{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T08:03:39Z","timestamp":1780041819899,"version":"3.53.1"},"reference-count":5,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Smoking Cessation Leadership Center"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Promotion Practice"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1177\/15248399261449740","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T10:55:21Z","timestamp":1779792921000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementing Trauma-Informed Training for Tobacco Use for Health Care Professionals in Two California Counties"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5655-0675","authenticated-orcid":false,"given":"Mark R.","family":"Hawes","sequence":"first","affiliation":[{"name":"University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Safier","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Clark","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Pamatmat","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Bonniot","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Cheng","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Almazar","sequence":"additional","affiliation":[{"name":"National Association of State Mental Health Program Directors, Alexandria, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Gillece","sequence":"additional","affiliation":[{"name":"National Association of State Mental Health Program Directors, Alexandria, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3747-984X","authenticated-orcid":false,"given":"Maya","family":"Vijayaraghavan","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"Abufarsakh B. Okoli C. T. C. Darville A. K. Williams L. B. Garcia A. R. Martin C. (2024). Tobacco use behavior among adults exposed to cumulative adverse childhood experiences: A systematic review and meta analysis. Addictive Behaviors 152 107948. https:\/\/doi.org\/10.1016\/j.addbeh.2023.107948","DOI":"10.1016\/j.addbeh.2023.107948"},{"key":"e_1_3_2_3_1","doi-asserted-by":"crossref","unstructured":"Agaku I. (2026 March 10). Tobacco product use among U.S. