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As of late 2011, the project has been underway for over four years. At this point, we  have published 6 papers related to our findings in scientific journals. In addition, Dr. Bailey has published six review and/or clinical guidelines papers based on her TIPS work. Finally, we have had 26 different presentations at scientific conferences based on TIPS findings. These are all summarized below. We encourage you to check back often for updates to this page as the program progresses.

The following Research Papers, based on our work to date, have been published in scientific journals:

  1. Bailey BA, Jones Cole L. Rurality and birth outcomes: Findings from Southern Appalachia and the potential role of pregnancy smoking. Journal of Rural Health, 25(2), 141-149, 2009.
                       Journal of Rural Health                                      Paper

  2. Bailey BA, Wright HN. Assessment of pregnancy cigarette smoking and factors that predict denial. American Journal of Health Behavior, 34 (2), 166-176, 2010.
                       American Journal of Health Behavior              Paper

  3. Bailey BA, Jones Cole L. Are obstetricians following best-practice guidelines for addressing pregnancy smoking? Results from Northeast Tennessee. Southern Medical Journal, 102(9), 894-899, 2009.
                       Southern Medical Journal                                   Paper

  4. Bailey BA, Wright HN. Breastfeeding initiation in a rural sample: Predictive factors and the role of smoking. Journal of Human Lactation, 27(1): 33-40, 2011.
                           Journal of Human Lactation                               Paper

  5. Carlosh, K, Allen S, Dalton WT, Bailey BA. Weight concern, body image, and compensatory behaviors in rural pregnant smokers: A preliminary investigation. Journal of Rural Mental Health, 35, 17-22, 2001.
                      Journal of Rural Mental Health                           Paper

  6. Bailey BA, McCook JG, Hodge A, McGrady L. Infant birth outcomes among substance using women: Why quitting smoking during pregnancy is just as important as quitting harder drugs. Maternal Child Health Journal, published online 21 Mar 2011; print version in press.
                       Maternal Child Health Journal                            Paper

So far, the following presentations have been, or are scheduled to be, given:
  1. Presented at the Fourth Annual Primary Care research Day at East Tennessee State University, September 2007: Implementing a Pregnancy Smoking Cessations Program: Challenges and Recommendations from the First Six Months of TIPS.   BA Bailey, LK Jones Cole.                                         Abstract                     Poster

  2. Presented at the Appalachian Student Research Forum at East Tennessee State University, April 2008: Access to Obstetric Care in Rural Northeast Tennessee: Association with Birth Outcomes. HN Wright, BA Bailey, LK Jones Cole.
                                                       Abstract                     Poster

  3. Presented at the Third Annual Mountain States Health Alliance Research Conference, June, 2008; Also presented at Primary Care Research Day, Johnson City, TN September, 2008; Also presented at the Women's Health Across the Life Cycle Conference, Johnson City, TN, September, 2008 (our presentation was the first place poster winner):  The Link Between Pregnancy Smoking and Poor Birth Outcomes in Northeast Tennessee.    BA Bailey, LK Jones Cole, K Rice.
                                                        Abstract                     Poster

  4. Presented at the Third Annual Mountain States Health Alliance Research Conference, June, 2008; Community Conditions and Birth Outcomes: The Issue of Rurality and Economic Status, and the Potential Role of Pregnancy Smoking. BA Bailey, LK Jones Cole, K Rice.
                                                        Abstract                   Presentation

  5. Presented at the Tennessee Public Health Association Annual Meeting, September, 2008; Also presented at the Society for Research on Nicotine and Tobacco annual meeting, Dublin, Ireland, April, 2009: Are Obstetricians Following Best-Practice Guidelines for Addressing Pregnancy Smoking: Results from Northeast Tennessee.  BA Bailey, LK Jones Cole.
                                                        Abstract                     Poster

  6. Presented at the Tennessee Public Health Association Annual Meeting, September, 2008: Rurality and Birth Outcomes: Findings from Southern Appalachia and the Potential Role of Pregnancy Smoking.  BA Bailey, LK Jones Cole.
                                                         Abstract                    Poster

  7. Presented at Primary Care Research Day, Johnson City, TN, September, 2008: Intention to Breastfeed in a Rural Appalachian Sample: The Roles of Smoking and Sociodemographics. HN Wright, BA Bailey.
                                                         Abstract                    Poster

