INTRODUCTION

Electromagnetic fields (EMFs) are ubiquitous, mainly due to the increased use of wireless communication systems. The widespread use of technology has raised significant public concern regarding the potential health impacts of EMF exposure.[1] However, the current scientific consensus notes limited evidence for the clinical health effects of extremely low-frequency EMF (ELF-EMF) exposure. The World Health Organization (WHO) states that “no adverse health effects have been established for exposure to low-level EMFs,” and recent evaluations by the European Commission’s group found “no systematic reviews or meta-analyses confirming significant associations between ELF-EMF exposure and neurodegenerative diseases or reproductive outcomes.”[2,3]

The global dependence on mobile phones is evident, with approximately 8.9 billion mobile connections and 5.1 billion unique mobile subscribers worldwide as of October 2018.[4] This trend contributes to a growing incidence of conditions such as electrical hypersensitivity (EHS), in which individuals report sensitivity to electromagnetic sources, including power lines and mobile phones. While EHS symptoms such as facial skin irritations and neurovegetative disturbances are documented,[5] the SCENIHR Opinion concluded that there is “no convincing evidence for a causal relationship between RF exposure and these symptoms.”[6]

Mobile phones pose a particular concern due to their proximity to the human brain and their high specific absorption rate of radiofrequency EMF (RF-EMF), which directly impacts user exposure.[1] Although studies have examined cellular effects and proposed carcinogenicity risks,[1,7] several reports emphasize that “the weight of evidence on health effects of Intermediate Frequency-EMF exposure is uncertain due to contradictory information.”[8,9] Further research has documented a range of common self-reported symptoms associated with EMF exposure, ranging from fatigue, musculoskeletal symptoms, and dizziness to more severe occurrences such as alterations in the blood– brain barrier,[7,10,11] though these findings remain inconclusive for clinical relevance.[12]

Both human and animal studies have revealed the biological effects of EMF exposure, documenting structural changes in neurons and memory impairment and reporting symptoms, including headaches, emotional tension, fatigue, and sleep disturbances.[13] However, biological effects do not equal health hazards, and most animal studies focus on acute, high-level exposures that exceed real-world conditions.[14] There is increasing interest in the central nervous system’s vulnerability, particularly in the head and ear regions during mobile phone use, given their proximity to EMF sources,[15,16] though recent cohort studies found no significant association between RF-EMF exposure and neurophysiological outcomes.[17]

Despite this scientific uncertainty, emerging concerns about RF-EMF’s potential impact on male fertility[18,19] and neuroprotective herbs[15,20] underscore the need for awareness among future healthcare professionals. This study evaluates Health Sciences students’ perceptions of EMF risks, focusing on bridging the gap between public concern and scientific evidence rather than establishing clinical causality.

MATERIAL AND METHODS

A cross-sectional study was conducted among health sciences colleges, including “Medicine,” “Nursing,” and “Applied Medical Sciences,” at Northern Border University, from October 22, 2023, to May 1, 2024, after obtaining the approval of the Bioethical Committee of the authors’ University (Approval No. 92/44/H). Furthermore, the “Helsinki Declaration” guidelines were followed.

Raosoft’s sample size calculator was utilized to compute the sample size (Raosoft Inc., Seattle, Washington, United States). It was determined that 317 individuals were necessary to achieve a 95% confidence interval, with the total population of health college students being 1800 and a margin of error of 5%. An additional 10% was added to the calculated figure to mitigate recall bias. Students of both genders, aged over 18, were included in this study. A convenience sampling approach was adopted, and the survey was administered to 350 participants. Of these participants, 341 gave consent to participate, resulting in a response rate of about 97%. For ethical considerations, all participants were apprised of the study’s objectives, and their consent was obtained under the promise of confidentiality and anonymity.

The questionnaire was meticulously developed through a two-step process: (1) Adaptation of the existing validated scale[21] and (2) de novo item generation for context-specific questions. Content validity was established through expert review by two specialists in environmental health and one in survey methodology. The adapted questionnaire underwent exhaustive translation and cultural adaptation processes following the WHO guidelines for instrument translation, including forward translation, expert panel review, back-translation, and pre-testing.[22] Reliability was assessed using Cronbach’s alpha coefficient (α = 0.82), indicating good internal consistency. To further refine the questionnaire, a pilot group of ten students completed it before official data collection commenced. Their feedback affirmed the clarity of the questionnaire. A four-point Likert scale was employed to gauge the student’s level of concern, with response options of “Much,” “Neutral,” “A Little,” and “I do not know.” Simultaneously, students’ knowledge was assessed using three-point options of “Yes,” “No,” or “I do not know.”

