Cellphones affects social communication, vision, breathing, and health: What to do!

Posted: September 4, 2024 | Author: erikpeper | Filed under: ADHD, attention, behavior, Breathing/respiration, cellphone, computer, digital devices, educationj, ergonomics, health, laptops, Neck and shoulder discomfort, posture, screen fatigue, self-healing, stress management, techstress, Uncategorized, vision, zoom fatigue | Tags: communication, myopia, pedestrian deaths, peripheral vision, text neck | 7 Comments

Adapted from: Peper, E. & Harvey, R. (2024). Cell phones affects social communication, vision, breathing, and mental and physical health: What to do! TownsendLetter-The Examiner of Alternative Medicine,September 15, 2024. https://townsendletter.com/smartphone-affects-social-communication-vision-breathing-and-mental-and-physical-health-what-to-do/

Abstract

Smartphones are an indispensable part of our lives. Unfortunately too much of a ‘good thing’ regarding technology can work against us, leading to overuse, which in turn influences physical,  mental and emotional development among current ‘Generation Z’ and ‘Millennial’ users (e.g., born 1997-2012, and 1981-1996, respectively). Compared to older technology users, Generation Z report more mental and physical health problems. Categories of mental health include attentional deficits, feelings of depression, anxiety social isolation and even suicidal thoughts, as along with physical health complaints such as sore neck and shoulders, eyestrain and increase in myopia. Long duration of looking downward at a smartphone affects not only eyestrain and posture but it also affects breathing which burden overall health. The article provides evidence and practices so show how technology over use and slouching posture may cause a decrease in social interactions and increases in emotional/mental and physical health symptoms such as eyestrain, myopia, and body aches and pains.  Suggestions and strategies are provided for reversing the deleterious effects of slouched posture and shallow breathing to promote health.

We are part of an uncontrolled social experiment

We, as technology users, are all part of a social experiment in which companies examine which technologies and content increase profits for their investors (Mason, Zamparo, Marini, & Ameen, 2022). Unlike University research investigations which have a duty to warn of risks associated with their projects, we as participants in ‘profit-focused’ experiments are seldom fully and transparently informed of the physical, behavioral and psychological risks (Abbasi, Jagaveeran, Goh, & Tariq, 2021; Bhargava, & Velasquez, 2021). During university research participants must be told in plain language about the risks associated with the project (Huh-Yoo & Rader, 2020; Resnik, 2021). In contrast for-profit technology companies make it possible to hurriedly ‘click through’ terms-of-service and end-user-license-agreements, ‘giving away’ our rights to privacy, then selling our information to the highest bidder (Crain, 2021; Fainmesser, Galeotti, & Momot, 2023; Quach et al., 2022; Yang, 2022).

Although some people remain ignorant and or indifferent (e.g., “I don’t know and I don’t care”) about the use of our ‘data,’ an unintended consequence of becoming ‘dependent’ on technology overuse includes the strain on our mental and physical health (Abusamak, Jaber & Alrawashdeh, 2022; Padney et al., 2020). We have adapted new technologies and patterns of information input without asking the extent to which there were negative side effects (Akulwar-Tajane, Parmar, Naik & Shah, 2020; Elsayed, 2021).  As modern employment shifted from predominantly blue-collar physical labor to white collar information processing jobs, people began sitting more throughout the day. Workers tended to look down to read and type.  ‘Immobilized’ sitting for hours of time has increased as people spend time working on a computer/laptop and looking down at smartphones (Park, Kim & Lee, 2020). The average person now sits in a mostly immobilized posture 10.4 hours/day and modern adolescents spent more than two thirds of their waking time sitting and often looking down at their smartphones (Blodgett, et al., 2024; Arundell et al., 2019).

Smartphones are an indispensable part of our lives and is changing the physical and mental emotional development especially of Generation Z who were born between 1997-2012 (Haidt, 2024). They are the social media and smartphone natives (Childers & Boatwright, 2021). The smartphone is their personal computer and the gateway to communication including texting, searching, video chats, social media (Hernandez-de-Menendez, Escobar Díaz, & Morales-Menendez, 2020; Nichols, 2020; Schenarts, 2020; Szymkowiak et al., 2021). It has 100,000 times the processing power of the computer used to land the first astronauts on the moon on July 20, 1969 according to University of Nottingham’s computer scientist Graham Kendal (Dockrill, 2020).  More than one half of US teens spend on the average more than 7 hours on daily screen time that includes watching streaming videos, gaming, social media and texting and their attention span has decreased from 150 seconds in 2004 to an average of 44 seconds in 2021 (Duarte, F., 2023; Mark, 2022, p. 96).

For Generation Z, social media use is done predominantly with smartphones while looking down. It has increased mental health problems such as attentional deficits, depression, anxiety suicidal thoughts, social isolation as well as decreased physical health (Haidt, 2024; Braghieri et al., 2023; Orsolini, Longo & Volpe, 2023; Satılmış, Cengız, & Güngörmüş, 2023; Muchacka-Cymerman, 2022; Fiebert, Kistner, Gissendanner & DaSilva, 2021;  Mohan et al., 2021; Goodwin et al., 2020).