  8. Presented at the Society for research on Nicotine and Tobacco annual meeting, Dublin, Ireland, April, 2009: Assessment of Cigarette Smoking During Pregnancy: The use of Behavioral Observation and Factors that Predict Denial. BA Bailey, HN Wright. 
                                                           Abstract                  Poster

  9. Presented at the first annual Community Conference on Breastfeeding, Johnson City, TN, April 2009: Predictors of Breastfeeding: Data from Northeast Tennessee. BA Bailey.
                                                          Presentation

  10. Presented at the Behavioral Science Forum's annual meeting, Chicago, IL, September 2009: Are prenatal care providers following best-practice guidelines for addressing pregnancy smoking? Results from Northeast Tennessee. BA Bailey, LK Jones Cole. 
                                                           Abstract                   Poster

  11. Presented at Primary Care Research Day, Johnson City, TN, September 2009: Pregnancy smoking intervention in Northeast Tennessee: Effectiveness data from the first two years of the TIPS program. BA Bailey. 
                                                           Abstract                  Presentation

  12. Presented at the Society for Research on Nicotine and Tobacco, Baltimore, MD February 2010: Pregnancy smoking, ETS exposure, and birth outcomes: Relative risk and timing of exposure. BA Bailey.
                                                          Abstract                    Poster

  13. Presented at the Conference on Human Development, New York, NY, April 2010: How do you deal with stress? Pregnant women’s methods of coping. AD Clements, BA Bailey, HN Wright.
                                                           Abstract                  Poster

  14. Presented at the Conference on Human Development, New York, NY, April 2010: Prenatal stress coping strategies predict breastfeeding initiation. AD Clements, BA Bailey, HN Wright.
                                                          Abstract                   Poster

  15. Presented at the Appalachian Student Research Forum and the Boland Undergraduate Research Symposium, Johnson City, TN, April 2010: Weight Concerns and body image related to compensatory behavior among rural pregnant smokers. Carlosh K, Allen S, Dalton WT, and Bailey B.
                                                           Presentation             Poster

  16. Presented at the Society for Spirituality, Theology, and Health annual meeting, Durham, NC, June 2010:  Prayer/Religiosity as primary stress coping strategy predicts health-related pregnancy and birth factors in a rural Appalachian sample. AD Clements, BA Bailey, HN Wright, A Ermakova.
                                                          Abstract                    Poster

  17. Presented at the Association of Behavioral and Cognitive Therapies annual meeting, San Francisco, CA, November 2010: Weight concerns and body image as related to compensatory behaviors among rural pregnant smokers. K Carlosh, S Allen, WT Dalton, BA Bailey.
                                                             Abstract                     Poster

  18. Presented at the Society for Research in Child Development annual meeting, Montreal, QE, CAN, March 2011; Also presented at Primary Care Research Day, Johnson City, TN, February 2011: Prenatal smoke exposure and language outcomes at 15 months: Social aspects of communication vs expressive and expressive language. BA Bailey, AD Clements, JL Scott, LU McGrady.
                                                       Abstract                        Poster

  19. Presented at Primary Care Research Day, Johnson City, TN, February 2011: Infant birth outcomes among substance using women: Why quitting smoking is just as important as quitting harder drugs. BA Bailey, JG McCook, AL Hodge, LU McGrady.
                                                       Abstract                       Presentation

  20. Presented at the Society for Research in Child Development annual meeting, Montreal, QE, CAN, March 2011: Measuring religiosity and risk in a prenatal population: Attendance, prayer, influence or surrender to predict developmental risk? AD Clements, BA Bailey, A Ermakova.
                                                      Abstract                         Poster

  21. Presented at the Association of Women's Health, Obstetric, and Neonatal Nursing annual meeting, Denver, CO, June 2011; Also presented at Primary Care Research Day, Johnson City, TN February 2011: Quitting smoking during pregnancy and birth outcomes: Evidence of gains following cessation by third trimester. BA Bailey, AD Clements, JG McCook, LU McGrady.
                                                      Abstract                         Poster

  22. Presented at the Appalachian Student Research Forum, Johnson City, TN, March 2011: Psychosocial risk factors for smoking in pregnant women in rural Appalachia. JH Turner, JA Correll, K Carlosh, BA Bailey, WT Dalton.
                                                      Abstract                        Poster

  23. Presented at the Tennessee Public Health Association annual meeting, September 2011, Franklin, TN; Also presented at the Women's Health Across the Lifespan conference, Johnson City, TN, October 2011: Postnatal depression predicts new mothers' smoking in Tennessee. LU McGrady, A Ermakova, BA Bailey.
                                                      Abstract                       Poster

