Appendix F. Evidence Tables

Selvi Williams; Evelyn Whitlock; Paula Smith; Beth Edgerton; Tracy Beil

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Williams S, Whitlock E, Smith P, et al. Primary Care Interventions to Prevent Motor Vehicle Occupant Injuries [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Aug. (Evidence Syntheses, No. 51.)

Appendix F. Evidence Tables

Evidence Table 1. Included studies birth to 4 years

Study Reference	Target Behavior	Study Design	Population Baseline Data-usage	Inclusion/Exclusion Criteria	Description Intervention	Intervention Format	Follow-up time frames	Outcomes	Results				USPSTF Quality
	Setting	Location
		Population Targeted
Primary care setting - during well child visits
Guyer 1989 ¹	Child restraints 0–5 yrs.	CCT	N: 286,676	Inclusion: at least one child in household <19 yrs	IG1: Concurrent implementation of five injury prevention projects conducted in healthcare settings and community. Components targeting infant and child safety seat use included injury counseling by pediatricians during WCC visits for children up to age 5 years using Framingham Safety Surveys; promotion of infant safety seat restraints for infants leaving maternity hospitals and in pre-school children.	Primary care, hospital-based, and community based programs to reduce accidental childhood injuries.	2 yrs	Behavioral Outcomes: Self-reported use of child safety restraints from approximately 5% of population.	Self-reported use (%):				Fair; baseline characteristics not reported but communities matched on important characteristics; outcomes measured at population-level, adjusted for SES
	PC component & peripartum hospitalization	14 communities in Massachusetts.	Age: NR	Exclusion: NR	CG: None of the five injury prevention projects were implemented. (Population had incidental participatory exposure to motor vehicle occupant injury-related interventions: 14% at baseline; 34% at 2 years post-intervention.) Exposure to the intervention assessed through telephone survey grouped respondents into three groups.	Parents		Health Outcomes: Motor vehicle occupant injury rates (age-adjusted); surveillance through hospitals; measured injuries requiring medical treatment in an emergency room, hospitalization, or resulting in death,			Pre-	Post-
	Burns, poisonings, suffocations, falls.	Families with children 0–5 yrs.	% male: NR			Indiv, unclear		Harms Measure: NR	IG		49.1	65
			% minority: NR			Intensity: Varied			CG		49.6	63.3
			SES: NR			Counseled on seating location: Unclear			p-value:		NR
			Baseline Data: 49% using child restraints						MVO Injury rates (per 10,000 children)
											Pre-	During
									IG		46.54	21.54
									CG		44.53	60.77
									Adjusted OR 2.78 (1.66, 4.66)a
									a=adjusted for socioeconomic status
Kelly 1987 ²	Infant car seat	RCT	N: 171	Inclusion: Attendance at primary care clinic for infant well-child visits.	IG: 3-part series of age-appropriate tailored safety information requiring active parent participation given by MD at 6, 9 and 12 month well-child visit,.	To reduce incorrect child restraint behavior through tailored education.	6 months after first visit	Behavioral Outcomes: Child riding without restraints or sitting in front seat, assessed through interview/home visit by blinded staff.	% usually riding without restraint				Fair/Poor; high attrition over 30%, analyze completers only; self-reported outcome and does not specify correct use
	PC-pediatrics	New Haven, CT	Age: NR	Exclusion: Did not continue well-child visits due to poor compliance, moving or changing to another physician.	CG: Routine safety information as part of well-child visits.	Parents			IG: 67
	Other behaviors:	Community hospital primary care clinic.	%male: NR			Individual; Print		Health Outcomes: NR	CG: 70
	Home safety: fires and burns; falls; poisoning; drowning; suffocation and choking; injuries due to sharp and heavy objects; electrical hazards.		% minority: NR			3 contacts for 45 minutes total.			P-value: NS
			SES: NR			Counseled on seating location: Unclear		Harms Measure: NR	% Usually sitting in front sea
			IG						IG: 33
			N: 85						CG: 53
			Maternal age: 23.4 yrs						P-value: <0.05
			% male in household: 18
			% minority: 96
			SES-receiving welfare: 91