The shift in communication from synchronous (face-to-face) to asynchronous (texting) has transformed communications and mental health as it allows communication while being insulated from the other’s reactions (Lewis, 2024).  The digital connection instead of face-to-face connection by looking down at the smart phone also has decreased the opportunity connect with other people and create new social connections, with three typical hypotheses examining the extent to which digital technologies (a) displace/ replace; (b) compete/ interfere with; and/or, (c) complement/ enhance in-person activities and relationships (Kushlev & Leitao, 2020).

As described in detail by Jonathan Haidt (2024), in his book, The Anxious Generation, the smartphone and the addictive nature of social media combined with the reduction in exercise, unsupervised play and childhood independence was been identified as the major factors in the decrease in mental health in your people (Gupta, 2023). This article focuses less on distraction such as attentional deficits, or dependency leading to tolerance, withdrawal and cravings (e.g., addiction-like symptoms) and focuses more on ‘dysregulation’ of body awareness (posture and breathing changes) and social communication while people are engaged with technology (Nawaz,Bhowmik, Linden & Mitchell, 2024).

The excessive use of the smartphones is associated with a significant reduction of physical activity and movement leading to a so-called sedentarism or increases of sitting disease (Chandrasekaran & Ganesan, 2021; Nakshine, Thute, Khatib, & Sarkar, 2022). Unbeknown to the smartphone users their posture changes, as they looks down at their screen, may also affect their mental and physical health (Aliberti, Invernizzi, Scurati & D’lsanto, 2020).

(1) Explore how looking at your smartphone affects you (adapted from: Peper, Harvey, & Rosegard, 2024)

For a minute, sit in your normal slouched position and look at your smartphone while intensely reading the text or searching social media. For the next minute sit tall and bring the cell phone in front of you so you can look straight ahead at it. Again, look at your smartphone while intensely reading the text or searching social media.

Compare how the posture affects you. Most likely, your experience is similar to the findings from students in a classroom observational study. Almost all experienced a reduction in peripheral awareness and breathed more shallowly when they slouched while looking at their cellphone.

Decreased peripheral awareness and increased shallow breathing that affects physical and mental health and performance. The students reported looking down position reduces the opportunity of creating new social connections. Looking down my also increases the risk for depression along with reduced cognitive performance during class (Peper et al., 2017; Peper et al., 2018). 

(2) Explore how posture affects eye contact (adapted from the exercise shared by Ronald Swatzyna, 2023)[2]

Walk around your neighborhood or through campus either looking downwards or straight ahead for 30 minutes while counting the number of eye contacts you make.

Most likely, when looking straight ahead and around versus slouched and looking down you had the same experience as Ronald Swatzyna (2023), Licensed Clinical Social Worker. He observed that when he walked a three-mile loop around the park in a poor posture with shoulders forward in a head down position, and then reversed direction and walked in good posture with the shoulders back and the head level, he would make about five times as many eye contacts with a good posture compared to the poor posture.

Anecdotal observations, often repeated by many educators, suggest before the omnipresent smartphone, students would look around and talk to each other before a university class began. Now, when Generation Z students enter an in-person class, they sit down, look down at their phone and tend not to interact with other students.

(3) Experience the effect of face-to-face in-person communication

During the first class meeting, ask students to put their cellphones away, meet with three or four other students for a few minutes, and share a positive experience that happened to them last week as well as what they would like to learn in the class.  After a few minutes, ask them to report how their energy and mood changed.

In our observational class study with 24 junior and senior college students in the in-person class and 54 students in the online zoom class, almost all report that that their energy and positive mood increased after they interacted with each other. The effects were more beneficial for the in-person small group sharing than the online breakout groups sharing on Zoom as shown in Figure 1.

Figure 1. Change in subjective energy and mood after sharing experiences synchronously in small groups either in-person or online.

Without direction of a guided exercise to increase social connections, students tend to stay within their ‘smartphone bubble’ while looking down (Bochicchio et al., 2022). As a result, they appear to be more challenged to meet and interact with other people face-to-face or by phone as is reflected in the survey data that Generation Z is dating much less and more lonely than the previous generations (Cox et al., 2023).  

What to do:

• Put the smartphone away so that you do not see it in social settings such as during meals or classes. This means that other people can be present with you and the activity of eating or learning.
• Do not permit smartphones in the classroom including universities unless it is required for a class assignment.
• In classrooms and in the corporate world, create activities that demands face-to-face synchronous communication.
• Unplug from the audio programs when walking and explore with your eyes what is going on around you.

(4) Looking down increases risk of injury and death

Looking down at a close screen reduces peripheral awareness and there by increases the risk of accidents and pedestrian deaths. Pedestrian deaths are up 69% since 2011 (Cova, 2024) and have consistently increased since the introduction of the iPhone in 2007 as shown in Figure 3.