  24. Presented at the March of Dimes Prematurity Prevention Symposium, January 2012, Washington, DC. Effectiveness of Rural Pregnancy Smoking Intervention: Lessons Learned from the First Three Years of Tennessee Intervention for Pregnant Smokers (TIPS) program. BA Bailey, L McGrady.
                                                     Abstract                       Poster

  25. To be presented at the Society for Research in Nicotine and Tobacco annual meeting, Houston, TX, March 2012; Also presented at the Women's Health Across the Lifespan conference, Johnson City, TN, October 2011: Secondhand smoke exposure during pregnancy: The role of intimate partner violence. BA Bailey.
                                                     Abstract                         Poster


Recently Published Review or Clinical Guidelines Papers Relating to TIPS

  1. Bailey B, Sokol RJ. Is prematurity a part of the Fetal Alcohol Spectrum Disorders? Expert Review of Obstetrics and Gynecology, 3(2), 245-255, 2008.
                     Expert Review of Obstetrics and Gynecology Review Paper

  2. Bailey B, Sokol RJ. Pregnancy and alcohol use: Evidence and recommendations for prenatal care. In: Clinical Obstetrics and Gynecology, 51(2): 436-444, 2008.
                     Clinical Obstetrics and Gynecology Review Paper

  3. Bailey B, Sokol RJ. Fetal Alcohol Syndrome. Encyclopedia of Drugs, Alcohol, and Addictive Behaviors (3rd ed). Macmillan, 2009.
                      Encyclopedia of Drugs, Alcohol, and Addictive Behaviors Review Paper

  4. Bailey B. Partner violence during pregnancy: Prevalence, effects, screening and management. International Journal of Women's Health, 2010:2: 183-197, 2010. 
                         International Journal of Women's Health Review Paper

  5. Bailey BA, Sokol RJ. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and Sudden Infant Death Syndrome. Alcohol Research and Health, 34, 86-91, 2011.
                   Alcohol Research and Health Paper

  6. Bailey BA, Sokol RJ. Tobacco and alcohol use during pregnancy. Clinical Maternal-Fetal Medicine (2nd ed). H. Winn, F. Chervanak & R. Romero, eds. Informa Healthcare, 2011.
                    Clinical Maternal-Fetal Medicine Chapter

Recent Review Presentations Related to TIPS

  1. Presented as a Grand Rounds Talk, Department of Psychiatry, East Tennessee State University, January 2008: Prenatal smoke exposure and psychiatric outcomes. BA Bailey.
                      Review Presentation

  2. Presented at the Psychiatry in the Mountains conference, Johnson City, TN, October 2008: Nicotine addiction in pregnant women. BA Bailey.
                      Review Presentation

Summary of Baseline and Ongoing Data Collection

Data have now been collected on regional deliveries through the end of 2009 from several area hospitals in our six county service area. Some of the highlights are summarized below. We have also developed the following reports:

Regional Smoking and Birth Outcomes: Rates and Trends (2006 to 2009)
                              Table                               Graph

Changes in Pregnancy Smoking Rates by Site
                              Table

Changes in Pregnancy Smoking Rates by Service
                              Table

Usefulness of Smoking Cessation Advice
                              Table

Smoke Exposure Status and Birth Outcomes
                              Table

Regional Birth Outcomes Associated with Smoking
                               Flyer

  • During the two year baseline period, there were well over 2000 deliveries at Johnson City Medical Center (JCMC) and over 2000 deliveries at Johnson City Specialty Hospital (JCSH) (both in Washington County).

  • At JCMC, the rate of self-report of smoking at delivery was 32%, while the rate at JCSH was 16%. This puts the overall county delivery smoking rate at 25%.

  • Smoking rates INCREASED from 2006 to 2007: from 31.4% to 33.0% at JCMC, from 14.5% to 17.1% at JCSH, and from 23.8% to 25.3% overall. This compares with a national pregnancy smoking rate of 12.0% and a state of Tennessee pregnancy smoking rate of 17.0%.

  • Smoking rates varied significantly by prenatal care practice, with rates at one practice approaching 40%.

  • The rate of preterm birth at the Johnson City delivery hospitals was 16.9% in 2006-2007, while the rate of low birth weight births was 14.8%. This compares with national rates of 12.7% and 8.1%, and state of Tennessee rates of 14.5% and 9.0%.

