Recommendation Statement
This statement is an update of the 1996 U.S. Preventive Services Task Force
(USPSTF) recommendations about motor vehicle injuries.
The U.S. Preventive Services Task Force reviewed evidence
on the effectiveness of counseling in primary care about the
proper use of child restraints in motor vehicles to prevent injury, as
well as evidence on the impact of primary care counseling to
prevent alcohol-related MVOIs in adolescents and adults. This included
information gathered in the process of making their 1996
recommendation, as well as the accompanying systematic review of
English-language articles published through 2005.
Select for copyright and source information.
Contents
Introduction
Summary of Recommendations and Evidence
Summary of Recommendation 1
Summary of Recommendation 2
Clinical Considerations
Other Considerations
Discussion
Recommendations of Others
References
Members of the USPSTF
The U.S. Preventive Services Task Force (USPSTF)
makes recommendations about preventive care services
for patients without recognized signs or symptoms of the
target condition.
It bases its recommendations on a systematic review of
the evidence of the benefits and harms and an assessment
of the net benefit of the service.
The USPSTF recognizes that clinical or policy decisions
involve more considerations than this body of evidence
alone. Clinicians and policymakers should understand
the evidence but individualize decision making to the
specific patient or situation.
Introduction
Over the past decade, legislation and enforcement
have contributed substantially to the increasing trends in the use of
child safety seats and safety belts. This high prevalence of
their use in the United States is considered a public health
success. The 1996 USPSTF recommendation addressed
primary care interventions to increase the use of these restraints.
The current recommendation focuses on the independent
role of primary care interventions to increase the
proper use of child safety seats, booster seats, and lap-and-shoulder
belts (that is, safety belts that include straps across
both the lap and the shoulder) to prevent motor vehicle
occupant injuries (MVOIs). This recommendation also addresses
the effectiveness of primary care counseling to prevent
alcohol-related MVOI in adolescents and adults (Figure;
Tables 1 and 2).
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Summary of Recommendations and Evidence
Recommendation 1: Counseling about Proper Use of Motor Vehicle Occupant Restraints to Prevent Motor Vehicle Occupant Injuries (MVOIs)
- 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.)
This is an I Statement.
|
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.
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Recommendation 2: Counseling to Prevent
Alcohol-Related MVOI in 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.
This is an I Statement.
|
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.
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Clinical Considerations
Patient Population under Consideration
This recommendation refers to behavioral counseling
interventions performed in the primary care setting, addressing
parents of all infants and children, children, adolescents,
and adults.
Elements of Effective Counseling Interventions
The injury prevention benefits of child safety seat and
booster seat use require proper use. (That is, the seats
should be age- and weight-appropriate and should be installed
and placed into the vehicle correctly.) Infants
younger than 1 year of age and weighing fewer than 20
pounds should be placed in rear-facing, infant-only car
safety seats or convertible seats positioned in the back seat.
Infants younger than 1 year of age and weighing between
20 and 35 pounds should be placed in rear-facing convertible
seats positioned in the back seat. Rear-facing child
safety seats must not be placed in the front passenger seat
of any vehicle that is equipped with an airbag on the front
passenger side. Death or serious injury can result from the
impact of the airbag against the child safety seat. Toddlers
1 to 4 years of age weighing 20 to 40 pounds should be
restrained in a forward-facing convertible seat or forward-facing-only seat positioned in the back seat. Young children
4 to 8 years of age and up to 4'9" (57 inches) in
height should be placed in a booster seat in the back seat.
After this age (or height), lap-and-shoulder belt use is appropriate. Children younger than 13 years of age should sit
in the back seat with lap-and-shoulder belts.
Behavioral counseling interventions that include an
educational component, as well as a demonstration of use
or a distribution component, are more effective than those
that include education alone.
Other Approaches to Prevention
Clinical counseling in conjunction with community-based
interventions has been effective in increasing proper
use of child safety seats. Over the past decade, legislation
and enforcement have contributed substantially to the increasing
trends in child safety seat and seat belt use. A comprehensive
strategy that includes community-based interventions,
primary care counseling in the primary care
setting, legislation, and enforcement is critical to the improvement
of proper safety restraint use and decrease in the
incidence of MVOI.
Other Relevant USPSTF Recommendations
The USPSTF currently recommends screening for alcohol
misuse and counseling targeted to those patients
identified as risky or harmful drinkers.1
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Other Considerations
Implementation
There is good evidence that community and public
health interventions, including legislation, law enforcement
campaigns, car seat distribution campaigns, media
campaigns, and other community-based interventions, are
effective in improving proper use of child safety seats,
booster seats, and seat belts.