			CG
			N: 86
			Maternal age: 23.6 yrs
			% male in household: 20
			% minority: 93
			SES-receiving welfare: 94
			Baseline usage: NR
Primary care setting - during well child visits
Liberato 1989 ³	RCT (randomized clinics)	Phoenix, AZ	N: 900 people observed driving in the clinic parking lot.	Inclusion: Parents of children 0–4 receiving outpatient care at clinic.	IG: Parking lot-drivers with unrestrained children (0–4 yrs) were given a printed warning; recommended they attain safety seat; advice to avoid a city citation fee by contacting the health educator who would encourage attendance at a formal class. Drivers with restrained children were given sunshade. Waiting rooms-buckle up stickers and cups with information were distributed; waiting room presentation participants were given sun shade; bulletin boards displayed information. Clinic staff (not MDs)-provided verbal reinforcement and incentives when subject arose. Monthly meetings-1 hour by health educator; lottery drawing of car seat.	To increase usage of car seats through education; coercion; and incentives.	6 months, 12 months	Behavioral Outcomes: Observed every third car with a passenger 0–4 yrs for car seat usage. Correct usage was not assessed. Assumption that the random sampling was representative of seat usage even though they are not necessarily the direct recipient of the intervention.	% safety seat non-usage				Fair/Poor; unclear if groups similar at baseline; observed outcome but did not specify correct use; unclear if assessor was blinded
	Infant/child car seats	6 randomly selected county outpatient care clinics.	Age: NR	Exclusion: Excluded from outcomes if did not drive to clinic.	CG Pre-intervention: Patients received usual care in maternity and well child clinics regarding importance of safety seats.	Parents of children 0–4		Health Outcomes: NR	month	0	6	12
	PC-pediatrics	Medically indigent	% male: NR			Group; indiv; print; other.		Harms Measure: NR	IG:	74.9	62.3*	64.7*
		% minority: 66.9	% minority: NR			Counseled on seating location: No.			CG:	87.8	89.1	70.0**
			SES: NR						*P<0.05 from baseline
			Baseline usage:						**NS
			IG: 25.1%
			CG: 12.2%
Reisinger 1981 ⁴	Infant car seat	CCT	N=269	Inclusion: Requested three pediatricians within a group practice and came in for at least one f/u visit.	IG: Received education regarding infant seat delivered by MD-pediatrician at postpartum hospital stay and well-child visits at 1 and 2 months. Pamphlet and formal prescription at postpartum; tailored message at 1 and 2 months; demonstration by pediatrician of seat use at 1 month.	To increase car seat usage through education and tailored counseling and modeling.	1, 2, 4, and 15 months.	Behavioral Outcomes: Observation of correct use of infant car seat upon arrival for WCC visits	% correctly observed using restraint				Fair; report some but not all important baseline characteristics; blinded observation of outcome, specifying correct use; 5% attrition at 2 months and 23% at 15 months; analyze completers only.
	PC-postpartum and PC-well child visit	Pittsburgh, PA	Age: NR	Exclusion: NR	CG: Received educational messages that did not include car seat usage.	Parent		Health Outcomes: NR			IG	CG
			% male: 0			Indiv, print, modeling		Harms Measure: NR	1 mo		38	31
			% minority: NR,“almost entirely white”			3 contacts over 2 months. Time-NR.			2 mo		50	29
			SES:“middle and upper middle class”			Counseled seating location: NR			4 mo		47	43
			IG						15 mo		56	50
			N=127
			Age: 27 yrs
			% male: 0
			% minority: NR
			CG
			N=142
			Age: 26 yrs
			% male: 0
			% minority: NR
			Baseline usage: NA
Scherz 1976 ⁵	Infant car seats	CCT	N: 500	Inclusion: Attendance at 4 wk well child visit	IG4: Display, pamphlet, 1–5 min with MD-pediatrician encouraging purchase of infant car seat.	To increase infant car seat usage through various intensities of education.	8 wks	Behavioral Outcomes: Correct infant seat use, which included using an approved car seat or car bed attached by seat belt. Self-reported on a survey.	% reporting safe car seat usage				Fair/Poor; Do not report baseline characteristics, report of 100% follow-up at 8 weeks is suspicious; 47% attrition at 9–12 months f/u (results not shown)