Figure 3. Increase in pedestrian death since the introduction of the iphone (data plotted from https://www.iihs.org/topics/fatality-statistics/detail/pedestrians)

In addition, the increase use of mobile phones is also associated with hand and wrist pain from overuse and with serious injuries such as falls and texting while driving due to lack of peripheral awareness.  McLaughlin et al (2023) reports an increase in hand and wrist injuries as well serious injuries related to distracted behaviors, such as falls and texting while driving. The highest phone related injuries (lacerations) as reported from the 2011 to 2020 emergency room visits were people in the age range from 11–20 years followed by 21–30 years.

What to do:

• Do not walk while looking at your smartphone. Attend to the environment around you.
• Unplug from the audio podcasts when walking and explore with your eyes what is going on around you.
• Sit or stop walking when answering the smartphone to reduce the probability of an accident.
• For more pragmatic suggestions, see the book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, by Peper, Harvey and Faass (2020).

(5) Looking at screens increases the risk of myopia

Looking at a near screen for long periods of time increases the risk of myopia (near sightedness) which means that distant vision is more blurry. Myopia has increased as children predominantly use computers or, smartphones with smaller screen at shorter distances.  By predominantly focusing on nearby screens without allowing the eye to relax remodels the eyes structure. Consequently, myopia has increase in the U.S. from 25 percent in the early 1970s to nearly 42 percent three decades later (OHSU, 2022).

Looking only at nearby screens, our eyes converge and the ciliary muscles around the lens contract and remain contracted until the person looks at the far distance. The less opportunity there is to allow the eyes to look at distant vision, the more myopia occurs. in Singapore 80 per cent of young people aged 18 or below have nearsightedness and  20 % of the young people have high myopia as compared to 10 years ago (Singapore National Eye Centre, 2024). The increase in myopia is a significant concern since high myopia is associated with an increased risk of vision loss due to cataract, glaucoma, and myopic macular degeneration (MMD). MMD is rapidly increasing and one of the leading causes of blindness in East Asia that has one of the highest myopia rates in the world (Sankaridurg et al., 2021).

What to do:

• Every 20 minutes stop looking at the screen and look at the far distance to relax the eyes for 20 seconds.
• Do not allow young children access to cellphones or screens.  Let them explore and play in nature where they naturally alternate looking at far and near objects.
• Implement the guided eye regenerating practices descrubed in the article, Resolve eyestrain and screen fatigue,  by Peper (2021).
• Read Meir Schneider’s (2016) book, Vision for Life, for suggestions how to maintain and improve vision.

(6) Looking down increases tech neck discomfort

Looking down at the phone while standing or sitting strains the neck and shoulder muscles because of the prolonged forward head posture as illustrated in the YouTube video, Tech Stress Symptoms and Causes (DeWitt, 2018). Using a smartphone while standing or walking causes a significant increase in thoracic kyphosis and trunk (Betsch et al., 2021).  When the head is erect, the muscle of the neck balance a weight of about 10 to 12 pounds or, approximately 5 kilograms; however, when the head is forward at 60 degrees looking at your cell phone the forces on the muscles are about 60 pound or more than 25 kilograms, as illustrated in Figure 4 (Hansraj, 2014).  

Figure 4. The head forward position puts as much as sixty pounds of pressure on the neck muscles and spine (by permission from Dr. Kenneth Hansraj, 2014).

This process is graphically illustrated in the YouTube video, Text Neck Symptoms and Causes Video, produced by Veritas Health (2020).

What to do:

• Keep the phone in front of you so that you do not slouch down by having your elbow support on the table.
• Every ten minutes stretch, look up and roll your shoulders backwards.
• Wear a posture feedback device such as the UpRight Go 2 to remind you when you slouch to change posture and activity (Peper et al., 2019; Stuart, Godfrey & Mancini, 2022).
• Take Alexander Technique lessons to improve your posture (Cacciatore, Johnson, & Cohen, 2020; AmAT, 2024; STAT, 2024).

(7) Looking down increases negative memory recall and depression

In our previous research, Peper et al. (2017) have found that recalling hopeless, helpless, powerless, and defeated memories is easier when sitting in a slouched position than in an upright position. Recalling positive memories is much easier when sitting upright and looking slightly upward than sitting slouched position. If attempting to recall positive memories the brain has to work hard as indicated by an significantly higher amplitudes of beta2, beta3, and beta4 EEG (i.e., electroencephalograph) when sitting slouched then when sitting upright  (Tsai et al., 2016). 

Not only does the postural position affect memory recall, it also affects mental math under time-pressure performance.  When students sit in a slouched position, they report that is much more difficult to do mental math (serial 7ths) than when in the upright position (Peper et al., 2018).  The effect of posture is most powerful for the 70% of students who reported that they blanked out on exams, were anxious, or worried about class performance or math. For the 30% who reported no performance anxiety, posture had no significant effect.  When students become aware of slouching thought posture feedback and then interrupt their slouching by sitting up, they report an increase in concentration, attention and school performance (Peper et al., 2024).

