Hunt D K, Lowenstein S R, Badgett R G, Steiner J F
Department of Medicine, University of Texas Health Science Center 78284-7879, USA.
Am J Med. 1995 Apr;98(4):343-8. doi: 10.1016/S0002-9343(99)80312-X.
The United States Preventive Services Task Force recommends that physicians routinely counsel all patients to wear safety belts. We undertook this study to determine the prevalence of the nonuse of safety belts among internal medicine patients, to measure the association of nonuse with other health risk factors, and to ascertain the safety belt counseling practices of physicians.
A total of 492 consecutive patients attending a university-based general medicine clinic were given a validated, self-administered questionnaire, and 94% responded. A medical chart review was performed in a blinded fashion on 94% of the eligible charts.
Of the 454 patients who provided safety belt information, 243 (54%) did not wear safety belts. Nonusers were more likely to be problem drinkers, inactive, obese, and to have a low income (adjusted odds ratios 1.8 to 2.0). Of patients with all four of these characteristics, 91% did not use safety belts. The leading reasons for safety belt nonuse were discomfort (35%), short driving distances (24%), and forgetfulness (13%). Obese patients were more likely to report discomfort as their reason for nonuse (odds ratio 2.4; 95% confidence limit 1.4 to 4.3). Eighteen patients (3.9%) reported that a physician had ever counseled them about safety belt use. Only two of 314 medical records (0.6%) noted physician questioning or counseling about safety belt use.
The majority of patients attending an internal medicine clinic do not wear safety belts. Nonusers are more likely to be problem drinkers, inactive, obese, and to have a low income. Patients with multiple health risk factors are at significant risk of nonuse. The most common reason for nonuse is physical discomfort, especially among obese patients. Finally, physicians rarely counsel patients to use safety belts.
美国预防服务工作组建议医生常规性地向所有患者提供关于系安全带的咨询。我们开展此项研究以确定内科患者中不系安全带的比例，衡量不系安全带与其他健康风险因素之间的关联，并确定医生关于系安全带的咨询做法。
共有492名连续就诊于一所大学附属医院普通内科门诊的患者接受了一份经验证的自填式问卷，94%的患者进行了回复。对94%符合条件的病历进行了盲法病历审查。
在提供安全带信息的454名患者中，243名（54%）不系安全带。不系安全带者更有可能是问题饮酒者、不活动、肥胖且收入低（校正比值比为1.8至2.0）。具备所有这四个特征的患者中，91%不系安全带。不系安全带的主要原因是不适（35%）、驾车距离短（24%）和遗忘（13%）。肥胖患者更有可能将不适作为不系安全带的原因（比值比2.4；95%置信区间1.4至4.3）。18名患者（3.9%）报告医生曾就系安全带问题向他们提供过咨询。314份病历中只有两份（0.6%）记录了医生对系安全带的询问或咨询。
就诊于内科门诊的大多数患者不系安全带。不系安全带者更有可能是问题饮酒者、不活动、肥胖且收入低。具有多种健康风险因素的患者不系安全带的风险显著。不系安全带最常见的原因是身体不适，尤其是肥胖患者。最后，医生很少向患者提供系安全带的咨询。
