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Tennessee Intervention for Pregnant Smokers

East Tennessee State University

Services Provided

While program activities are varied, and include a multitude of community outreach, service, and educational activities, the two primary tasks of TIPS are:

  1. To provide ongoing smoking cessation assistance to pregnant women in the region. Project counselors work in 6 prenatal care sites and at one delivery hospital in the region. Over 3200 pregnant women have received TIPS Counselor services, including smoking cessation counseling and support, help with barriers to quitting, and practical assistance with life issues.
  2. To train prenatal care providers (physicians, nurses, health department workers) to provide brief smoking cessation counseling and assistance to pregnant patients, and to provide ongoing support for/evaluation of their efforts. To date, 280 health care professionals, and over 1,000 health professions students have received such training and ongoing support. These professionals have since provided prenatal care to over 10,000 women.

Program Successes

  • Among all TIPS program participants, 30% quit smoking completely by delivery. In the final 2 years of the program the intervention was revised resulting in a quit rate of 41% among women who met with a TIPS Counselor at least 4 times. These pregnancy smoking cessation rates are more than double those from other intervention programs.
  • Over 55% of patients quit at least once; of those who didn't quit, 70% significantly reduced their amount of smoking.
  • Of TIPS participants who began their pregnancy as smokers but had quit by entry into prenatal care, 88% remained smoke free to delivery. Recidivism rates reported for other interventions typically exceed 50%.
  • TIPS patients who quit smoking gave birth to infants a half pound heavier, more than half an inch longer, and were 30% less likely to be born preterm. All but one woman who quit smoking gave birth to a child who survived to hospital discharge, compared with a 5% fetal/neonatal demise rate for continued smokers. At 15 months of age, children born to TIPS patients who smoked through pregnancy had delayed fine motor, language, and cognitive development, and had significantly more health problems, than children born to TIPS women who quit smoking.
  • Women who significantly reduced their level of smoking were 28% less likely to give birth preterm and 45% less likely to have their newborn admitted to the NICU.
  • 70% of participants with significant SHS exposure eliminated or significantly reduced this exposure.
  • Women who reduced or eliminated second hand smoke exposure had a 50% reduction in risk for preterm delivery, and a 65% reduction in risk for a NICU admission.
  • Finally, physicians who consistently implemented brief smoking interventions had patients 50% less likely to be smoking at delivery, compared with patients of physicians who infrequently or rarely addressed smoking.

Regional Successes

  • Since the beginning of the TIPS program, the percentage of women in the six-county region who smoke throughout pregnancy has gone from a high of 31.9% in 2007 to a low of 24.5% in 2011. This represents a 23% decrease in pregnancy smoking in the region.
  • The percentage of low birth weight deliveries has dropped from 9.8% to 7.8%, an 18% decline.
  • The percentage of preterm deliveries in the TIPS service area has dropped from 13.4% to 10.0%, or 24%.
  • Based on the number of preterm births eliminated per year, and the average hospital costs associated with these births, a region-wide savings in newborn hospital costs of $9,497,500 has been seen over the 5.5 year period.

Thus, for a $2 million investment, the TIPS program has led to a $9.5 million reduction in newborn hospital costs, untold additional savings in long-term health and educational expenses, and significantly improved quality of life for women and children in the region.

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