause of mortality in CF. Our aim was to define the burden of CFLD in the UK using national registry data and identify risk factors for progressive disease.MethodsA longitudinal population-based cohort study was conducted. Cases were defined as all patients with CFLD identified from the UK CF Registry, 2008–2013 (n = 3417). Denominator data were derived from the entire UK CF Registry. The burden of CFLD was characterised. Regression analysis was undertaken to identify risk factors for cirrhosis and progression.ResultsPrevalence of CFLD increased from 203.4 to 228.3 per 1000 patients during 2008–2013. Mortality in CF patients with CFLD was more than double those without; cirrhotic patients had higher all-cause mortality (HR 1.54, 95% CI 1.09 to 2.18, p = 0.015). Median recorded age of cirrhosis diagnosis was 19 (range 5–53) years. Male sex, Pseudomonas airway infection and CF related diabetes were independent risk factors for cirrhosis. Ursodeoxycholic acid use was associated with prolonged survival in patients without cirrhosis.ConclusionsThis study highlights an important changing disease burden of CFLD. The prevalence is slowly increasing and, importantly, the disease is not just being diagnosed in childhood. Although the role of ursodeoxycholic acid remains controversial, this study identified a positive association with survival.

Journal article

Mireku MO, Barker MM, Mutz J, Shen C, Dumontheil I, Thomas MSC, Röösli M, Elliott P, Toledano MBet al., 2019, Processed data on the night-time use of screen-based media devices and adolescents’ sleep quality and health-related quality of life, Data in Brief, Vol: 23, ISSN: 2352-3409

The data presented in this article relate to the research article entitled “Night-time screen-based media device use and adolescents' sleep and health-related quality of life”. The present data reports findings from the investigation of the relationship between night-time screen-based media devices (SBMD) use and both sleep quality and health-related quality of life (HRQoL) among 11 to 12-year-olds. Baseline data from a large cohort of 6,616 adolescents from 39 schools in and around London, UK, participating in the Study of Cognition Adolescents and Mobile Phone (SCAMP) were analysed. Self-report data on adolescents’ use of any SBMD (mobile phone, tablet, laptop, television etc.) were the main exposures of interest. Mobile phone and television were the most commonly used portable and non-portable device, respectively. Sleep variables were derived from self-reported weekday and/or weekend bedtime, sleep onset latency (SOL) and wake time. Sleep quality was assessed using four standardised dimensions from the Swiss Health Survey. HRQoL was estimated using the KIDSCREEN-10 questionnaire.

Journal article

Mireku MO, Barker M, Mutz J, Dumontheil I, Thomas MSC, Roosli M, Elliott P, Toledano Met al., 2019, Night-time screen-based media device use and adolescents’ sleep and health-related quality of life, Environment International, Vol: 124, Pages: 66-78, ISSN: 0160-4120

ObjectiveThe present study investigates the relationship between night-time screen-based media devices (SBMD) use, which refers to use within 1 h before sleep, in both lit and dark rooms, and sleep outcomes and health-related quality of life (HRQoL) among 11 to 12-year-olds.MethodsWe analysed baseline data from a large cohort of 6616 adolescents from 39 schools in and around London, United Kingdom, participating in the Study of Cognition Adolescents and Mobile Phone (SCAMP). Adolescents self-reported their use of any SBMD (mobile phone, tablet, laptop, television etc.). Sleep variables were derived from self-reported weekday and/or weekend bedtime, sleep onset latency (SOL) and wake time. Sleep quality was assessed using four standardised dimensions from the Swiss Health Survey. HRQoL was estimated using the KIDSCREEN-10 questionnaire.ResultsOver two-thirds (71.5%) of adolescents reported using at least one SBMD at night-time, and about a third (32.2%) reported using mobile phones at night-time in darkness. Night-time mobile phone and television use was associated with higher odds of insufficient sleep duration on weekdays (Odds Ratio, OR = 1.82, 95% Confidence Interval, CI [1.59, 2.07] and OR = 1.40, 95% CI [1.23, 1.60], respectively). Adolescents who used mobile phones in a room with light were more likely to have insufficient sleep (OR = 1.32, 95% CI [1.10, 1.60]) and later sleep midpoint (OR = 1.64, 95% CI [1.37, 1.95]) on weekends compared to non-users. The magnitude of these associations was even stronger for those who used mobile phones in darkness for insufficient sleep duration on weekdays (OR = 2.13, 95% CI [1.79, 2.54]) and for later sleep midpoint on weekdays (OR = 3.88, 95% CI [3.25, 4.62]) compared to non-users. Night-time use of mobile phones was associated with lower HRQoL and use in a dark room was associated with even lower KIDSCREEN-10 score (β = –1.18, 95% CI [–1.85, –0.52]) compared to no use.ConclusionsWe found consistent

Journal article

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