Counseling About Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use While Driving

• The USPSTF concludes that the current evidence is insufficient to assess the incremental benefit, beyond the efficacy of legislation and community-based interventions, of counseling in the primary care setting, in improving rates of proper use of motor vehicle occupant restraints (child safety seats, booster seats, and lap-and-shoulder belts). (Go to Clinical Considerations for definitions of proper use.)
  
  Rating: "I" Recommendation

Rationale:

Importance: Motor vehicle occupant injury is the leading cause of death in U.S. children, adolescents, and young adults age 3 to 33 years and of unintentional injury-related deaths for persons of all ages. Proper use of motor vehicle occupant restraints (child safety seats, booster seats, and lap-and-shoulder belts) is associated with a 45% to 70% reduction of fatality risk. Improper use reduces the efficacy of restraints substantially.

Recognition of behavior: Approximately 80% of adults use seat belts. General use of child safety seats is 90%, and booster seat use is rapidly increasing. However, proper use of child safety seats and booster seats in infants and children is low.

Effectiveness of counseling to change behavior: Legislation and community-based interventions along with counseling in primary care settings have dramatically increased the use of motor vehicle occupant restraints and have reduced the incidence of MVOIs in all populations. However, the incremental benefit of primary care counseling for general restraint use in the context of legislation and community interventions is unknown. There is insufficient evidence addressing the efficacy of counseling in the primary care setting to increase the proper use of motor vehicle occupant restraints in the current high-use environment. This constitutes a critical gap in the evidence for counseling.

Harms of counseling: There is no evidence addressing the harms of counseling; however, these potential harms are estimated to be none or minimal in magnitude. USPSTF assessment. The USPSTF concludes that current evidence is insufficient to assess the net benefit of counseling interventions in primary care settings to increase proper use of motor vehicle occupant restraints to reduce MVOIs in children, adolescents, and adults.

• The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine counseling of all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcohol-impaired.
  
  Rating: "I" Recommendation

Rationale:

Importance: Alcohol use is involved in nearly 40% of all traffic-related fatalities.

Effectiveness of counseling to change behavior: There is evidence that screening for misuse of alcohol and targeted counseling of those persons who screen positive reduce alcohol consumption and alcohol-related MVOI. However, there is a critical gap in the evidence of the efficacy of behavioral counseling interventions directed to all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcohol-impaired.

Harms of counseling: There is no evidence addressing the harms of counseling to prevent alcohol-related MVOI; however, these potential harms are estimated to be none or minimal in magnitude.

USPSTF assessment: The USPSTF concludes that the evidence is insufficient to assess the net benefit of universal counseling in the primary care setting (in the absence of screening and targeted counseling) to reduce the incidence of alcohol-related MVOI.