	PC-pediatrics	Well child clinic in an army medical center in Tacoma, WA	Age: NR	Exclusion: NR	IG3: Display, pamphlet, 1–2 min from RN encouraging purchase of infant car seat.	Parent		Health Outcomes: NR	IG4: 22
			% male: NR		IG2: Display and pamphlet.	Indiv, print		Harms Measure: NR	IG3: 22
			% minority: NR		IG1: Information display only.	Counseled on seating location: NR			IG2: 8
			SES: NR		CG: No stimulus				IG1: 12
			Baseline Data: NR						CG: 9
									P <0.001
									3&4 vs 1, 2 & CG: P <0.001
Primary care setting - antepartum only
Alavarez 1993 ⁶	Infant car seats	RCT	N: 14	Inclusion: NR	IG1: At a prenatal visit during the last month of pregnancy with an unspecified type of provider, participants received: discussion of Illinois child passenger legislation; an explanation of the benefits of automobile restraint devices along with behavior modification strategies for use; a list of available infant and toddler restraints; and a demonstration of appropriate use of one type of restraint, and received an infant automobile restraint device on loan for 5 months for a $10 deposit at initial visit.	To increase infant car seat use through education, modeling, and access.	Discharge, and 6 weeks after discharge	Behavioral Outcomes: Observed correct use of infant safety seat	Proper use at hospital discharge:				Fair - Outcome assessed by blinded observers; 0% attrition but very small sample size
Study #2	PC-prenatal visit	Chicago, IL	Age: NR	Exclusion: NR	IG2: Same as above, but the restraint device was made available at the six-week post-partum visit instead of during the last month of pregnancy.	Parent		Health Outcomes: NR	IG1: 6/7 (86% (c))
		Low income Hispanic population	% male: 0%			Individual		Harms Measure: NR	IG2: 1/7 (14% (c))
			% minority: 100%			1 visit			P-value < 0.01
			SES: Two single mothers on public assistance, 12 married women whose husbands were laborers.			Counseled on seating location: NR			Proper use at 6 week visit:
			Baseline usage: 13 out of 14 infants unrestrained in a random sample of newborns at same clinic.						IG1: 4/7 (57% (c))
									IG2: 1/7 (14% (c))
									P-value NS
Serwint 1996 ⁷	Infant car seats	RCT-block randomization	N: 156	Inclusion: Nulliparous women; ≥ 18 years; fetus of gestational age ≤28 weeks; not yet selected a pediatrician	IG: Had a prenatal visit with a pediatrician scheduled between 32 and 36 weeks gestation. Received a welcome letter to the pediatric clinic with a brochure for proper health care utilization. Counseled by a PGY-2 pediatric resident on multiple anticipatory guidance topics if attended visit.	To see if prenatal visits to a pediatrician had an effect on health behaviors post-birth	2 months post birth	Behavioral Outcomes: Child did not always use of child safety seat in last month assessed through questionnaire.	Reported use of car seat-last ride:				Fair/Poor; High attrition over 30%; analyze completers only; low adherence in IG (57%); self-reported outcome and does not specify correct use
	PC-prenatal pediatrics	Urban; hospital-based residents' clinic	IG	Exclusion: Admitted prenatal drug use; had a recognized psychiatric illness; or had HIV	CG: Not offered a visit, received card with future pediatrician information, welcome letter, and brochure.	Parent		Health Outcomes: NR	IG (n=54) 77%
	Breastfeeding; emergency room visits; circumcision; health maintenance; mother/pediatrician relationship	Low-income;primarily African American families	N: 81			Individual, print		Harms Measure: NR	CG (n=51) 86%
			Age: 20.2 (±2.1)			Seating location-NR			P-value = 0.33
			% male: 0						Reported ownership of infant car seat:
			% minority (African American): 91						IG (n=54) 83%
			SES (medical assistance): 98						CG (n=51) 94%
			CG						P-value=0.15
			N: 75
			Age: 20.7 (±2.5)
			% male: 0
			% minority (African American): 91
			SES (medical assistance): 95
			Baseline usage: not applicable
Peripartum inpatient setting only