Links between primary care and community interventions
are critical for improving proper child safety seat,
booster seat, and seat belt use.
Research Needs
On the basis of the effectiveness of legislation and
community-based interventions in increasing child safety
seat and seat belt use, increasing booster seat use will probably
require similar interventions. Randomized, controlled
trials (RCTs) of counseling interventions are needed to
clarify the effectiveness of counseling parents and children
in the primary care setting to improve proper use of child
safety and booster seats.
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Discussion
Burden of Disease
Motor vehicle-related injuries are the leading cause of
death for children, adolescents, and young adults between
3 and 33 years of age in the United States and of unintentional
injury-related deaths for persons of all ages. Adolescent
and young adult drivers have the highest MVOI fatality
rates, even when controlling for vehicle miles
traveled. Increasing the use of occupant restraint devices,
such as child safety seats and lap-and-shoulder safety belts,
and reducing alcohol-impaired driving are among the most
important behavioral methods to reduce motor vehicle-related deaths.2
The rising prevalence of restraint use over the past
decade is considered a public health success.3 A combination
of public health interventions, including state legislation,
media campaigns, and primary care counseling, has
contributed to this increase in child safety seat and adult
lap-and-shoulder belt use. In the mid-1990s, state regulations
mandating child safety seat and lap-and-shoulder belt
use were put into place. All 50 states currently have laws
requiring safety seats for infants and children, and 49 states
and the District of Columbia have adult seat belt use laws,
but only half of the states that have these child safety laws
include guidance for children 4 to 8 years of age in booster
seats. State legislation largely varies, such as permitted unrestrained
travel for different specific circumstances or the
inability of drivers to receive a citation from the police
unless they have been stopped for another traffic violation.
States with primary enforcement have increased restraint
use by 12% to 23% and have decreased motor vehicle-related fatality rates.
The current prevalence of restraint use is more than
90% for children 1 to 3 years of age; however, proper use
of car seats in infants and children is estimated to be only
20%.4,5 For children 4 to 8 years of age, booster seat
use is less prevalent—premature advancement to seat belts
occurs, leading to an increased risk for injuries.2 When
used correctly, child safety seats reduce fatality risk by more
than 70% for infants up to 1 year of age and 54% for
children 1 to 4 years of age.2 Variation in restraint use
depends on the occupant's sex, age, seating position, economic
status, race, and ethnicity. Restraint use for children
younger than 9 years of age is complicated by the additional
need to correctly use the age-appropriate car safety
seat or belt-positioning booster seat.5 Between 20% and
84% of the time, misuse is severe enough to compromise
the effectiveness of the child safety seat or booster seat.
Alcohol use plays an important role in motor vehicle-related fatalities. Thirty-nine percent of MVOI deaths in
individuals 3 to 34 years of age are related to alcohol. More
than 80% of alcohol-impaired driving episodes reported by
people also include binge drinking.6 Evidence from
multiple time-series studies demonstrates that raising the
legal drinking age or lowering legal blood concentration
limits can statistically significantly reduce alcohol-related,
fatal crashes.2
Effectiveness of Counseling to Change Behavior
There is fair-quality evidence from 1 group-level controlled
clinical trial (CCT) that a combination of community
and clinical interventions aimed at increasing the correct
use of restraints reduces the risk for MVOI by 39.2
injuries per 10 000 children per year; however, the independent
contribution of the primary care counseling interventions
could not be determined. On the basis of 13
CCTs and RCTs, there is fair-quality evidence that, among
infants and children up to age 4 years, behavioral counseling
interventions are effective in increasing short-term, correct
use of infant and child safety seats at the time of
hospital discharge or within 2 months after initially delivering
the intervention.2 Two fair-quality CCTs and 2
fair- to poor-quality CCTs or RCTs demonstrated that
counseling by pediatricians during well-child clinic visits
increases the self-reported proper use and observed correct
use of restraints for at least 2 months. Three of these studies
with follow-up at 4 months or later showed no statistically
significant increase in restraint use in the intervention
group compared with the control group.7-9 One fair- to
poor-quality group-level RCT demonstrated that well-child
clinic education in addition to coercion, incentives,
and rewards by nonphysician primary care clinic staff and
health educators results in a 10% higher rate of observed
infant and child safety seat use at 12 months after program
initiation in the intervention group compared with the
control group that received usual well-child clinic education
only.10 Investigators of 1 fair- to poor-quality RCT
and 1 fair-quality RCT evaluated the effect of counseling
pregnant women during the last trimester of pregnancy
and measured self-reported use or observed correct use at discharge after delivery, at 6 to 8 weeks after delivery and
discharge, or at both times. In 1 study, an intervention of
education plus car seat distribution, compared with education
only, resulted in an increase in observed correct use at
discharge. At 6 weeks after discharge, the difference was
not statistically significant. In the second trial, self-reported