How we move and walk also affects our subjective energy. In most cases, when people sit for a long time, they report feeling more fatigue; however, if participants interrupt sitting with short movement practices they report becoming less fatigue and improved cognition (Wennberg et al., 2016). The change in subjective energy and mood depends upon the type of movement practice.  Peper & Lin (2012) reported that when students were asked to walk in a slow slouching pattern looking down versus to walk quickly while skipping and looking up, they reported that skipping significantly increased their subjective energy and mood while the slouch walking decreased their energy.  More importantly, student who had reported that they felt depressed during the last two years had their energy decrease significantly more when walking very slowly while slouched than those who did not report experiencing depression.  Regardless of their self-reported history of depression, when students skipped, they all reported an increase in energy (Peper & Lin, 2012; Miragall et al., 2020).

What to do:

• Walk with a quick step while looking up and around.
• Wear a posture feedback device such as the UpRight Go 2 to remind you when you slouch to change posture and activity (Peper et al., 2019; Roggio et al., 2021).
• When sitting put a small pillow in the mid back so that you can sit more erect (for more suggestions, see the article by Peper et al., 2017a, Posture and mood: Implications and applications to therapy).
• Place photo and other objects that you like to look a slightly higher on your wall so that you automatically look up.

(8) Shallow breathing increases the risk for anxiety

When slouching we automatically tend to breathe slightly faster and more shallowly.  This breathing pattern increases the risk for anxiety since it tends to decrease pCO₂  (Feinstein et al., 2022; Meuret, Rosenfield, Millard & Ritz, 2023; Paulus, 2013; Smits et al., 2022; Van den Bergh et al., 2013). Sitting slouched also tends to inhibit abdominal expansion during the inhalation because the waist is constricted by clothing or a belt –sometimes labeled as ‘designer jean syndrome’ and may increase abdominal symptoms such as acid reflux and irritable bowel symptoms (Engeln & Zola, 2021; Peper et al., 2016; Peper et al., 2020). When students learn diaphragmatic breathing and practice diaphragmatic breathing whenever they shallow breathe or hold their breath, they report a significant decrease in anxiety, abdominal symptoms and even menstrual cramps (Haghighat et al., 2020; Peper et al., 2022; Peper et al., 2023).

What to do:

• Loosen your belt and waist constriction when sitting so that the abdomen can expand.
• Learn and practice effortless diaphragmatic breathing to reduce anxiety.

Conclusion

There are many topics related to postural health and technology overuse that were addressed in this article. Some topics are beyond the scope of the article, and therefore seen as limitations. These relate to diagnosis and treatment of attentional deficits, or dependency leading to tolerance, withdrawal and cravings (e.g., addiction-like symptoms), or of modeling relationships between factors that contribute to the increasing epidemic of mental and physical illness associated with smartphone use and social media, such as hypotheses examining the extent to which digital technologies (a) displace/ replace; (b) compete/ interfere with; and/or, (c) complement/ enhance in-person activities and relationships. Typical pharmaceutical ‘treat-the-symptom’ approaches for addressing ‘tech stress’ related to technology overuse includes prescribing ‘anxiolytics, pain-killers and muscle relaxants’ (Kazeminasab et al., 2022; Kim, Seo, Abdi, & Huh, 2020). Although not usually included in diagnosis and treatment strategies, suggesting improving posture and breathing practices can significantly affect mental and physical health.  By changing posture and breathing patterns, individuals may have the option to optimize their health and well-being.

Explore the following blogs for more background and useful suggestions

Reflections on the increase in Autism, ADHD, anxiety and depression: Part 1-bonding, screen time, and circadian rhythm

Increase attention, concentration and school performance

Reduce anxiety

Reduce stress, anxiety and negative thoughts with posture, breathing and reframing

References

Abbasi, G. A., Jagaveeran, M., Goh, Y. N., & Tariq, B. (2021). The impact of type of content use on smartphone addiction and academic performance: Physical activity as moderator. Technology in Society, 64, 101521. https://doi.org/10.1016/j.techsoc.2020.101521

Abusamak, M., Jaber, H. M., & Alrawashdeh, H. M. (2022). The effect of lockdown due to the COVID-19 pandemic on digital eye strain symptoms among the general population: a cross-sectional survey. Frontiers in Public Health, 10, 895517. https://doi.org/10.3389/fpubh.2022.895517

Akulwar-Tajane, I., Parmar, K. K., Naik, P. H., & Shah, A. V. (2020). Rethinking screen time during COVID-19: impact on psychological well-being in physiotherapy students. Int J Clin Exp Med Res, 4(4), 201-216. https://doi.org/10.26855/ijcemr.2020.10.014

Aliberti, S., Invernizzi, P. L., Scurati, R., & D’Isanto, T. (2020). Posture and skeletal muscle disorders of the neck due to the use of smartphones.  Journal of Human Sport and Exercise , 15 (3proc), S586-S598. https://www.jhse.ua.es/article/view/2020-v15-n3-proc-posture-skeletal-muscle-disorders-neck-smartpho;  https://air.unimi.it/retrieve/handle/2434/774436/1588570/HSE%20-%20Posture%20and%20skeletal%20muscle%20disorders.pdf