The survey is divided into two primary sections. The first focuses on students’ demographic information, including age, sex, marital status, college, and academic year. The second section addresses the awareness and perception of risk linked to EMF exposure, featuring 26 questions.

The researchers disseminated the structured questionnaire through Google Forms in the WhatsApp groups of each relevant class. The collected data were analyzed using IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, New York, USA). Frequencies and percentages represented qualitative variables, and they were compared using the Chi-square or Fisher exact tests. Conversely, quantitative variables were presented as means and standard deviations and compared by the Student t-test or analysis of variance. A scoring system was employed to assess the student’s knowledge/perception, where one point was awarded for each correct response. A score of 75% or higher of the maximum possible points denoted excellent knowledge. Scores ranging from 50% to 74% constituted good knowledge, while those below 50% signified poor knowledge.[23] The level of statistical significance was set at a P ≤ 0.05.

RESULTS

The study recruited 341 undergraduate students from various health sciences colleges, with a mean age of 20.3 ± 2.1 (range 17–33) years old. Table 1 shows that most participants, 63.3% (n = 216), fell within the 17–20-year-old range. The distribution of genders was relatively balanced, with females representing 51.3% (n = 175) of the participants. In addition, the majority were enrolled in the College of Medicine, constituting 72.1% (n = 246).

Table 1: Study participant’s characteristics (n=341).

Participant’s characteristics Frequency (%) Age   17–20 years 216 (63.3)   21–23 years 101 (29.6)   >23 years 24 (7.0) Sex   Male 166 (48.7)   Female 175 (51.3) Marital status   Single 331 (97.1)   Married 10 (2.9) College   Medicine 246 (72.1)   Nursing 47 (13.8)   Applied Medical Sciences 48 (14.1) Education year   1st year 113 (33.1)   2nd year 71 (20.8)   3rd year 48 (14.1)   4th year 40 (11.7)   5th year 21 (6.2)   6th year 48 (14.1)

Table 2 reveals variable levels of knowledge and fluctuating degrees of concern related to the potential risks associated with EMF devices. Most participants (n = 183, 53.7%) indicated possessing “a little” knowledge about device radiation, suggesting familiar concept recognition but possibly low understanding. A smaller group of respondents (n = 84, 24.6%) remained “neutral,” and those claiming “Much” knowledge comprised a minor cohort (n = 26, 7.6%). Concern over radiation exposure was less significant; the largest group, consisting of 160 individuals (46.9%), expressed concern, while 75 participants (22.0%) did not express a definitive opinion, remaining “Neutral.” When assessing the perception of EMF risk and its correlation with students’ academic levels, the data appear evenly spread. Approximately 145 students (42.5%) believe that there is some risk, while 73 (21.4%) do not hold a conclusive attitude.

Table 2: Awareness and perception of electromagnetic fields (n=341).

Awareness and perception of EMF risk A Little (%) Neutral (%) Much (%) I don't know (%) Knowledge about EMF devices’ radiation 183 (53.7) 84 (24.6) 26 (7.6) 48 (14.1) Worried about getting radiation from their EMF devices 160 (46.9) 75 (22.0) 48 (14.1) 58 (17.0) Perception of EMF risk and students’ academic level 145 (42.5) 73 (21.4) 66 (19.4) 57 (16.7)

Figure 1 presents the distribution of daily usage rates for EMF devices (e.g., smartphones, microwave ovens, computers, laptops, and Wi-Fi devices) among undergraduate students. Eighty-nine students (26.1%) reported using EMF devices for <2 hrs daily, while 117 (34.3%) indicated that their EMF device usage was around 5 hrs/day.

Figure 1: Rate of daily use of electromagnetic field devices among undergraduate students (n=341).