use at 2 months did not statistically significantly differ
between a counseling education group and control group.11 Trials demonstrate that car seat distribution in addition
to educational interventions provided in the inpatient
peripartum setting results in greater differences in use than
do educational interventions alone.2
Two studies of counseling interventions in primary
care settings for older children and adolescents have been
published. One fair-quality CCT of children 5 to 19 years
of age who were not wearing their seat belts en route to the
office visit reported short-term improvement in observed
seat belt use among the children immediately after pediatrician-delivered counseling.12 A fair-quality RCT reported
no difference in seat belt use by fifth and sixth
graders who received education through an office-based
injury prevention program that involved counseling and a
written family contract, compared with a control group
that received similar information that targeted alcohol and
tobacco use at 12 to 36 months.13
No RCTs have been conducted for behavioral counseling
for booster seat use in the age group of 4 to 8 years
in the primary care setting. Investigators of 1 fair- to poor-quality
RCT evaluated booster seat education with and
without distribution of a free booster seat in the emergency
department.14 The study demonstrated high self-reported
use in the education plus distribution or installation
group compared with education only and control groups;
however, it has limitations in internal and external validity.
A 2006 Cochrane Collaboration meta-analysis demonstrated
that interventions outside of the primary care setting
that included distribution and education, incentives
and education, and enforcement components resulted in
2-fold increases in the use of booster seats.15
One RCT addressed the effects of counseling adults to
use seat belts. Investigators of this fair- to poor-quality
RCT studied adults who watched a 6-minute film, and
they compared self-reported seat belt use at 6 months between
the group that watched a film on seat belt use and
the group who watched a film of comparable length that
did not mention seat belt use.16
Self-reported seat-belt use increased equally in both the control and treatment groups.
However, strong evidence
suggests that safety belt laws, primary enforcement
strategies, and enhanced enforcement strategies increase
seat belt use.17
No evidence has addressed the effect of behavioral
counseling interventions delivered to all patients in the primary
care setting in reducing driving while under the influence
of alcohol or riding with an alcohol-impaired
driver.
Potential Harms of Counseling
There is no evidence on harms of counseling in the
primary care setting, with respect to the use of age- and
weight-appropriate restraints or the avoidance of driving
while under the influence or riding with alcohol-impaired
drivers. Potential harms are estimated to be none to minimal
in magnitude.
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Recommendations of Others
The Centers for Disease Control and Prevention's
Guide to Community Preventive Services,18 known as
"The Community Guide," recommends child safety seat
use laws, community-wide information and enhanced enforcement
campaigns, and distribution or incentive programs
plus education programs to increase safety seat use
in infants and children. The Community Guide recommends
safety belt legislation, primary enforcement laws,
and enhanced enforcement programs to increase seat belt
use in adolescents and adults. The Community Guide recommends
0.08 blood alcohol concentration laws, lower
blood alcohol concentration laws for young drivers, minimum
legal drinking age laws, sobriety checkpoints, mass
media campaigns, school-based programs, and alcohol
server intervention training programs.
The American Academy of Family Physicians supports
the counseling of all parents and patients older than 2 years
of age about accidental injury prevention, including the use
of child safety seats and lap-and-shoulder belts; encourages
the development of uniform standardized tests to determine
alcohol or drug impairment in all U.S. states; and
encourages its members to take an active role in developing
strategies to promote the increased use and availability of
restraint systems, including air bags. The American Academy
of Family Physicians also supports primary enforcement
of occupant restraint system legislation, encourages
authorities to document the use of occupant restraint systems,
and encourages the media to report use as appropriate.19
The American Medical Association supports mandatory
seat belt use laws that do not simultaneously relieve
automobile manufacturers of their responsibility to install
passive restraints and supports education of state medical
societies about these laws; discussion of MVOIs between
physicians and their patients; and the use of active, approved
restraints for both adults and children.20
The American Academy of Pediatrics recommends
that clinicians provide up-to-date, appropriate information
for parents on car safety seat choices and proper use.21
The American College of Obstetricians and Gynecologists
recommends that clinicians counsel all women on
the use of seat belts; that pregnant women be counseled on
proper seat belt fit during pregnancy and proper use of a
car seat for their infant; and that adolescent women be
counseled to avoid driving or other situations requiring full
attention after drinking or riding with a driver who has
been drinking.22-25
The National Highway Traffic Safety Administration
(http://www.nhtsa.gov) recommends education, training, enforcement,
outreach, and legislation to increase proper restraint
use by children, adolescents, and adults. It recommends
community and legislative interventions for and
screening and clinical counseling of patients who drink
heavily to reduce alcohol- and drug-impaired driving.