Christophersen 1982 ⁸	Infant car seats	RCT	N=30	Inclusion: Delivered a single live born infant; baby's doctor within 10 miles.	IG: Discharge staff person brought in a free loaner car seat at time of discharge and then offered to demonstrate proper infant placement in seat before leaving room, carrying infant in seat, and correct restraining with lap belt in family's vehicle. If mother refused, no further effort was made.	To increase infant restraint use through demonstration and access to free car seat.	Discharge and 4–6 weeks postpartum	Behavioral Outcomes: Observed use and correct use of infant car seat.	% correct use of restraint				Fair; observed outcome and low attrition (10% at follow-up) but small sample size and has other methodological flaws
	Peripartum hospitalization	Suburban Kansas City Hospital	Age: NR	Exclusion: NR	CG: Usual care.	Parent		Health Outcomes: NR			IG	CG
			% male: 0			Format: individual; demonstration and access.		Harms Measure: NR	Discharge		67	0 (*)
			% minority: NR			1 contact, time-2 minutes more than time normally needed to discharge patient.			4–6 wks		29	23 (NS)
			SES: NR (see comments)			Counseled seating location: Yes.
			Baseline usage: NA
Lindqvist 1993 ⁹	Infant car seats	CCT	N: 1157	Inclusion: Live birth at the participating hospitals during the test period.	IG: An infant car seat was loaned free of charge during the mother's post-partum inpatient hospitalization. Maternity ward staff demonstrated the use of the seat and parents viewed videotape. Seats were returned at 9 months.	To increase car seat usage through education and tailored counseling and modeling.	9 months and 15 months	Behavioral Outcomes: Self reported use of car seat by questionnaire.	% reporting more or less frequently restrained at 9 months:				Fair/Poor - Data are self-reported and correct use is not specified. No effort was made to follow-up on 13% of infants in intervention group whose mothers did not accept the car seat loan.
	Peripartum hospitalization	(group level)	Age: NR	Exclusion: NR	CG: Usual care.	Parent		Health Outcomes: Self report of motor vehicle accidents resulting in injuries during 0–9 months.	IG: 96.2%
		Sweden	% male: 0			Indiv, print, modeling		Harms Measure: NR	CG: 49.4%
		3 community hospitals in smaller cities.	% minority: NR			1 contact,Time-NR.			P-value: NR
			SES: NR			Counseled seating location: NR			% reporting car seat use at 15 months:
			IG						IG: 98.7%
			N: 764						CG: 97.6%
			SES-car ownership: 97.9%						P-value: NR
			CG						Motor vehicle accident-related injuries during 0–9 months: No motor vehicle accidents resulted in personal injuries in control or intervention groups.
			N: 393
			SES-car ownership: 96.4%
Reisinger 1978 ¹⁰	Infant car seats	CCT	N: 1,103	Inclusion: Delivered live baby within the study period.	IG1: Received two pamphlets from research staff with training regarding child safety seat use and given in-room access to purchase car seat. Seat delivered to room and correct use demonstrated for women who purchased it.	To increase infant restraint use through education and access to care seat, demo modeling	Discharge and 2–4 months post-partum	Behavioral Outcomes: Observation of correct use of infant carrier (infant care seat restrained with car seat belt.)	% use at hospital discharge (85.55 sample)				Fair; blinded observation of outcome; measured correct use; report no difference in baseline SES characteristics between groups.
			Age: NR	Exclusion: Babies who were to be adopted; those whose babies died; not English speaking or deaf; no car ownership; not discharged prior to next treatment group initiated.	IG2: Same as IG1, but also visit from health educator regarding use of car seat	Parent		Health Outcomes: NR	CG: 6
			% male: 0		IG3: Same as IG1 and offered free car seat.	Format: varied per group: print; individual; access, modeling		Harms Measure: NR	IG1: 8 (lit+ access)
	Peripartum hospitalization	Pittsburgh, PA	% minority: NR			1 contact: education component approximately 10 min for IG2.			IG2: 8 (Lit+ access+ health ed)
		Postnatal couples prior to discharge	SES: NR		CG: Car seats available for purchase in gift shop.	Counseled seating location: No.			IG3: 11 )lit+ free carrier
			Baseline usage: NA						% use at follow-up(66.5% sample):
									CG: 21
									IG1: 22
									IG2: 20
									IG3: 28
									P values: NR
									Baseline for behavior: NR