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Figure 2 illustrates undergraduate students’ perceptions about their degree of exposure to EMF from electronic devices. Seventy-nine students (23.2%) believed that they were exposed to a minimal degree of EMF, while 81 (23.8%) expressed neutral views. In contrast, most students (152, 44.6%) perceived their EMF exposure as very high.

Figure 2: The perceptions of undergraduate students regarding their degree of exposure to electromagnetic fields from electronic devices (n=341).

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Upon analyzing students’ beliefs about the leading potential sources of EMF from the listed resources [Table 3], microwave ovens were identified as the most potent source of EMF (n = 149, 43.7%). Computers and televisions were often considered the lesser sources, as indicated by 127 (37.2%) and 128 (37.5%) students, respectively. Regarding perceptions of body organ vulnerability to EMF radiation and protective measures, 149 students (43.7%) believed that the heart and breasts are the most vulnerable organs to EMF radiation, with a similar number (n = 144, 42.2%) indicating they did not know. Concerning the symptoms believed to be associated with chronic or high-dose EMF exposure, the most reported symptoms pertained to cognitive and emotional issues, reflected as brain fog (58.4%) and depression (57.8%) linked to EMF exposure.

Table 3: Source and risk associated with exposure to electromagnetic fields (n=341).

Aspect of knowledge No (%) Yes (%) I don’t know (%) Do you think a microwave oven produces the strongest EMF? 78 (22.9) 149 (43.7) 114 (33.4) Do you think the computer produces the strongest EMF? 127 (37.2) 81 (23.8) 133 (39.0) Do you think television produces the strongest EMF? 128 (37.5) 78 (22.9) 135 (39.6) Do you think Wi-Fi devices produce the strongest EMF? 95 (27.9) 96 (28.2) 150 (44.0) Do you think smartphones produce the strongest EMF? 101 (29.6) 108 (31.7) 132 (38.7) Do you think radiant electrical heating produces the strongest EMF? 96 (28.2) 98 (28.7) 147 (43.1) Do you think radios produce the strongest EMF? 89 (26.1) 118 (34.6) 134 (39.3) Are the heart and breasts most vulnerable to EMF radiation? 48 (14.1) 149 (43.7) 144 (42.2) Are reproductive organs most vulnerable to EMF radiation? 105 (30.8) 68 (19.9) 168 (49.3) Is the brain the most vulnerable organ to EMF radiation? 31 (9.1) 203 (59.5) 107 (31.4) Are respiratory organs most vulnerable to EMF radiation? 129 (37.8) 53 (15.5) 159 (46.6) Brain fog common symptoms that are believed to be associated with chronic or high-dose EMF exposure 199 (58.4) 58 (17.0) 84 (24.6) Depression is a common symptom that is believed to be associated with chronic or high-dose EMF exposure 42 (12.3) 197 (57.8) 102 (29.9) Dementia common symptoms that are believed to be associated with chronic or high-dose EMF exposure 70 (20.5) 151 (44.3) 120 (35.2) Autism common symptoms that are believed to be associated with chronic or high-dose EMF exposure 86 (25.2) 130 (38.1) 125 (36.7) Muscle aches are common symptoms that are believed to be associated with chronic or high-dose EMF exposure 90 (26.4) 145 (42.5) 106 (31.1) Increased cancer risk common symptoms that are believed to be associated with chronic or high-dose EMF exposure 103 (30.2) 115 (33.7) 123 (36.1) Do you think awareness of the dangers of EMF radiation in your community is enough? 50 (14.7) 168 (49.3) 123 (36.1) Distance from an EMF source is the most common way to protect against the risks of exposure to electromagnetic waves 38 (11.1) 197 (57.8) 106 (31.1) Reduce EMF exposure time is the most common way to protect against the risks of exposure to electromagnetic waves 34 (10.0) 216 (63.3) 91 (26.7) Antioxidant-rich foods are the most common ways to protect against the risks of exposure to electromagnetic waves 50 (14.7) 110 (32.3) 181 (53.1)

In examining community awareness and protective measures against EMF, nearly half of the students (49.3%) did not believe that there was sufficient awareness of the risks of EMF radiation in their communities [Table 3]. The most frequent protection method against EMF exposure endorsed by students was reducing exposure time (63.3%). However, dietary measures, like consuming foods rich in antioxidants, were not as widely accepted as protective (32.3%), with more than half of the participants (181, 53.1%) uncertain of their effectiveness.