AmSAT. (2024). American Society for the Alexander Technique. Accessed July 27, 2024. https://alexandertechniqueusa.org/

Arundell, L., Salmon, J., Koorts, H. et al. (2019). Exploring when and how adolescents sit: cross-sectional analysis of activPAL-measured patterns of daily sitting time, bouts and breaks. BMC Public Health 19, 653. https://doi.org/10.1186/s12889-019-6960-5

Bhargava, V. R., & Velasquez, M. (2021). Ethics of the attention economy: The problem of social media addiction. Business Ethics Quarterly, 31(3), 321-359. https://doi.org/10.1017/beq.2020.32

Betsch, M., Kalbhen, K., Michalik, R., Schenker, H., Gatz, M., Quack, V., Siebers, H., Wild, M., & Migliorini, F. (2021). The influence of smartphone use on spinal posture – A laboratory study. Gait Posture, 85, 298-303. https://doi.org/10.1016/j.gaitpost.2021.02.018

Blodgett, J.M., Ahmadi, M.N.,  Atkin, A.J.,  Chastin,  S., Chan, H-W., Suorsa, K., Bakker, E.A., Hettiarcachchi, P., Johansson, P.J.,  Sherar,L. B., Rangul, V., Pulsford, R.M…. (2024). ProPASS Collaboration , Device-measured physical activity and cardiometabolic health: the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium, European Heart Journal, 45(6) 458–471, https://doi.org/10.1093/eurheartj/ehad717

Bochicchio, V., Keith, K., Montero, I., Scandurra, C., & Winsler, A. (2022). Digital media inhibit self-regulatory private speech use in preschool children: The “digital bubble effect”. Cognitive Development, 62, 101180. https://doi.org/10.1016/j.cogdev.2022.101180

Braghieri, L., Levy, R., & Makarin, A. (2022). Social Media and Mental Health (July 28, 2022). Available at SSRN: https://ssrn.com/abstract=3919760 or http://dx.doi.org/10.2139/ssrn.3919760

Cacciatore, T. W., Johnson, P. M., & Cohen, R. G. (2020). Potential mechanisms of the Alexander technique: Toward a comprehensive neurophysiological model. Kinesiology Review, 9(3), 199-213. https://doi.org/10.1123/kr.2020-0026

Chandrasekaran, B., & Ganesan, T. B. (2021). Sedentarism and chronic disease risk in COVID 19 lockdown–a scoping review. Scottish Medical Journal, 66(1), 3-10. https://doi.org/10.1177/0036933020946336

Childers, C., & Boatwright, B. (2021). Do digital natives recognize digital influence? Generational differences and understanding of social media influencers. Journal of Current Issues & Research in Advertising, 42(4), 425-442. https://doi.org/10.1080/10641734.2020.1830893

Cox, D.A., Hammond, K.E., & Gray, K. (2023). Generation Z and the Transformation of American Adolescence: How Gen Z’s Formative Experiences Shape Its Politics, Priorities, and Future. Survey Center of American Life, November 23, 2023. Accessed July 4, 2024. https://www.americansurveycenter.org/research/generation-z-and-the-transformation-of-american-adolescence-how-gen-zs-formative-experiences-shape-its-politics-priorities-and-future/

Crain, M. (2021). Profit over privacy: How surveillance advertising conquered the internet. U of Minnesota Press. https://www.amazon.com/Profit-over-Privacy-Surveillance-Advertising/dp/1517905044

Cova, E. (2024). Pedestrian fatalities at historic high. Smart Growth America (data from U.S. Department of Transportation (USDOT). Accessed July 2, 2024. https://smartgrowthamerica.org/pedestrian-fatalities-at-historic-high/

Duarte, F. (2023). Average Screen Time for Teens (2024). Exploding Topics. Accessed July 5, 2024. https://explodingtopics.com/blog/screen-time-for-teens#average

DeWitt, D. (2018). How Does Text Neck Cause Pain? Spine-Health October 26, 2018. Accessed July 5, 2024. https://www.spine-health.com/conditions/neck-pain/how-does-text-neck-cause-pain

Dockrill, P. (2020). Your laptop charger is more powerful than Apollo11’s computer, says apple developer. Science Alert, Janural 12, 2020. Accessed July 4, 2024. https://www.sciencealert.com/apollo-11-s-computer-was-less-powerful-than-a-usb-c-charger-programmer-discovers

Elsayed, W. (2021). Covid-19 pandemic and its impact on increasing the risks of children’s addiction to electronic games from a social work perspective. Heliyon, 7(12). https://doi.org/10.1016/j.heliyon.2021.e08503

Engeln, R., & Zola, A. (2021). These boots weren’t made for walking: gendered discrepancies in wearing painful, restricting, or distracting clothing. Sex roles, 85(7), 463-480. https://doi.org/10.1007/s11199-021-01230-9