Tietge 1987 ¹¹	Infant car seats	CCT	N: 93	Inclusion: First time mothers, gave consent, were discharged during experimental period.	IG2: Watched 14-min video from Physicians for Automotive Safety (including demonstration of proper use of infant safety seat) and 5 minute face-to-face instruction session which included practice by subject	To increase infant car seat usage through education and modeling.	Discharge	Behavioral Outcomes: Observed correct use of infant car seat.	% Correct seat usage				Fair/Poor; 27% attrition (cannot determine if differential); analyzed completers only; excluded 5 women in intervention group who did not watch film.
	PC-peripartum hospital	Major community hospital in San Diego, CA	Age: NR	Exclusion: If could not verify that participant viewed video or were not viewed at discharge.	IG1: Viewed video.	Parent		Health Outcomes: NR	IG2: 74.2
			% male: 0		CG: Given no safety seat information.	Indiv, video		Harms Measure: NR	IG1: 68.8
			% minority: 16 % (calc)			1 contact, 19 minutes total			CG: 63.3
			SES: 73.29% had some college or more			Counseled on seating location: NR			NS
			65.6% ≥$2,000/mo
			Baseline usage: NA
Primary care - Referable Education courses
Barone 1988 ¹²	Car seat	RCT - (group level)	N: 79 couples or individuals	Inclusion: Participation in toddler education class; consenting to a home visit and safety assessment; attended health and safety-education presentation; lived in dwelling where they could control the setting of the water heater; not engaging in major water use 2 hrs preceding home visit.	IG: Viewed home safety slides; slides addressing water temperature, smoke detectors and child restraints; 6-minute film regarding crash tests of restrained and unrestrained children; education packet; and digital thermometer.	Conflict-theory model of decision-making. To increase car seat usage as compared to control.	Unclear	Behavioral Outcomes: Observed correctly installed car seat.	% having correctly installed car seat:				Fair/Poor;randomization method unclear; age of children in groups not reported; unclear of outcome assessment was blinded.
	PC-R: parent education classes	Suburban Kansas City medical center.	IG	Exclusion: NR	CG: Viewed home safety slides only.	Parent		Health Outcomes: NR	IG: 100%
	Yes, water temperature, smoke detectors	Parents who elected to participate in a continuing-education series.	N: 41 couples or individuals			Group		Harms Measure: NR	CG: 100%
			Age, mean yrs: 32-mother, 34-father			1 session of 2 hours			NS
			% male: NR			Counseled on seating location: unclear
			% minority: NR
			SES-education: 2.98 mean (2=H.S., 3=baccalaureate)
			Income: 4.7 mean (4=$31–40,000; 5=$41–50,000)
			Baseline usage: NR
			CG
			N: 38 couples or individuals
			Age, mean yrs: 32-mother, 33-father
			% male: NR
			% minority: NR
			SES-education: 2.87 mean (2=H.S., 3=baccalaureate)
			Income: 4.54 mean (4=$31–40,000; 5=$41–50,000)
			Baseline usage: NR
Goodson 1985 ¹³	Infant car seats	CCT (group level)	N: 163	Inclusion: attendance at hospital prenatal class.	IG: Half hour lecture given by social worker including a discussion; demonstration of correct use of infant safety seat with a doll; 10-min film by the Insurance Institute for Highway Safety illustrating crash results of unrestrained infant; question and answer session; brochures.	To increase use of infant car seat through education and modeling.	4–6 months post-partum	Behavioral Outcomes: Use of crash-tested car seat on the last ride self-reported during a phone interview.	IG: 96.1%				Fair/Poor; baseline characteristics are not reported, 17% attrition with analysis of completers only; unclear if outcome assessors were blinded; correct use not specified
	PC-R: prenatal classes		Age: NR			Parents		Health Outcomes: NR	CG: 78.3%
			% male: 0		CG: Usual cursory mention of child passenger safety.	Group; film, demonstration, question and answer;		Harms Measure: NR	P < 0.001
		San Francisco	% minority: NR	Exclusion: no car ownership.		One 30-min session.
						Counseled on seating location: NR
		Prenatal couples	SES: NR
			Hospital A
			N: 67
			Age: NR
			% male: 0
			% minority: 24
			SES-Median education: 16 yrs
			Hospital B
			N: 69
			Age: NR
			% male: 0
			% minority: 77
			SES-Median education: 12 yrs
			Baseline seatbelt usage of parents:
			Hospital A: never wear 6%
			Hospital B: never wear 38%

