The document summarizes a student's practicum experience evaluating the Baby & Me Tobacco Free program in Montgomery County, Tennessee. The program aims to reduce smoking among pregnant women. Over the first year, 47 women enrolled but many dropped out. CO monitoring tests showed reductions in smoking levels for remaining participants. An analysis of program data could provide insights to reduce low birthweight births from smoking and save an estimated $910,000 in hospital costs annually.

1. Introduction
Baby and Me Tobacco Free: An Evidence-Based Evaluation
In the Montgomery County, Tennessee Area
Student: Christina Newby, Prevention Science Track Site Supervisor: Joey Smith
Montgomery County Health Department
Objectives
Implications, Discussion, Conclusions
Project Design
Smoking is one of the leading cause of preventable death in the United
States. According to the Centers for Disease Control and Prevention, smoking
during pregnancy can lead to several problems for both the mother and her
baby, such as pregnancy complications, premature births, sudden infant
death syndrome (SIDS), and low-birth weight infants. When tobacco use is
avoided during pregnancy, the risk of a miscarriage is decreased, the baby’s
lungs grow stronger, premature delivery is prevented, the baby’s birth weight
is improved, and the baby’s overall health is better.
Based on hospital data from the Tennessee Department of Health, in
the last three years, 500 women (15.2%) from Montgomery County reported
smoking during pregnancy. The delivery cost for underweight babies due to
smoking in Montgomery County is over 2.9 million dollars each year.
To increase knowledge, save money, and decrease the prevalence of
smoking among pregnant women in Montgomery County, the Department of
Health decided to collaborate with a program entitled, Baby & Me Tobacco
Free, which will assist with providing the necessary prenatal services needed
to stop this deadly habit. Baby & Me Tobacco Free is a research-based
smoking cessation program that was launched in 2002, and is currently
partnering with health facilities and organizations in the U.S. Since 2002, the
program has improved lives and strengthened communities by helping
thousands of women (1).
Figure 1: Baby & Me Tobacco Free Poster
• Assist the County Director at the Montgomery County Health
Department with the collection of data from patients who participated in
the Baby & Me Tobacco Free program.
• Examine data collected to determine relationships, patterns and trends.
• Actively participate in meetings pertaining to current progress and future
goals of the Baby & Me Tobacco Free program.
• Compare data with other participating county health departments.
Lessons Learned
Data Collection, Data Sources
Project Status Update
The County Director gathered healthcare workers from the Montgomery County Health Department to discuss a
management plan referred to as “Plan-Do-Check-Act” (PDCA) for the control and continuous improvement needed
along the Baby & Me Tobacco Free process. Since this was a new project, this helped verify and prioritize problems
along the way. The following recommendations were made:
• Budgeting for Marketing/Advertising for Pre-Natal Anti-Smoking, therefore proposing more money in next years
grant for this project.
• Tracking how many months pregnant each participant is at the start of the program and at each session
attended.
• Developing ways to retrieve more hospital data of the baby’s gestational weeks and birth weights from
participants who report a CO reading of 0-6ppm versus those who drop out.
Conclusion
The Baby & Me Tobacco Free data collected at the Montgomery County Health Department can be used to provide
healthcare professionals with related trends, perceived knowledge, habits and behaviors seen in pregnant smokers.
Acknowledgements: Special thanks to the Montgomery County Director, Joey Smith, as well as other participating staff members for their support. I would like to also show my appreciation to the EMPH staff for their assistance with this experience.
Summer 2015
Overall Goal
The purpose of this practicum experience was to analyze and evaluate
data collected during the first year of the Baby & Me Tobacco Free project at
the Montgomery County Health Department. The overall goal is to reduce the
number of low birth weight births attributed to women who smoke during
pregnancy. Motivating pregnant women to stop smoking and continue to be
smoke-free following pregnancy is also an important goal for change.
Data Collection
All data throughout this practicum were collected from the Montgomery County Director and
participating staff, who documented, as well as recorded, findings resulting from client
registration forms, CO monitoring tests, and other communication from patients during their
health department visits.
Data Sources
Data came from the following target population :
• Health department patients
• WIC & social support service participants
• Residents that heard about the program
• Residents to the health department for a pregnancy tests.
