Tennessee Intervention for Pregnant Smokers (TIPS)
The TIPS program was funded in 2007 by Governor Bredesen’s Office of Children’s Care Coordination, for a total of $1.4
million for a four year period. The program goal is to improve birth outcomes in Northeast Tennessee by reducing rates
of pregnancy smoking and smoke exposure. The six target counties, Carter, Hawkins, Johnson, Sullivan, Unicoi, and
Washington, have the highest rates of pregnancy smoking in the state (nearly 40% of pregnant women here smoke).
Consequently, rates of low birth weight and preterm births are much higher than national and state averages.
While program activities are varied, and include a multitude of community outreach, service, and educational
activities, the two primary tasks of TIPS are:
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To train prenatal care providers (physician, nurses, health department workers) to provide brief smoking
cessation counseling and assistance to pregnant patients, and to provide ongoing support for and evaluation of
their efforts. To date, 209 health care professionals have received such training and ongoing support. These
professionals have since provided prenatal care to over 5,000 women.
To provide ongoing case management services and smoking cessation assistance to high risk pregnant women in
the region. Project case managers work in six prenatal care sites and at one delivery hospital in the region. Over
1300 pregnant women have received TIPS case management services, including additional smoking cessation
counseling and support, help with barriers to quitting, and practical assistance with life issues.
Program Successes
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Among women who met with a Case Manager at least 4 times, 20% quit smoking completely by delivery, and
35% had at least one quit attempt. These rates are more than double what has been reported for other
intervention programs across the country.
Of TIPS participants who began their pregnancy as smokers but had quit by entry into prenatal care, 90%
remained smoke free to delivery. Recidivism rates reported for other interventions are typically around 50%.
TIPS women who quit smoking gave birth to infants a half pound heavier, more than half an inch longer, and
were 25% less likely to be born preterm. All women who quit smoking gave birth to a child that survived to
hospital discharge, compared with a 6% fetal/neonatal demise rate for continued smokers.
Women who significantly reduced their level of smoking were 24% less likely to give birth preterm and 44% less
likely to have their newborn admitted to the NICU.
64% of participants with significant SHS exposure eliminated or significantly reduced this exposure.
Women who reduced or eliminated second hand smoke exposure had a 47% reduction in risk for preterm
delivery, and a 60% reduction in risk for a NICU admission.
Regional Successes
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Since the beginning of the TIPS program, the percentage of women in the six county region who smoke
throughout pregnancy has gone from a decade high in 2007 of 31.9% to a low of 25.8% in 2009. This represents
a 20% decrease in pregnancy smoking in the region.
The percentage of low birth weight deliveries has dropped from 9.8% to 8.1%, a 17.3% decline.
The percentage of preterm deliveries in the TIPS service area has dropped from 13.4% to 10.6%, or 20.9%.
Based on the number of preterm births eliminated per year, and the average increased associated hospital
costs, a region-wide savings in newborn hospital costs of $2,721,000 has been seen over the 3 year period.
Thus, the TIPS program has resulted in a $2.72 million reduction in newborn hospital costs, untold savings in longterm health and educational expenses, and improved quality of life for women and children in the region.