TABLE 1.

Recommendations for Counseling

Recommended ManeuverOrganizations RecommendingOrganizations Recommending AgainstEvidence From TrialsReferences to Reviews and TrialsResults
Injury prevention (in general)AAFP, AAP, CTF, GAPS, USPSTF, ICSI, Bright FuturesYes2427, 30, 33Modest decreases in some risk behaviors with counseling; the most effective strategies are multifactorial and time-intensive
Bicycle/motorcycle helmetsCTF, ICSI, Bright FuturesYes26, 32Conflicting evidence, possible small effect of counseling on bicycle helmet use
Automobile occupant restraintsICSI, USPSTF, Bright FuturesYes26, 32Modest increase in automobile restraint use
Poisoning preventionICSI, CTF, Bright FuturesMr Yuk stickers specifically; AAFP, USPSTFYes30, 31, 135, 136No difference in safety behaviors among counseled families; use of Mr Yuk stickers increases exposure to poisons
Choking preventionICSI, Bright FuturesNoNone found
Sunburn/skin cancer preventionICSI, CTF, USPSTF, Bright FuturesNoNone found
Violence, including child abuse, counselingAAP, ICSI, Bright FuturesYes34Interventions in the office setting do not prevent violent behavior; comprehensive and home visit-based programs have some effect
Passive smoke exposure counselingICSI, AAFP, USPSTF, Bright FuturesYes37, 38Brief, office-based interventions not effective; modest effect of intensive counseling
Smoking/tobacco use counselingICSI, AAFP, GAPS, USPSTF, Bright FuturesNo39, 40, 107110Studies of adults find office counseling effective; effectiveness increases with treatment intensity
Drinking and drugs (including drinking and driving) counselingICSI, USPSTF, Bright FuturesYes32, 41, 42Brief, office-based interventions not effective; 1 randomized, clinical trial showed slight increase in drinking in intervention group
STD preventionAAFP, CTF, GAPS, USPSTF, Bright FuturesYes43474 trials showed minimal effect of brief, office-based counseling; more intensive intervention resulted in decreased incidence of STDs
Pregnancy preventionGAPS, ICSI, USPSTF, CTF, Bright FuturesNo48No studies of brief, office-based counseling; of other programs, only intensive, multifaceted programs show an effect
Physical activityAAFP, GAPS, Bright FuturesYes51, 52Brief advice does not change physical activity; multimodal interventions have modest effect
Nutrition/diet counselingAAP, GAPS, ICSI, AAFP, USPSTF, Bright FuturesNo49, 501 randomized, clinical trial underway
BreastfeedingAAFP, CTF, ICSI, USPSTF, Bright FuturesYes5456, 137, 138One-on-one prenatal education increases breastfeeding, multifaceted programs have greater effect, breastfeeding support programs extend duration, counseling on pacifiers changes pacifier use but not duration of breastfeeding
Infant sleep position counselingICSI, AAP, Bright FuturesNo58
Oral health counselingAAP, ICSI, CTF, USPSTF, Bright FuturesNo59, 60