CLINICAL GUIDELINES
Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: A Systematic Evidence Review for the U.S. Preventive Services Task Force
Selvi B. Williams, MD, MPH;
Evelyn P. Whitlock, MD, MPH;
Elizabeth A. Edgerton, MD, MPH;
Paula R. Smith, RN, BSN; and
Tracy L. Beil, MS
7 August 2007 | Volume 147 Issue 3 | Pages 194-206
Background: Motor vehicle–related injuries are the leading cause of death among children, adolescents, and young adults.
Purpose: To systematically review evidence of the effectiveness of counseling people of any age in primary care settings about occupant restraints or alcohol-related driving to prevent injuries.
Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, and Traffic Research Information Service; published systematic evidence reviews; experts; and bibliographies of selected trials.
Study Selection: Randomized, controlled trials (RCTs); controlled clinical trials (CCTs); or comparative observational research studies that evaluated behavioral counseling interventions feasible to conduct in primary care or referral from primary care.
Data Extraction: Investigators abstracted data on study design, setting, patients, interventions, outcomes, and quality-related study details.
Data Synthesis: Trials report that counseling to increase the use of child safety seats leads to increased short-term restraint use (7 CCTs, 6 RCTs). Interventions that included a demonstration of correct use or distribution of a free or reduced-cost child safety seat reported larger effects. Few trials described the effect of counseling children 4 to 8 years of age to use booster seats (1 RCT); counseling older children, adolescents, or adults to use seat belts (1 CCT, 2 RCTs); or counseling unselected primary care patients to reduce alcohol-related driving behaviors (no trials).
Limitations: Most of the relevant trials were published before the widespread enactment of child safety seat legislation and had methodological flaws.
Conclusions: The incremental effect of primary care counseling to increase the correct use of child safety seats in the current regulatory environment is not established. The effectiveness of primary care counseling to reduce alcohol-related driving has not been tested. Studies are needed.
Author and Article Information
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From the Oregon Evidence-based Practice Center and Kaiser Permanente Center for Health Research, Portland, Oregon, and the Agency for Healthcare Research and Quality, Rockville, Maryland.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors acknowledge the reviewers of the full evidence report (Flaura Winston, MD, MPH; Randy Elder, MEd; and David Grossman, MD, MPH); the guidance from the USPSTF liaisons; and Janelle Guirguis-Blake, MD, MPH, for their contributions to this project. The authors also acknowledge Elizabeth O'Connor, PhD, and Jeffrey Fellows, PhD, for their scientific contributions throughout the course of conducting the evidence review and thank Daphne Plaut, MLS, Taryn Cardenas, BS, and Kevin Lutz, MFA, for their assistance in the preparation of this manuscript.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (http://www.preventiveservices.ahrq.gov).
Current Author Addresses: Drs. Williams and Whitlock, Ms. Smith, and Ms. Beil: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.
Dr. Edgerton: Department of Pediatrics, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010.
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