: Calc= Calculated Value; CG= Control Group; IG= Intervention Group; Indv. = Individual; N= Number; NR= Not Reported; PC= Primary Care; PC-F= Primary Care Feasible; PC-R= Primary Care Referable; RCT= Randomized Controlled Trial; SES= Socioeconomic Status

Evidence Table 2. Included studies ages 4–8 booster seats

Study Reference	Target Behavior	Study Design	Population	Inclusion/Exclusion Critieria	Description Intervention	Intervention Format	Follow-up time frames	Outcomes:	Results	USPSTF Quality
	Setting	Location	Baseline Data-usage
		Population Targeted
Gittelman ^14, ¹⁵	Booster Seats	RCT	N: 225	Included: families with child 4–7 years old, 40–80 lbs., living in target zip codes, presenting with any chief complaint	IG1: Education-only; Certified car seat technician delivered 5-min.of instruction on importance of booster seats and their correct use; provided instructions on how to obtain a booster seat and where to go for fitting seats; and answered questions. Car seat technicians were trained for 32 hours prior to delivering intervention.	To evaluate the effectiveness of booster seat education for families residing in lower socioeconomic neighborhoods within an emergency department	1 month post ED visit	Behavioral Outcomes:	IG1= 8.7%	Fair/Poor; high overall attrition (35%); differential attrition across groups; self-reported outcomes; analyzed completers only; do not report process measures
	PC-F; emergency department	Urban hospital- pediatric emergency department	age: NR	Excluded: Already used a booster seat; critically ill; primary language not English; no home phone for follow-up; no automobile at visit or able to return with a automobile the same day of visit	IG2: Educational and booster seat give giveaway-same as IG1 with the addition of a free booster seat properly installed at the end of the visit	Parent/child		Self-reported booster seat use	IG2= 98.2%
		Families with children ages 4–7 years residing in low socioeconomic zip codes who presented to the ED for any chief complaint and reported not using booster seats	%male: NR		CG: Standard discharge instructions from the ED.	Indiv; print, video, demonstration		Health Outcomes: NR	CG= 1.3%
			%minority: NR			1 session; 5-minutes		Harms Measure: NR	P=<0.001 (IG2 compared to IG1 and CG combined)
			SES: 77.2% had Medicaid and 9.8% were self-pay; all participants resided in zip codes representing low socioeconomic communities			Counseled on seat location: NR
			IG1
			N: 75
			age(mean): 66.2 months
			%male: 52%
			%minority: 71% African American
			SES: all participants resided in zip codes representing low socioeconomic communities
			IG2
			N: 75
			age (mean): 64.4 months
			%male: 52%
			%minority: 76% African American
			SES: all participants resided in zip codes representing low socioeconomic communities
			CG
			N: 75
			age (mean): 65.3 months
			%male: 52%
			%minority: 77% African American
			SES: all participants resided in zip codes representing low socioeconomic communities
			No difference in age, race, gender, or number of children in the home between study groups.

: Calc= Calculated Value; CG= Control Group; IG= Intervention Group; Indv. = Individual; N= Number; NR= Not Reported; PC= Primary Care; PC-F= Primary Care Feasible; PC-R= Primary Care Referable; RCT= Randomized Controlled Trial; SES= Socioeconomic Status