The distribution of knowledge scores among the study participants indicated a significant inclination toward lower knowledge levels. Nearly half the participants (n = 162, 47.5%) fell into the “Poor” knowledge category. One-hundred-fifty students (44%) were categorized as having “Average” knowledge, and a small percentage (n = 29, 8.5%) scored within the “Good” knowledge category [Figure 3].

Figure 3: Distribution of knowledge score among undergraduate students (n=341).

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A comparison of average knowledge scores per participant characteristics shows that female participants had significantly higher mean knowledge scores than their male counterparts within the study cohort. Furthermore, single individuals displayed a higher mean knowledge score. Regarding the college affiliations, students from “Applied Medical Sciences” exhibited the highest mean knowledge scores among the listed colleges [Table 4].

Table 4: Comparison of mean of knowledge score according to participant’s characteristics.

Participant’s characteristics Mean±SD P-value Age   17–20 years 9.2±5.3 0.120a   21–23 years 8.1±5.4   >23 years 7.4±6.1 Sex   Male 7.1±5.1 0.000b*   Female 10.3±5.2 Marital status   Single 8.9±5.4 0.045b*   Married 5.4±5.0 College   Medicine 8.4±5.3 0.002a*   Nursing 8.1±6.4   Applied Medical Sciences 11.2±4.2 Education year   1st year 9.2±5.5 0.000a*   2nd year 11.2±4.2   3rd year 6.2±4.7   4th year 7.9±6.1   5th year 6.8±4.3   6th year 8.2±5.7

Analysis of the association of the study participants’ characteristics with their knowledge scores – stratified into three categories (i.e., poor, average, and good) as shown in Table 5 – aligned with the results in Table 4. Females constituted a larger proportion of the “Good” (72.4%) and “Average” (65.3%) knowledge categories than males (P = 0.000). Notably, significant differences were apparent in the distribution of knowledge scores among different colleges and years of education. Specifically, 1st-year students were more prevalent in the “Good” knowledge group (41.4%) [Table 5].

Table 5: Association of participant’s characteristics with knowledge score grouping.

Participant's characteristics Knowledge score grouping P-value Poor Average Good n % n % n % Age   17–20 years 92 56.8 103 68.7 21 72.4 0.199   21–23 years 57 35.2 38 25.3 6 20.7   >23 years 13 8.0 9 6.0 2 6.9 Sex   Male 106 65.4 52 34.7 8 27.6 0.000*   Female 56 34.6 98 65.3 21 72.4 Marital status   Single 155 95.7 147 98.0 29 100.0 0.296   Married 7 4.3 3 2.0 0 0.0 College   Medicine 126 77.8 103 68.7 17 58.6 0.001*   Nursing 26 16.0 15 10.0 6 20.7   Applied Medical Sciences 10 6.2 32 21.3 6 20.7 Education year   1st year 53 32.7 48 32.0 12 41.4 0.000*   2nd year 14 8.6 48 32.0 9 31.0   3rd year 31 19.1 17 11.3 0 0.0   4th year 24 14.8 12 8.0 4 13.8   5th year 15 9.3 6 4.0 0 0.0   6th year 25 15.4 19 12.7 4 13.8 DISCUSSION

This study explored awareness, perceptions, and usage patterns of EMF devices among undergraduate health sciences students. Despite their educational environment, about half of the participants reported limited knowledge about EMF radiation, aligning with findings from Saudi Arabia[24] and the USA.[25] This lack of knowledge extends even to medical staff in healthcare facilities.[26] Interestingly, nearly half of the respondents expressed concern about EMF exposure, indicating a significant risk perception that does not necessarily match their knowledge level.[27] This discrepancy underscores the need to distinguish public perception from scientific consensus.[28] Various factors can influence risk perception, such as cultural background, demographic characteristics, sense of control, and media exposure.[29] Risk perception does not always reflect actual risks, as shown in this study. This discrepancy could be attributed to widespread public fears and widely disseminated information rather than systematic education.