Fainmesser, I. P., Galeotti, A., & Momot, R. (2023). Digital privacy. Management Science, 69(6), 3157-3173. https://doi.org/10.1287/mnsc.2022.4513

Feinstein, J. S., Gould, D., & Khalsa, S. S. (2022). Amygdala-driven apnea and the chemoreceptive origin of anxiety. Biological psychology, 170, 108305. https://10.1016/j.biopsycho.2022.108305

Fiebert, I., Kistner, F., Gissendanner, C., & DaSilva, C. (2021). Text neck: An adverse postural phenomenon. Work, 69(4), 1261-1270. https://doi.org/10.3233/WOR-213547

Goodwin, R. D., Weinberger, A. H., Kim, J. H., Wu. M., & Galea, S. (2020). Trends in anxiety among adults in the United States, 2008–2018: Rapid increases among young adults. Journal of Psychiatric Research. 130, 441–446. https://doi.org/10.1016/j.jpsychires.2020.08.014

Gupta, N. (2023). Impact of smartphone overuse on health and well-being: review and recommendations for life-technology balance. Journal of Applied Sciences and Clinical Practice, 4(1), 4-12. https://doi.org/10.4103/jascp.jascp_40_22

Haghighat, F., Moradi, R., Rezaie, M., Yarahmadi, N., & Ghaffarnejad, F. (2020). Added Value of Diaphragm Myofascial Release on Forward Head Posture and Chest Expansion in Patients with Neck Pain: A Randomized Controlled Trial.  Research Square. https://doi.org/10.21203/rs.3.rs-53279/v1

Haidt, J. (2024). The Anxious generation: How the great rewiring of childhood is causing an epidemic of mental illness. New York: Penguin Press. https://www.anxiousgeneration.com/book

Hansraj, K.K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 25, 277-279. https://pubmed.ncbi.nlm.nih.gov/25393825/

Hernandez-de-Menendez, M., Escobar Díaz, C. A., & Morales-Menendez, R. (2020). Educational experiences with Generation Z. International Journal on Interactive Design and Manufacturing (IJIDeM), 14(3), 847-859. https://doi.org/10.1007/s12008-020-00674-9

Huh-Yoo, J., & Rader, E. (2020). It’s the Wild, Wild West: Lessons learned from IRB members’ risk perceptions toward digital research data. Proceedings of the ACM on Human-Computer Interaction, 4(CSCW1), 1-22. https://doi.org/10.1145/3392868

IIHS (2024). Fatality Facts 2022Pedestrians. The Insurance Institute for Highway Safety (IIHS). Accessed July 2, 2024. https://www.iihs.org/topics/fatality-statistics/detail/pedestrians

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J., … & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders, 23, 1-13. https://doi.org/10.1186/s12891-021-04957-4

Kim, K. H., Seo, H. J., Abdi, S., & Huh, B. (2020). All about pain pharmacology: what pain physicians should know. The Korean journal of pain, 33(2), 108-120. https://doi.org/10.3344/kjp.2020.33.2.108

Kushlev, K., & Leitao, M. R. (2020). The effects of smartphones on well-being: Theoretical integration and research agenda. Current opinion in psychology, 36, 77-82. https://doi.org/10.1016/j.copsyc.2020.05.001

Lewis, H.R. (2024). Mechanical intelligence and counterfeit humanity. Harvard Magazine, 126(6), 38-40. https://www.harvardmagazine.com/2024/07/harry-lewis-computers-humanity#google_vignette

Mark, G. (2023). Attention Span: A Groundbreaking Way to Restore Balance, Happiness and Productivity. Toronto, Canada: Hanover Square Press. https://www.amazon.com/Attention-Span-Finding-Fighting-Distraction-ebook/dp/B09XBJ29W9

Mason, M. C., Zamparo, G., Marini, A., & Ameen, N. (2022). Glued to your phone? Generation Z’s smartphone addiction and online compulsive buying. Computers in Human Behavior, 136, 107404. https://doi.org/10.1016/j.chb.2022.107404

McLaughlin, W.M., Cravez, E., Caruana, D.L., Wilhelm, C., Modrak, M., & Gardner, E.C. (2023). An Epidemiological Study of Cell Phone-Related Injuries of the Hand and Wrist Reported in United States Emergency Departments From 2011 to 2020. J Hand Surg Glob, 5(2),184-188. https://doi.org/10.1016/j.jhsg.2022.11.009

Meuret, A. E., Rosenfield, D., Millard, M. M., & Ritz, T. (2023). Biofeedback Training to Increase Pco2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?. Psychosomatic medicine, 85(5), 440-448. https://doi.org/10.1097/PSY.0000000000001188

Miragall, M., Borrego, A., Cebolla, A., Etchemendy, E., Navarro-Siurana, J., Llorens, R., … & Baños, R. M. (2020). Effect of an upright (vs. stooped) posture on interpretation bias, imagery, and emotions. Journal of Behavior Therapy and Experimental Psychiatry, 68, 101560. https://doi.org/10.1016/j.jbtep.2020.101560

