BuckleUpBoston! (BUB), now in its ninth year, is a child passenger safety program (CPS) coordinated by the Boston Public Health Commission’s Childhood Injury Prevention Program (CIPP). BUB serves as an important resource for low-income families in Boston who are in need of a child safety seat. Patients qualify for the program if they fall below poverty level or meet Massachusetts state guidelines for MassHealth (Massachusetts Medicaid program). BUB recipients are primarily Latino or African-American. Every year BUB protects over 1,600 low-income children by providing their families with a free or low-cost car safety seat and training on correct use.
The BUB program is comprised of two major components. The first is the BuckleUpBoston! coalition. The coalition is an alliance of hospitals, health centers, and public and private institutions led by CIPP. The members of the coalition are committed to child passenger safety and improving access to car safety seats to underserved city populations. Coalition members meet on a bi-monthly basis to discuss current CPS issues and plan events throughout Boston. Members receive a bi-monthly E-newsletter with CPS updates and are provided with CPS training opportunities. The second program component is car seat distribution. The BuckleUpBoston! distribution program provides the opportunity for low-income Boston residents to have easy access to car safety seats through their community health center or hospital. Health center or hospital staff, at 22 participating distribution sites, train patients on correct car seat use and provide a seat on-site.
The goal of BUB is to increase awareness about CPS and usage rates of seats amongst low-income families in the city of Boston. The program objectives and outcomes are:
Improve access to affordable child safety seats: By distributing car seats to families who otherwise might not have access to them, the BuckleUpBoston! program expects to decrease the incidence of injuries to children involved in car crashes. Increase knowledge of correct use of child passenger restraints: As part of the BuckleUpBoston! program, parents receive training and educational materials about car seat use prior to receiving a car seat. They are also referred to local certified CPS technicians who can install their seats correctly.
According to the National Highway Traffic Safety Administration, motor vehicle crashes are the leading cause of unintentional injury-related death to children. Approximately 29% of children ages four and under ride unrestrained. They are therefore riding at twice the risk of death and injury.
In 2002 and 2003, Boston was fortunate in that there were no fatalities for children ages four and under involved in motor vehicle crashes. The city’s low traffic fatality rate can be attributed to its superb emergency response system and close proximity to trauma centers. Even so, the Massachusetts Department of Public Health reports that, in the city of Boston during 2003, there were 264 emergency room visits for motor vehicle occupant injuries in children ages 0 to 4 years old. Boston’s low-income children are disproportionately at a higher risk for injuries caused by non-use of car seats. Only 25% of children aged 0 to 4 years old who are covered by Medicaid travel in car safety seats, compared to the 70% of other children aged 0 to 4 who use car safety seats.
The BuckleUpBoston! program is innovative in a variety of ways. Firstly, it is the only car seat distribution program of its kind in the state of Massachusetts. While there are car seat rental and loan programs at individual sites around the state, the BUB distribution program is unique in that it is comprised of 22 collaborating sites. By bringing together major hospitals and community health centers throughout the city of Boston, BUB has been able to successfully reach its target population – low-income urban families. Over 1,600 families receive a car seat through the BUB program annually.
BUB is also innovative in that it bridges the gap between distribution of seats and proper installation by following a train-the-trainer model. Hospitals or health centers who wish to participate in the program must send at least one staff member to a CPS training. After the staff member(s) completes the training, they can begin to distribute seats to parents. They must, however, train the parents on correct use of the seat before distributing it. As part of the training, parents are also provided with information on where they can have their car seat properly installed by a Certified Child Passenger Safety Technician.
Finally, the program is innovative because the BuckleUpBoston! coalition has been involved in promoting a booster seat bill in the state of Massachusetts. The legislation hopes to reduce injury and death to children in motor vehicle crashes by raising the age and weight requirements for children who travel in booster seats to the national standard of 57 inches. By helping to mobilize community members and supporting the policy through letters and testimonies, coalition members continue to reinforce their commitment to child passenger safety.
Agency Community RolesWith the Boston Public Health Commission’s Childhood Injury Prevention Program (CIPP) as the lead agency, the BuckleUpBoston! coalition currently enjoys the membership and support of every major hospital, health center, and several public and private organizations around the city of Boston (see attached list). The coalition’s hospital partners played an important role in founding BUB in 1996 by providing the initial monies for the program launch. Because hospitals cannot legally release newborn infants from their grounds without an appropriate child safety restraint, forming a partnership with local community health centers was to their advantage. By participating in and supporting BUB, the hospitals were able to perform fewer on-floor car seat trainings, and also distribute fewer car seats. This synergy between the hospitals and community health centers have helped to make the BUB program a success. Through its hospital and health center partners, CIPP has been able to successfully reach its target audience of low-income urban families.
