An Open Letter to Maryland State Legislators: Digital Device Health & Safety Bill — A Win-Win

UPDATE: 2018 BILL : HB1110, “Public Schools – Health and Safety Guidelines and Procedures – Digital Devices.”

Thank you in advance for your time and consideration. Please support proposed bills regarding Health and Safety Guidelines and Procedures – Digital Devices.  This is especially important with the vastly increased use of new devices such as tablets, laptops, and smartphones, as well as screen-based learning and testing in schools.

You might have been told recently that not enough is known about health or safety measures in this arena, especially from school board representatives who may not be aware of what is already available. Yet current medical research clearly indicates the need for digital device safety guidelines in schools, and offers actual tips and training.

Medical and professionally informed guidelines would help prevent ergonomic and other long-term fallout: such as computer vision syndrome, neck pain, etc. (see lists and research below). Many of these devices are being used by children as young as 6-years-old in various school districts.

Support for this bill would be a win-win.

In 2017, the Senate Bill and House bill gained steam:

“Requiring the Department of Health and Mental Hygiene, in consultation with the State Department of Education, to develop health and safety guidelines and procedures for the use of digital devices in public school classrooms; and requiring each county board of education to implement specified health and safety guidelines and procedures for the use of digital devices in public school classrooms beginning in the 2018-2019 school year.”

Maryland, which offers some of the best public school districts in the nation, should be a leader on safe student use of tech in classrooms. Based on in-depth research during the past year, here are a few citations for quick reference. Note especially the school-related work of Karen Jacobs, Clinical Professor, Department of Occupational Therapy at Boston University, one of the primary experts in the field.

For example, one six-year cohort study led by Jacobs, cited* below, concludes: “Participatory ergonomics training and use of external devices may have significant health benefits for children involved in notebook programs who have daily exposure to this technology for school and leisure purposes.”

Some of the issues cited by children using the devices: neck and shoulder pain, back pain, and other musculoskeletal discomforts, as well as “visual symptoms such as dry/watery eyes and sore, tired eyes during the study.

As you are likely aware, Baltimore County Public Schools is pursuing a district-wide digital initiative others expect could be replicated around the state of Maryland. This laptop-per-student program (grades 1-12) has a number of extreme cost burdens — approaching $300 million for the first several years alone — and other problems so far, including declining county PARCC standardized test scores. It’s titled Students and Teachers Accessing Tomorrow, or STAT.

STAT and similar digital initiatives, like those in Montgomery County Public Schools and neighboring Prince George’s County, translate to increased student screen time. Some tech upgrades and digital options in schools are needed, when reasonable and balanced. Safety measures are a digital equity issue as well, because many children in less affluent school districts also have reduced access to appropriate health care screening or mitigation.

You might hear arguments that there’s no evidence of problems, but as you can see that is not true. You might hear pushback about mandates, yet when children are at risk –wrist pain, retinal issues, or behavioral issues related to gaming curricula, etc.– it is our government’s role to serve its people, and to help keep safe the hundreds of thousands of families in Maryland. 

Unfortunately, many school systems are entrenched in digital initiatives and contracts that rely on corporate vendors. As a result, legislators and others might encounter pressure from the education technology industry to halt such bills, as these companies would like to increase student screen time to enable for-profit digital curricula and ongoing embedded assessments or online tests. I have no problem with such companies per se, yet should corporate priorities influence how we oversee the health of the next generation? There needs to be consistent oversight. (School-edtech ties also can prove problematic on a number of levels.)

See this story re: some of those concerns, and possible school leader bias regarding tech.

In terms of overall safety, can much be done? Yes: screen-time guidelines, and limits on per-day usage, are advisable. Ergonomic education for teachers. Frequent breaks. Better posture training. Appropriate lighting. Proper screen height. Supports for neck or forearms. See the in-depth work by advocate Cindy Eckard, as well as researchers from Harvard University, the Curtis National Hand Center, The University of Washington, among others via additional links and quotes below.

Feel free to share this information with fellow legislators and others. Baltimore County Public Schools’ health council offered a few suggestions but has not addressed this issue adequately–which is why we can’t rely on county school systems to do what is appropriate. We also can’t rely on the vagaries of information and medical resources available to various school districts, especially in areas where poverty and equity are challenges. 

The University of Southern California reports that African-American children are most prone to myopia, followed by Asian-Americans, Latinos and Caucasians.

In the end, these parameters and guidelines should also be in place as a reference point for private and parochial schools, as children in these environments should be protected as well.

As the Digital Age progresses, this is a global issue especially for our next generation. Maryland should set a very high standard for the safety of our children.

An open letter from Joanne C. Simpson, BCPS parent, college educator, freelance journalist, to Maryland State Senators on the Education, Health, and Environmental Affairs Committee.


News Coverage: 

A CBS News story on HB866/SB1089


Baltimore County Public Schools’ STAT program costs and related issues:

Studies, Jacobs: 

Jacobs, K., Hudak, S., McGiffert, J. (at press). Computer-related posture and musculoskeletal discomfort in middle school students. WORK.

*Jacobs, K., Kaldenberg, J., Markowitz, J., Wuest, E., Hellman, M., Umez-Eronini, A., Barr, A. (2013). An ergonomics training program for student notebook computer users: Preliminary outcomes of a six-year cohort study. WORK, 221–230.