Daily use of EMF-emitting devices is prevalent, with 34.3% of students using these devices for approximately 5 hrs. daily. This extensive use is concerning, given the perceived exposure rate of 44.6%. The implications of such high exposure in educational settings where students frequently engage with technology for academic purposes require urgent attention.[30,31] However, it is critical to note that while public concern persists, reports emphasize that “the weight of evidence on health effects of ELF-EMF exposure is uncertain due to contradictory information.”[32,33]

Microwave ovens were recognized as the most potent sources of EMF, aligning with common public perceptions.[34] Participants identified the heart, breasts, and brain as the most susceptible organs to EMF exposure, predominantly reporting cognitive and emotional symptoms. These perspectives must be evaluated considering current scientific evidence, which remains inconclusive on these health risks.[35]

While awareness of protective measures was generally low, reducing exposure time was widely recognized. This discrepancy underscores the need for practical and easily accessible guidance on protective measures.

Female students and those from “Applied Medical Sciences” demonstrated higher mean knowledge scores, suggesting that specific subgroups may be more exposed to EMF risk information. However, the inconsistency of knowledge association with the educational year implies that advancing through the academic program does not automatically lead to increased EMF awareness. This highlights the need for curriculum reforms that emphasize evidence-based education on EMF risks, particularly given the ongoing scientific debate about clinical effects.

Researchers emphasized that active learning techniques are more effective in enhancing students’ understanding compared to traditional lecture-based approaches.[36] Thus, to foster a deeper and more consistent understanding of EMF across educational years, it is crucial to integrate comprehensive and interactive learning strategies throughout the curriculum. Such initiatives would help reconcile the perceptions with scientific uncertainty, as reflected in studies showing that health professionals often overestimate risks unsubstantiated by clinical evidence.[37] Our finding regarding this issue disagrees with a study conducted among adolescents in Turkey that revealed a risk perception toward mobile phones directly associated with academic levels;[38] however, it is in alignment with others who found the 1st academic year as an independent risk factor for mobile dependence/exposure rate,[39,40] whereas other studies reported a higher rate in 3rd-year medical students.[41,42]

To address the identified knowledge gaps and misconceptions, we recommend (a) formulating targeted educational programs for students, healthcare professionals, and the public, focusing on bridging the gap between perception and scientific consensus; (b) partnering with stakeholders to create guidelines for reducing EMF exposure in various settings, guided by the precautionary principle; and (c) conducting further research on long-term health effects of EMF exposure and the effectiveness of educational interventions.

Limitations and future directions

While providing valuable insights, this study has several limitations that should be considered when interpreting the results and generalizing its findings: (a) As an exploratory study, the current findings are primarily descriptive and cannot establish causal relationships between variables. This limits the ability to draw definitive conclusions about the factors influencing EMF awareness and risk perception among health sciences students, (b) the reliance on self-reported information may introduce recall/social desirability bias, potentially affecting the accuracy of the reported EMF device usage/perceived exposure levels, (c) this study focused on undergraduate health sciences students from a single institution, which may limit the generalizability of the findings to students in other academic disciplines, health sciences students in other regions of Saudi Arabia or other countries, and the general population, (d) the absence of objective measurements of EMF exposure limits the ability to correlate perceived exposure with actual exposure levels, and (e) the study’s cross-sectional nature prevents observing changes in awareness/perceptions over time, particularly as students’ progress through their academic programs.

Future research should (a) employ longitudinal designs to track changes in EMF awareness and risk perception over time, (b) include objective measurements of EMF exposure to correlate with self-reported data, (c) expand the study population to include diverse academic disciplines and multiple institutions across different regions, (d) incorporate qualitative methods to gain deeper insights into the factors influencing EMF awareness and risk perception, and (e) conduct comparative studies between health sciences students and the general population to identify knowledge gaps and tailor educational interventions accordingly. By addressing these limitations in future studies, researchers can provide more robust and generalizable insights into EMF awareness and risk perception among various populations, ultimately informing more effective public health interventions and policies.

CONCLUSION

In summary, there appears to be a basic level of awareness about EMF device radiation among participants, yet there is a trend toward minimal knowledge and concern. However, many people are still undecided or uninformed, indicating areas where expanded educational outreach could be beneficial. The relatively high concern in those with perceived greater knowledge implies that as students learn more about EMF, their level of concern may increase.