The BuckleUpBoston! program has effectively partnered with corporations in the past. When the program first began, a partnership with the local Kmart was formed. BUB distribution sites provided their patients with car seat vouchers that could be redeemed at Kmart. By partnering with a large retail chain, the program received visibility and also saved money in freight and delivery charges. Unfortunately, the Boston area Kmarts closed in 2003. BUB also partnered with Executive Auto Glass (EAG), a local auto glass replacement company. In concert with BUB and the Greater Boston Safe Kids Coalition, EAG hosted car seat check points throughout the city and state.
Several community partners have also participated in the BUB coalition. The Boston Police Department has dedicated several of their community service officers to CPS safety by registering them to become Certified CPS Technicians. The Boston Fire Department has hosted car seat checkpoints in the past, and the Emergency Medical Services of Boston plans to host checkpoints in the future.
In turn, CIPP coordinates the coalition by providing CPS updates and training opportunities to its members, planning child safety seat inspections, and actively recruiting the participation of more hospitals and health centers. CIPP also funds 14 health center distribution sites, and provides CPS resources and materials to all coalition members.
Costs and ExpendituresThe Boston Public Health Commission's Childhood Injury Prevention Program (CIPP) pays the salary and fringe benefits of a full-time coordinator who manages administrative and outreach activities of the BuckleUpBoston! Program. For FY 2005, the city provided approximately $5,000 for the program. In addition, BUB received $16,000 in funding from external grants. Each of the 14 CIPP-funded BUB sites receives $1,500 worth of car seats. The collection of co-payments is crucial to the vitality of the program. If each site collects co-payments for every seat distributed, CIPP is able to order 75 child safety seats per year for each site. CIPP plans to pursue corporate sponsorship and foundation grants to sustain BUB in the future.
ImplementationHealth centers who wish to join BuckleUpBoston! and receive funding from CIPP must commit to providing the following infrastructure:Provide at least 1 staff member who will:
Coordinate its site’s BUB program
Train parents or guardians on correct car safety seat use.
Distribute seats to trained parents or guardians only.
Collect co-payments and demographic information data from each parent or guardian who receives a seat, and send to CIPP.
Send each assigned staff member to a 4 or 8 hour training on child passenger safety.
Set up an account to deposit co-payments collected for the car seats.
Make arrangements for the storage of car seats at your health center.
Set up a schedule for training patients.
Send at least one staff member to BUB meetings to keep updated on Child Passenger Safety developments and contribute to BUB coalition issues.
Participate in educational campaigns periodically.
Institutionalize the car seat distribution program such that the health center will maintain the program even if the assigned employee ceases to work in that capacity.
CIPP-funded sites that do not abide by the guidelines risk the loss of funding. Hospitals and health centers that are self-sustaining also commit to a similar infrastructure.
A six-month follow-up was conducted with a smaller random sample of participants to assess program implementation and outcomes. A group of smokers who did not receive patches was used for comparison. The study was conducted by phone. Non-responders to the third call were asked to complete a mailed evaluation survey. Participants who completed the surveys were mailed $20.00 MetroCards to compensate them for their time and participation in the study. The evaluation component was completed entirely by DOHMH staff.
The study results are based on a 61% response rate. Outcome data collected were compared to the baseline information collected during intake. Differences between the participants and the comparison group were also assessed. Results showed that a diverse group of participants were enrolled in the program including residents of all New York City boroughs, women, young adults, low-income individuals and people of various race and ethnicities. Seventy-eight percent of the participants smoked more than 20 cigarettes (one pack) per day.
In contrast to the comparison group, participants were about 1.6 times more likely to report a quit attempt and more than five times as likely to stop smoking for a week or longer. In addition to the 33% 7-day quit rate, participants who received one or more counseling calls were about one-third more likely to quit than those who received no counseling calls. Participants who were not successful in quitting reported a significant decrease in cigarette consumption.
The marked differences in findings for the participant and comparison groups attests to the efficacy of the program. In addition, the program proved to be a cost-effective way to treat nicotine addiction.