Jacobs, K., Foley, G., Punnett, L., Hall, V., Gore, R., Brownson, E., Ansong, E., Markowitz, J., McKinnon, M., Steinberg, S., Wuest, E., Dibaccari, L.,  & Ing, A. (2011). University students’ notebook computer use: lessons learned using e-diaries to report musculoskeletal discomfort. Ergonomics, 54:2, 206-21


Note: “Karen Jacobs, a Boston University clinical professor of occupational therapy, has authored several studies on tech ergonomics, with upcoming findings showing that ergonomic education significantly improves neck posture in middle school students using tablets.

Trained occupational therapists already based at some schools can offer guidance, Jacobs said. “Children don’t want to be in pain,” she added, noting that kids — some of whom experience headaches, eye strain or neck discomfort after using tech devices — need frequent breaks and physical movement, not static postures. “It’s really important that our children are doing lots of different things.”

Debra Milek, a University of Washington associate professor in environmental and occupational health sciences, noted that worn-out tendons, neck pain and carpal tunnel syndrome have plagued computer users and store cashiers, and ended the careers of guitarists. “Discomfort may be an early indicator of future injury,” Milek noted, “which is why it’s important to pay attention to how we use these devices.'”


Digital Disabilities 

Jacobs’ peer-reviewed articles with others that might also be related. (Study breaks and other practical tips)

Other research: Harvard University T.H. Chan School of Public Health, Jack Dennerlein, Professor of Ergonomics and Safety. In 2012, he led a Harvard University study that found that adjusting tablet viewing angle — to as straight ahead as possible — provides relief.

Recent posts and Tweets (contact Cindy Eckard):

Quick List of Medical Concerns to watch for:

  1. Increased, irreversible myopia Because long-term fixed distance viewing is very well known to promote nearsightededness, the pre-teen and teenage developmental precondition for myopia is being exacerbated when middle school kids are required to stare at a computer for excessive periods of time. 10 – 15 year-old children are already prone to myopia; it’s the shape their eyes are taking at this stage in their physical development.
  2. Retinal damage and premature macular degeneration The UV blue light emissions that damage the back of our eyes are better able to penetrate children’s eyes because the kids are not blinking, and because a child’s eye doesn’t have the necessary pigmentation to protect against the blue light. So the child is literally staring into a computer with damaging blue light penetrating right to the back of his eye.
  3. Digital eye strain and musculoskeletal discomforts Experts in children’s health are quick to point out that children are not just small adults. When using digital devices, kids are often unaware of the discomfort they are experiencing and do not correct their posture or take a break when their eyes get dry or blurry.  They suffer more than adults, and don’t do anything about it.
  4. Sleeplessness and its damaging side effects Because so much work is done on a computer at school, most homework and studying also has to take place on a computer in the evening. This is especially problematic for our kids because the blue light from the digital devices suppresses a hormone called melatonin, which is necessary for sleep. Our kids are now being deprived of sleep because of the schools’ constant reliance on computers, which brings a host of additional serious health risks to our children. Some kids are actually being misdiagnosed with ADHD, when the truth is, they’re just exhausted.
  5. Increased propensity for psychological issues The constant use of digital devices is emerging as a psychological problem for many young people whose reliance on virtual experiences is replacing actual interaction with friends and family. Some experts, such as Dr. Nicholas Kardaras, are suggesting that digital devices are not only addictive, but lead to additional problems for young children such as depression, anxiety, pornography use and gambling. UCLA research has shown that children are losing their ability recognize emotional expressions in other people’s faces.

Supporting links for the above list:


Johns Hopkins University’s Mid-Year STAT Evaluation

STAT Year Three Mid-Year Evaluation Presentation by the Johns Hopkins Center for Research and Reform in Education (CRRE), which is working under a 2014-19 $711,000 contractwith the Baltimore County Public School system.

STAT Year Three, Mid-Year Evaluation Report by various CCRE researchers, some of whom also conduct reports for edtech industry companies and organizations; That includes a $80,000 study for DreamBox Learning Math, which is also a BCPS vendor with a nearly $1.2 million contract, set to be expanded. “Co-Principal Investigator (2015 – 2016). Efficacy study of DreamBox Learning Math. DreamBox ($80,000).”

February 16, 2017 Baltimore County Board of Education Curriculum and Instruction Committee meeting at which the evaluation was presented.

During the meeting, which was live streamed (see link above), BOE Member Ann Miller posted on her Facebook page: BCPS Board Member Ann Miller (NOTE:  LH = Lighthouse, the schools where STAT is piloted):

BCPS Board Member Ann Miller
BCPS Board Member Ann Miller Gilliss: What is explanation for performance changes? A: results are not statistically significant. LH schools were slightly more economically disadvantaged. Learning curve. Not enough data to show but encouraging on PARCC compared to state.
BCPS Board Member Ann Miller
BCPS Board Member Ann MillerGilliss: should we expect continued growth as we go forward? A: PARCC we are looking at LH schools in Y2. I would expect performance to be still low for new program. These results aren’t saying STAT was effective in achievement, but does say STAT didn’t interfere in achievement in Y2.