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References
1. U.S. Preventive Services Task Force. Screening and behavioral counseling
interventions in primary care to reduce alcohol misuse: recommendation statement.
Ann Intern Med 2004;140:554-6. [PMID: 15068984]
2. Williams S, Whitlock E, Edgerton E, Smith P, Beil T. Primary Care Interventions
to Prevent Motor Vehicle Occupant Injuries. Prepared for the Agency
for Healthcare Research and Quality by the Oregon Evidence-based Practice
Center, Portland, Oregon. Evidence Synthesis No. 51. Rockville, MD: Agency
for Healthcare Research and Quality; August 2007. AHRQ Publication No. 07-05103-EF-1. Accessed at www.ahrq.gov/clinic/serfiles.htm on 7 August 2007.
3. Motor-vehicle safety: a 20th century public health achievement. MMWR
Morb Mortal Wkly Rep 1999;48:369-74. [PMID: 10369577]
4. Glassbrenner D. Child restraint use in 2004—overall results. Washington,
DC: U.S. Department of Transportation, National Highway Traffic Safety
Administration; 2005. Accessed at http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809845.pdf on February 2007.
5. Decina LE, Lococo KH. Misuse of Child Restraints. Washington, DC: U.S.
Department of Transportation, National Highway Traffic Safety Administration;
2004. Report no. DOT HS 809 671. Accessed at www.nhtsa.dot.gov/people/injury/research/Misuse/images/misusescreen.pdf on 31 May 2007.
6. Quinlan KP, Brewer RD, Siegel P, Sleet DA, Mokdad AH, Shults RA, et al.
Alcohol-impaired driving among U.S. adults, 1993-2002. Am J Prev Med 2005; 28:346-50. [PMID: 15831339]
7. Guyer B, Gallagher SS, Chang BH, Azzara CV, Cupples LA, Colton T.
Prevention of childhood injuries: evaluation of the Statewide Childhood Injury
Prevention Program (SCIPP). Am J Public Health 1989;79:1521-7. [PMID: 2817165]
8. Kelly B, Sein C, McCarthy PL. Safety education in a pediatric primary care
setting. Pediatrics 1987;79:818-24. [PMID: 3554131]
9. Reisinger KS, Williams AF, Wells JK, John CE, Roberts TR, Podgainy HJ.
Effect of pediatricians' counseling on infant restraint use. Pediatrics 1981;67: 201-6. [PMID: 7243445]
10. Liberato C, Eriacho B, Schmiesing J, Krump M. SafeSmart Safety Seat
Intervention Project: a successful program for the medically-indigent. Patient
Educ Couns 1989;13:161-70.
11. Serwint JR, Wilson ME, Vogelhut JW, Repke JT, Seidel HM. A randomized
controlled trial of prenatal pediatric visits for urban, low-income families.
Pediatrics 1996;98:1069-75. [PMID: 8951255]
12. Macknin ML, Gustafson C, Gassman J, Barich D. Office education by
pediatricians to increase seat belt use. Am J Dis Child 1987;141:1305-07.
13. Stevens MM, Olson AL, Gaffney CA, Tosteson TD, Mott LA, Starr P.
A pediatric, practice-based, randomized trial of drinking and smoking prevention
and bicycle helmet, gun, and seatbelt safety promotion. Pediatrics 2002;109:490-7. [PMID: 11875146]
14. Gittelman MA, Pomerantz WJ, Laurence S. An emergency department
intervention to increase booster seat use for lower socioeconomic families. Acad
Emerg Med 2006;13:396-400. [PMID: 16531596]
15. Ehiri JE, Ejere HO, Magnussen L, Emusu D, King W, Osberg JS. Interventions
for promoting booster seat use in four to eight year olds traveling
in motor vehicles. Cochrane Database Syst Rev 2006:CD004334. [PMID: 16437484]
16. Hempel RJ. Intervention to increase seat belt use at a primary care center. J
Am Board Fam Pract 1992;5:483-7. [PMID: 1414449]
17. Dinh-Zarr TB, Sleet DA, Shults RA, Zaza S, Elder RW, Nichols JL, et al.
Reviews of evidence regarding interventions to increase the use of safety belts. Am
J Prev Med 2001;21:48-65. [PMID: 11691561]
18. Centers for Disease Control and Prevention. Guide to Community Preventive
Services. Accessed at www.thecommunityguide.org on 12 February 2007.
