Implementing Trauma-Informed Training for Tobacco Use for Health Care Professionals in Two California Counties.

Tobacco use remains a leading cause of preventable death in the United States, and smoking is disproportionately concentrated among individuals who have experienced trauma. Trauma-informed care offers a framework for addressing tobacco use in this population, yet few training programs provide guidance on integrating trauma-informed principles into cessation treatment. To address this, our team added a tobacco treatment module to the Trauma, Addictions, Mental Health, and Recovery (TAMAR) training for behavioral health providers in two California counties. We conducted semi-structured qualitative interviews with seven community-based providers who completed the training and analyzed them using inductive thematic analysis. Participants described the module as relevant and actionable. Participants reported changes in practice after the training, including adding tobacco questions to intake workflows, incorporating mindfulness strategies to help clients manage cravings, and integrating cessation goals into treatment planning. Participants viewed trauma-informed cessation care as requiring empathy, cultural humility, nonjudgment, and an understanding of the role of trauma in tobacco use. Barriers included limited time, staffing constraints, insufficient cessation training, rigid workflows, and a lack of physical space to deliver the training. Facilitators included organizational support, leadership buy-in, and access to professional development in providing cessation care. Participants emphasized that one-time trainings are insufficient to sustain trauma-informed tobacco treatment. Effective implementation requires organizational infrastructure, repeated reinforcement of skills, and materials that support real-time application. Findings highlight the need to align trauma-informed cessation curricula with the realities of diverse community settings and to expand training opportunities for professionals serving populations experiencing trauma.