Mohan, A., Sen, P., Shah, C., Jain, E., & Jain, S. (2021). Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: Digital eye strain among kids (DESK study-1). Indian journal of ophthalmology, 69(1), 140-144. https://doi.org/10.4103/ijo.IJO_2535_20

Muchacka-Cymerman, A. (2022). ‘I wonder why sometimes I feel so angry’ The associations between academic burnout, Facebook intrusion, phubbing, and aggressive behaviours during pandemic Covid 19. Polish Psychological Bulletin, 53(4). https://doi.org/10.24425/ppb.2022.143376

Nakshine, V. S., Thute, P., Khatib, M. N., & Sarkar, B. (2022). Increased screen time as a cause of declining physical, psychological health, and sleep patterns: a literary review. Cureus, 14(10). https://doi.org/10.7759/cureus.30051

Nawaz, S., Bhowmik, J., Linden, T., & Mitchell, M. (2024). Validation of a modified problematic use of mobile phones scale to examine problematic smartphone use and dependence. Heliyon, 10(2). https://doi.org/10.1016/j.heliyon.2024.e24832

Nicholas, A. J. (2020). Preferred learning methods of generation Z. Faculty and Staff – Articles & Papers. Digital Commons @ Salve Regina. Salve Regina University. https://digitalcommons.salve.edu/fac_staff_pub/74 

OHSU. (2022). Myopia on the rise, especially among children. Casey Eye Institute. Oregan Health and Science University. Accessed July 7, 2024. https://www.ohsu.edu/casey-eye-institute/myopia-rise-especially-among-children

Orsolini, L., Longo, G., & Volpe, U. (2023). The mediatory role of the boredom and loneliness dimensions in the development of problematic internet use. International Journal of Environmental Research and Public Health, 20(5), 4446. https://doi.org/10.3390/ijerph20054446

Pandey, R., Gaur, S., Kumar, R., Kotwal, N., & Kumar, S. (2020). Curse of the technology-computer related musculoskeletal disorders and vision syndrome: a study. International Journal of Research in Medical Sciences, 8(2), 661. https://doi.org/10.18203/2320-6012.ijrms20200253

Park, J. C., Kim, S., & Lee, H. (2020). Effect of work-related smartphone use after work on job burnout: Moderating effect of social support and organizational politics. Computers in human behavior, 105, 106194. https://doi.org/10.1016/j.chb.2019.106194

Paulus, M.P. (2013). The breathing conundrum-interoceptive sensitivity and anxiety. Depress Anxiety.30(4), 315-20. https://doi.org/10.1002/da.22076

Peper, E. (2021). Resolve eyestrain and screen fatigue. Well Being Journal, 30(1), 24-28. https://wellbeingjournal.com/resolve-eyestrain-and-screen-fatigue/

Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49. https://doi.org/10.5298/1081-5937-44.1.03

Peper, E., Chen, S., Heinz, N. & Harvey, R. (2023). Hope for menstrual cramps (dysmenorrhea) with breathing.  Biofeedback, 51(2), 44–51. https://doi.org/10.5298/1081-5937-51.2.04

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91 

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books. https://www.amazon.com/Beyond-Ergonomics-Prevent-Fatigue-Burnout/dp/158394768X

Peper, E., Harvey, R., & Mason, L. (2019). “Don’t slouch!” Improve health with posture feedback. Townsend Letter-The Examiner of Alternative Medicine, 436, 58-61. https://www.researchgate.net/publication/337424599_Don%27t_slouch_Improve_health_with_posture_feedback

Peper, E., Harvey, R., Mason, L., & Lin, I.-M. (2018). Do better in math: How your body posture may change stereotype threat response. NeuroRegulation, 5(2), 67–74. http://dx.doi.org/10.15540/nr.5.2.67

Peper, E., Harvey, R. & Rosegard, E. (2024). Increase attention, concentration and school performance with posture feedback. Biofeedback, 52(2). https://doi.org/10.5298/1081-5937-52.02.07

Peper, E. & Lin, I-M. (2012). Increase or decrease depression-How body postures influence your energy level.  Biofeedback, 40 (3), 126-130. https://doi.org/10.5298/1081-5937-40.3.01

Peper, E., Lin, I-M, & Harvey, R. (2017a). Posture and mood: Implications and applications to therapy. Biofeedback, 35(2), 42-48. https://doi.org/10.5298/1081-5937-45.2.03

Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback.45 (2), 36-41. https://doi.org/10.5298/1081-5937-45.2.01

Peper, E., Mason, L., Harvey, R., Wolski, L, & Torres, J. (2020). Can acid reflux be reduced by breathing? Townsend Letters-The Examiner of Alternative Medicine, 445/446, 44-47. https://www.townsendletter.com/article/445-6-acid-reflux-reduced-by-breathing/

Quach, S., Thaichon, P., Martin, K. D., Weaven, S., & Palmatier, R. W. (2022). Digital technologies: tensions in privacy and data. Journal of the Academy of Marketing Science, 50(6), 1299-1323. https://doi.org/10.1007/s11747-022-00845-y

