Table 2. Summary of Studies Evaluating Counseling to Increase the Use of
Occupant Restraints among Children Age 4 Years or Older, Adolescents,
and Adultsa
| Study, Year (Reference) |
USPSTF
Qualityb |
Study Design |
Sample Size, n |
Timing and Setting |
Groups and Intervention Components |
| Age 4-8 y |
| Gittleman et al., 200633 |
Fair to poor |
RCT |
225 |
During ED visit; ED |
IG1: Certified car seat technician delivered a
5-min instruction on importance of booster seats, correct use, how to obtain
a booster seat, and where to go for a fitting station
IG2: Same as IG1, plus received free booster seat with proper installation
and instructions
CG: Standard discharge instructions from the ED |
| Age 9-19 y |
| Stevens et al., 200234 |
Fair |
Group RCT (cluster randomization) |
12 clinics (3145 children) |
34 contacts over 36 mo; WCC visits to
pediatrician office |
IG: Received counseling from pediatrician,
contract for family policy, letter, reminders at follow-up visits, biannual
telephone calls alternating parent and child, brochure, newsletters for parents
(12) and children (12) on gun safety, seat belt use, bicycle helmet use
CG: Received all the same contacts as the IG with the information targeting
alcohol and tobacco use |
| Macknin et al., 198743 |
Fair |
CCT |
385 |
Single contact; WCC visits |
IG: Physician-pediatrician asked a screening
question about seat belt use; if yes—positive reinforcement; if no—give facts
about seat belt use, and a contract promising use was signed patient and physician
CG: No mention of seat belt |
| Adults |
| Hempel, 199235 |
Fair to poor |
RCT |
360 |
Single contact, Primary care center |
IG: Viewed a 6-min film explaining why one
should wear seat belts; nurse practitioner gave an appeal to wear seat belts
based on her personal conviction
CG: Viewed a 6-min film on general preventive health care guidelines with
no mention of seat belts |
(Table 2 continued)
| Study, Year (Reference) |
Outcome Measured for Assessment |
Observation Time Point |
Results (IG vs. CG) |
Absolute Difference (IG vs.
CG) (95% CI), percentage points |
Comments |
| Age 4-8
y |
| Gittleman et al., 200633 |
Self-reported booster seat use |
1-mo post-ED visit |
IG1 vs. CG: 8.7% vs. 1.3% (P = NS)
IG2 vs. CG: 98.2% vs. 1.3% (P = NR)
IG2 vs. IG1 and CG: 98.2% vs. 5.5% (P < 0.001) |
7.4 (-3 to 16)
96.9 (90 to 100)
92.7 |
Families who used booster seats at baseline were
excluded from trial; study families all resided in low SES ZIP codes;
71%–77% African American; 35% attrition at 1 mo; differential attrition
across groups |
| Age 9-19 y |
| Stevens et al., 200234 |
Self reported use |
12 mo
24 mo
36 mo |
OR (CG vs. IG), 0.87 (CI, 0.73 to 1.04) (P
= 0.12)
OR (CG vs. IG), 0.96 (CI, 0.79 to 1.15) (P = 0.65)
OR (CG vs. IG), 0.89 (CI, 0.73 to 1.09) (P = 0.27) |
Unable to calculate because use was NR for
either CG or IG at any follow-up time point |
Children were in 5th or 6th grade when enrolling
in study; baseline use 72%-74% in both groups; 31% attrition reported
at all 3 time points; cannot calculate attrition at individual follow-up
time points |
| Macknin et al., 198743 |
Observed use
Self-reported seat belt use |
Postvisit
1 y |
Those not wearing previsit vs. wearing postvisit:
IG, 38%; CG, 5% (P <0.001)
IG, 62%; CG, 67% (P = NS) |
Unable to calculate
-5 (-20 to 10) |
Enrolled children age 5-19 y; baseline
use was 61%-63% in both groups; predominantly white, middle class;
0% attrition at postvisit, 35% attrition at 1 y |
| Adults |
| Hempel, 199235 |
Seat belt use assessed through questionnaire
using a linear scale |
Baseline
6 mo |
22% vs. 20%
37.3 vs. 33.6% (P = NS) |
3.7 (-8 to 16) |
Rural, primarily indigent population; 25%
attrition at 6 mo |
Notes:
a. CCT = controlled clinical trial; CG = control group; ED =
emergency department; IG = intervention group; NR = not reported;
NS = not significant; OR = odds ratio; RCT = randomized, controlled trial;
SES = socioeconomic status; USPSTF = U.S. Preventive Services Task Force;
WCC = well-child care.
b. The USPSTF quality criteria are
described in Appendix Table 5.
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