  • Pregnancy smoking was significantly associated with all birth outcomes including birth weight, birth length, preterm delivery, and NICU admissions. Smoking was associated with at 12oz drop in birth weight, nearly a week reduction in gestational age at delivery, and a nearly doubled rated of NICU admission.

  • During the two year baseline period, there were nearly 1000 deliveries at Sycamore Shoals Hospital (SSH) in Elizabethton (Carter County).

  • At SSH, the rate of self-report of smoking at delivery was 41% during the two-year period, however rates DROPPED SLIGHTLY from 2006-2007.

  • Despite the high rate of pregnancy smoking, the rates of preterm delivery and low birth weight were quite low at SSH during the two year period (both rates just under 5%). This is likely due to the fact that all high risk women and those who go into labor preterm are sent to JCMC for delivery whenever possible.

  • Data for deliveries from 2006 to 2007 have been collected by reviewing all delivery charts at Indian Path Hospital in Kingsport (Sullivan County). During the two year period there were just over 2,000 deliveries. The pregnancy smoking rate in 2006 was 39.2%, which INCREASED to 41.1% in 2007.

  • Analysis of birth data from Indian Path Hospital is ongoing.

  • Data collection has not yet been completed for Bristol Regional Medical Center in Bristol (Sullivan County) or Holston Valley Medical Center in Kingsport (also Sullivan County).

We have also begun an analysis of the data collected by the Health Departments on all women who received WIC and other Health Department services during pregnancy and after delivery. This will allow us to compare Northeast Tennessee with the rest of the state. Here is what we know so far:

  • As expected, pregnancy smoking rates are higher in Northeast Tennessee than anywhere else in the state.
  • In 2006, the statewide pregnancy smoking rate among women participating in WIC was 23%. At 38%, Northeast Tennessee had the highest rate of pregnancy smoking, followed by the East region at 33%. All other regions has smoking rates less than 30%, with rates for multiple regions below 15%.
  • In 2006, the rate of low birth weight births among WIC participants in Northeast Tennessee exceeded those for metropolitan Davidson and Shelby counties.
  • Analysis of Health Department data is ongoing, and will continue as we receive numbers for 2007 and beyond.

Summary of Initial Program Effectiveness

Analysis of the effectiveness of case management services is underway. A total of 1,254 pregnant women who were smoking at the beginning of their pregnancy were invited to participate in Phase One (first three and a half years) of the TIPS program. Almost 90% of them (1,108) agreed to participate and met with a TIPS staff member at least one time. Here is what we know about these women:

  • Of the women who began pregnancy as smokers, 28% had quit by delivery.

  • An additional 15% of the women who smoked had at least one quit attempt during pregnancy.

  • While over half of the women continued to smoke, 45% cut down how much they smoked: 29% reduced by at least a half pack per day, 6% reduced by a pack per day or more.

  • One in ten women with second hand smoke exposure were able to completely eliminate their exposure, while another 58% were able to substantially reduce their exposure

  • Meeting with a Case Manager four or more times, using he TIPS self-help book, and taking advantage of outside referrals all significantly increased the likelihood that a TIPS participant would quit smoking during pregnancy.

  • Participating in in-depth counseling, receiving information about stress reduction and cessation for others, receiving Case Manager assistance with practical issues, and taking advantage of outside referrals all significantly increased the likelihood that a TIPS participant would significantly reduce their smoking during pregnancy.

  • Two or more meetings with a Case Manager, two or more 5 A's counseling sessions, receiving information on mental health issues and cessation for others, and taking advantage of outside referrals all significantly increased the likelihood that a TIPS participant would make at least one quit attempt during pregnancy.

  • Women who quit smoking during pregnancy had significantly better birth outcomes than women who continued to smoke - newborn birth weights were more than a half a pound greater, and these babies were significantly less likely to be preterm or admitted to the NICU.

  • Women who significantly reduced, but did not eliminate smoking also saw improved birth outcomes - in particular they had a significantly decreased risk of preterm delivery, a fetal or neonatal death, or a NICU admission

  • Finally, continued second hand smoke exposure during pregnancy led to poor birth outcomes similar to those experienced by women who themselves smoked throughout pregnancy

More detailed information can be found in this poster and this presentation.

Analysis of the implementation and effectiveness of physician provided 5 A's smoking cessation counseling is underway. We will also be looking in more depth at the effectiveness of the services we provide. Please check back for updates.

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