Figure 2: The Baby & Me Tobacco Free Logo
How the Baby & Me Tobacco Free Program Works:
Pregnant women, who visit the Montgomery County
Health Department and are interested in the Baby &
Me Tobacco Free program complete the following
unique approach:
1. Agree to quit smoking and complete an application.
At this time, the program manager will arrange for the
women’s first appointment, where she will receive
specific information about the program and an initial
intake session will then be held.
2. Each participant will receive at least four, monthly
prenatal cessation counseling sessions, support
needed, and carbon monoxide (CO) monitoring.
A CO breath test shows the amount of carbon
monoxide in the breath (ppm), which is an indirect,
non-invasive measure of blood Carboxyhemoglobin
(%COHb), which is the level of CO in the blood (2).
3. The mother will return monthly, after the baby is
born, to continue CO monitoring. If the CO test
results prove that she has remained smoke-free ,
she receives a $25 monthly voucher for diapers up
to 6-12 months postpartum.
References:
1. Baby & Me Tobacco Free. (2013). Press in the News. Retrieved from
http://babyandmetobaccofree.org/Pages/Press.html
2. Bittoun, R. (2008). Carbon monoxide meter: The essential clinical tool-the ‘stethoscope”-of smoking cessation.
Journal of Smoking Cessation, 3(2),69-70. DOI 10.1375/jsc.3.3.69
The Baby & Me Tobacco Free made its debut at the Montgomery County Health Department in May 2014.
Since January 2015, the following have been reported:
By the numbers
47 pregnant women enrolled
18 women completed all four prenatal counselling sessions
29 women dropped out *
27 women received vouchers for diapers for remaining smoke-free after postpartum month 1
*Major reasons for drop-outs: lack of family support, other household smokers, stress, apathy/lack of
motivation, transportation problems, early delivery.
Figure 3 illustrates the charts that explain results from CO monitoring tests from participants after each of
the four total sessions.
A B C D E
County
Number of mothers
who reported
smoking anytime
during pregnancy
Percent smoking
anytime during
pregnancy
Goals
for
reduction
Number of pregnant
smoking ‘quitters’
needed to meet
county goal
Montgomery 500 15.2%
Reduce 10% 50
The Montgomery County Health Department Response:
Table 1: MEETING THE COUNTY GOAL
Step 1: Record your county in Column A, record the number of mothers who
reported smoking in Column B, and the percentage in Column C.
Step 2: Plug in the reduction goal in Column D. Multiply Column D by Column
B. Insert result in Column E.
A B C D E
County goal –
Number of smoking
pregnancies to be
reduced (Column E
above)
Percent of low birth
weight births
attributable to
smoking
Number of low
birth weight births
attributable to
smoking
Average hospital
charges for low
birth weight babies
above normal
delivery costs
Cost savings due to
reduction in
meeting county
goal
50 25% 13 $70,000 $910,000.00
Table 2: CALCULATION OF COST SAVINGS (RETURN ON INVESTMENT)
Step 1: Insert selected county goal for number of smoking pregnancies to be
prevented from Column E in Table 1 into Column A.
Step 2: Calculate number of low birth weight births to be attributable to
smoking based on your state statistics (derived from Tennessee State Health
Department’s Maternal and Child Health, every 1 out of 4 babies). Multiply
Column A by Column B and insert Column C.
Step 3: Calculate estimated cost savings based on your state estimates.
Multiply average additional hospital charges Column D by county goal in
Column C and insert in Column E.
SESSION 1
0-6ppm 7-11ppm 12-20ppm 20+ ppm
SESSION 2
0-6ppm 7-11ppm 12-20ppm 20+ ppm
SESSION 3
0-6ppm 7-11ppm 12-20ppm 20+ ppm
SESSION 4
0-6ppm 7-11ppm 12-20ppm 20+ ppm
CO (ppm) Cigarette Consumption
0-6 Non-Smoker
7-10 Light Smoker
11-20 Heavy Smoker
20+ Very Heavy Smoker
# of participants: 47 # of participants: 47
# of participant drop outs: 15
# of participants remaining: 32
# of participants: 32
# of participant drop outs: 12
# of participants remaining: 20
# of participants: 20
# of participant drop outs: 2
# of participants remaining: 18
An analysis of the Baby & Me, Tobacco Free program at the Montgomery County Health Department can help provide insight to
residents of the community and positively impact several mothers’ lives, as well as those of their babies and families.
Table 3: CO Monitoring
Test Levels
Figure 3: CO Monitoring Test Results