19. American Academy of Family Physicians. American Academy of Family
Physicians Policy & Advocacy policies: safety. Accessed at www.aafp.org/online/en/home/policy/policies/s/safety.html on 31 May 2007.
20. American Medical Association. Policy H-15.982. Mandatory seat belt utilization
laws. In: Health and Ethics Policies of the AMA. Accessed at www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf on 31 May 2007.
21. Selecting and using the most appropriate car safety seats for growing children:
guidelines for counseling parents. Pediatrics 2002;109:550-3. [PMID:
11875159]
22. ACOG Committee Opinion. Primary and preventive care: periodic assessments.
Obstet Gynecol 2003;102:1117-24. [PMID: 14672497]
23. American Academy of Pediatrics, American College of Obstetricians and
Gynecologists. Guidelines for Perinatal Care, 5th ed. Elk Grove Village, IL:
American Academy of Pediatrics; 2002.
24. American College of Obstetricians and Gynecologists. Primary and preventive
health care for female adolescents. In: Health Care for Adolescents. Washington,
DC: American Coll of Obstetricians and Gynecologists; 2003:1-24.
25. American College of Obstetricians and Gynecologists. Substance use. In:
Special Issues in Women's Health. Washington, DC: American Coll of Obstetricians
and Gynecologists; 2005:113.
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Members of the U.S. Preventive Services Task Force
Corresponding Author: Ned Calonge, M.D., M.P.H., Chair, U.S. Preventive Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.
Members of the U.S. Preventive Services Task Force*: are
Ned Calonge, MD, MPH, Chair (Colorado Department of Public
Health and Environment, Denver, Colorado); Diana B.
Petitti, MD, MPH, Vice Chair (Kaiser Permanente Southern
California, Pasadena, California); Thomas G. DeWitt, MD
(Children’s Hospital Medical Center, Cincinnati, Ohio); Leon
Gordis, MD, MPH, DrPH (Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland); Kimberly D. Gregory,
MD, MPH (Cedars-Sinai Medical Center, Los Angeles, California);
Russell Harris, MD, MPH (University of North Carolina
School of Medicine, Chapel Hill, North Carolina); Kenneth W.
Kizer, MD, MPH (National Quality Forum, Washington, DC);
Michael L. LeFevre, MD, MSPH (University of Missouri School
of Medicine, Columbia, Missouri); Carol Loveland-Cherry,
PhD, RN (University of Michigan School of Nursing, Ann Arbor,
Michigan); Lucy N. Marion, PhD, RN (Medical College of
Georgia, Augusta, Georgia); Virginia A. Moyer, MD, MPH
(University of Texas Health Science Center, Houston, Texas);
Judith K. Ockene, PhD (University of Massachusetts Medical
School, Worcester, Massachusetts); George F. Sawaya, MD (University
of California, San Francisco, San Francisco, California);
Albert L. Siu, MD, MSPH (Mount Sinai Medical Center, New
York, New York); Steven M. Teutsch, MD, MPH (Merck &
Company, West Point, Pennsylvania); and Barbara P. Yawn,
MD, MSc (Olmsted Research Center, Rochester, Minnesota).
*Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.
Disclaimer: Recommendations made by the USPSTF are independent of
the U.S. government. They should not be construed as an official position
of the Agency for Healthcare Research and Quality or the U.S.
Department of Health and Human Services.
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Copyright and Source Information
This document is in the public domain within the United States. For
information on reprinting, contact Randie Siegel, Director, Division of
Printing and Electronic Publishing, Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850.
Requests for linking or to incorporate content in electronic resources
should be sent to: info@ahrq.gov.
Source: U.S. Preventive Services Task Force. Counseling about proper use of motor vehicle occupant restraints and avoidance of alcohol use while driving: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2007;147:187-93.
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Current as of August 2007
Internet Citation:
U.S. Preventive Services Task Force. Counseling About Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use While Driving: U.S. Preventive Services Task Force Recommendation Statement. August 2007. First published in Ann Intern Med 2007;147:187-93. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf07/mvoi/mvoirs.htm