Evidence Table 3. Included studies 9–19 year olds

Study Reference	Target Behavior	Study Design	Population	Inclusion/Exclusion Criteria	Description Intervention	Intervention Format	Follow-up time frames	Outcomes	Results	USPSTF Quality
	Setting	Location	Baseline Data-usage
		Population Targeted
Stevens 2002 ¹⁶	Seat belts	RCT-Cluster randomized	N: 3145	Inclusion: 5th and 6th grade students attending well-child visits with a parent/guardian	IG: Received counseling from pediatrician during WCC visits; contract for family policy; letter; reminders at follow-up visits; biannual phone calls alternating parent and child; brochure, newsletters for parents (12) and children (12) regarding gun safety, seat belt use, and bicycle helmet use.	To prevent or delay onset of health risk behaviors and enhance safety behaviors	12, 24, 36 months	Behavioral Outcomes: Child did not always use seatbelt in last month assessed through questionnaire.	Odds Ratio CG to IG	Fair; report baseline characteristics;
	PC	12 rural and urban pediatric PC practices in New England	Age: 11.0/11.0 yrs	Exclusion: Only one pair per family could participate	CG: Received all the same contacts as the IG with the information targeting alcohol and tobacco use.	Office systems' approach		Health Outcomes: NR	12 month: 0.87 (0.73, 1.04)	adjusted for several important possible confounding variables; but self-reported outcomes; 27% attrition and analyzed completers only
	Alcohol and tobacco use; bicycle helmet use; gun storage		% male: 54/50			Parent and child		Harms Measure: NR	P-value=0.12
			% minority: NR			Indiv, print, phone			24 month: 0.96 (0.79, 1.15)
			SES: NR			34 contacts over 36 months			P-value=0.65
			Baseline usage:						36 month: 0.89 (0.73, 1.09)
			IG-74.4%						P-value=0.27
			CG-71.9%
Macknin 1987 ¹⁷	Seat belts	CCT	N=385	Inclusion: Age 5–19 yrs; coming in for a well-child visit	IG: MD-pediatrician asked a screening question regarding seat belt use. If yes; positive reinforcement. If no; give facts about seat belt use. Patient and MD signed a contract promising use.	A single, brief physician intervention to increase seat belt use.	Post-visit, 12 months.	Behavioral Outcomes: Observed seat belt use.	% not using seat belt pre-visit	Fair; report baseline characteristics; observed outcomes; behavior change analyzed only among those not using SB pre-visit and very short-term observed f/u; longer term f/u was self-reported and higher attrition (35%)
	PC	Private pediatric group practice	Age (mean): 8.35 yrs	Exclusion: NR	CG: No mention of seat belt use was made.	Parent; Child/adolescent		12-month follow-up is self-report questionnaire of seat belt use.	IG: 63©
		Predominantly white, middle-class	% male:			Indiv.; print.		Health Outcomes: NR	CG: 61©
			% minority:			One contact, time-NR.		Harms Measure: NR	% of those not wearing pre-visit who were wearing post-visit.
			SES:			Counseled on seat location: NR.			IG: 38
			Baseline usage: Pediatricians estimated it to be < 50%						CG: 5
									P < 0.001
									% reporting seat belt use at 1 year
									IC: 62%
									CG: 67%
									P = ns

: CG= Control Group; IG= Intervention Group; Indv. = Individual; N= Number; NR= Not Reported; PC= Primary Care; PC-F= Primary Care Feasible; PC-R= Primary Care Referable; RCT= Randomized Controlled Trial; SES= Socioeconomic Status; © = calculated

Evidence Table 4. Included studies adults

Study Reference	Target Behavior	Study Design	Population	Inclusion/Exclusion Criteria	Description Intervention	Intervention Format	Follow-up time frames	Outcomes	Results				USPSTF Quality
	Setting	Location	Baseline Data-usage
		Population Targeted
Hempel 1992 ¹⁸	Seat belts	RCT	N: 360	Inclusion: between 14 and 60 years	IG: Viewed a 6-minute film explaining why one should wear seat belts. Nurse practitioner gave an appeal to wear seat belts based on her personal conviction.	To increase seat belt use	6 months	Behavioral Outcomes: Seat belt use assessed through questionnaire using a linear scale.	Seat Belt use, %				Fair/poor; high attrition (25%); analyze completers only; outcome is self-reported an not well-maseked
	PC	Rural primary care center in a primarily indigent area.	IG	Exclusion: Acutely ill (temperature > 101.0°F; severe pain; mental status changes; or other acute distress); refused to sign a release; or were unable to comprehend the intervention (intellectual impairment or psychosis).	CG: Viewed a 6-minute film regarding general preventive health care guidelines with no mention of seat belts.	Adult		Health Outcomes: NR		Baseline	6mo	P-value
			Age (mean): 30 y			Individual; video		Harms Measure: NR	IG	22	37.3	0.00052
			% male: 22.9			Two contacts totaling approximately 8 minutes over 6 months			CG	20	33.6	0.00085
			% minority: 0					Between groups NS
			SES: NR
			CG
			Age (mean): 30 y
			% male: 31.1
			% minority: 0
			SES: NR

: Calc= Calculated Value; CG= Control Group; IG= Intervention Group; Indv. = Individual; N= Number; NR= Not Reported; PC= Primary Care; PC-F= Primary Care Feasible; PC-R= Primary Care Referable; RCT= Randomized Controlled Trial; SES= Socioeconomic Status

Bookshelf ID: NBK34025

Contents

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