Resnik, D. B. (2021). Standards of evidence for institutional review board decision-making. Accountability in research, 28(7), 428-455. https://doi.org/10.1080/08989621.2020.1855149

Roggio, F., Ravalli, S., Maugeri, G., Bianco, A., Palma, A., Di Rosa, M., & Musumeci, G. (2021). Technological advancements in the analysis of human motion and posture management through digital devices. World journal of orthopedics, 12(7), 467. https://doi.org/10.5312/wjo.v12.i7.467

Sankaridurg, P., Tahhan, N., Kandel, H., Naduvilath, T.,   Zou, H., Frick,K.D., Marmamula, S., Friedman, D.S., Lamoureux, e. Keeffe, J.   Walline,  J.J., Fricke, T.R., Kovai, V., & Resnikoff, S. (2021) IMI Impact of Myopia. Invest. Ophthalmol. Vis. Sci, 62(5), 2. https://doi.org/10.1167/iovs.62.5.2

Satılmış, S. E., Cengız, R., & Güngörmüş, H. A. (2023). The relationship between university students’ perception of boredom in leisure time and internet addiction during social isolation process. Bağımlılık Dergisi, 24(2), 164-173. https://doi.org/10.51982/bagimli.1137559

Schenarts, P. J. (2020). Now arriving: surgical trainees from generation Z. Journal of surgical education, 77(2), 246-253. https://doi.org/10.1016/j.jsurg.2019.09.004

Schneider, M. (2016).  Vision for life. Ten Steps to Natural Eyesight Improvement. Berkeley: North Atlantic books. https://www.amazon.com/Vision-Life-Revised-Eyesight-Improvement/dp/1623170087

Singapore National Eye Centre.  (2024). Severe myopia cases among children in Singapore almost doubled in past decade. CAN. Accessed July 4, 2024. https://www.channelnewsasia.com/singapore/myopia-children-cases-almost-double-glasses-eye-checks-4250266

Smits, J. A., Monfils, M. H., Otto, M. W., Telch, M. J., Shumake, J., Feinstein, J. S., … & Exposure Therapy Consortium. (2022). CO2 reactivity as a biomarker of exposure-based therapy non-response: study protocol. BMC psychiatry, 22(1), 831. https://doi.org/10.1186/s12888-022-04478-x

STAT (2024). The society of teachers of the Alexander Technique. Assessed July 27, 2024. https://alexandertechnique.co.uk/

Stuart, S., Godfrey, A., & Mancini, M. (2022). Staying UpRight in Parkinson’s disease: A pilot study of a novel wearable postural intervention. Gait & Posture, 91, 86-93. https://doi.org/10.1016/j.gaitpost.2021.09.202

Swatzyna, R. (2023).  Personal communications.

Szymkowiak, A., Melović, B., Dabić, M., Jeganathan, K., & Kundi, G. S. (2021). Information technology and Gen Z: The role of teachers, the internet, and technology in the education of young people. Technology in Society, 65, 101565. https://doi.org/10.1016/j.techsoc.2021.101565

Tsai, H. Y., Peper, E., & Lin, I. M.*(2016). EEG patterns under positive/negative body postures and emotion recall tasks. NeuroRegulation, 3(1), 23-27. https://doi.org/10.15540/nr.3.1.23

Van den Bergh, O., Zaman, J., Bresseleers, J., Verhamme, P.,   Van Diest, I. (2013). Anxiety, pCO2 and cerebral blood flow, International Journal of Psychophysiology, 89 (1), 72-77. https://doi.org/10.1016/j.ijpsycho.2013.05.011

Veritas Health. (2020). Text Neck Symptoms and Causes Video. YouTube video, accessed August 29, 2024. https://www.spine-health.com/conditions/neck-pain/how-does-text-neck-cause-pain?source=YT

Wennberg, P., Boraxbekk, C., Wheeler, M., et al. (2016). Acute effects of breaking up prolonged sitting on fatigue and cognition: a pilot study. BMJ Open, 6, e009630. https://doi.org/10.1136/bmjopen-2015-009630

Yang, K. H. (2022). Selling consumer data for profit: Optimal market-segmentation design and its consequences. American Economic Review, 112(4), 1364-1393. https://www.aeaweb.org/articles/pdf/doi/10.1257/aer.20210616

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[1] Correspondence should be addressed to: Erik Peper, Ph.D., Institute for Holistic Health Studies, Department of Recreation, Parks, Tourism and Holistic Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132  Email: epeper@sfsu.edu;  web: www.biofeedbackhealth.org;  blog: www.peperperspective.com

[2] I thank Ronald Swatzyna (2023), Licensed Clinical Social Worker for sharing this exercise with me.  He discovered that a difference in the number of eye contacts depending how he walked. When he walked a 3.1 mile loop around the park  in a poor posture- shoulders forward, head down position- and then reversed direction and walked in good posture with the shoulders back and the head level, that  that he make about 5 times as many eye contacts with good posture compared to the poor posture. He observed that he make about five times as many eye contacts with good posture as compared to the poor posture.

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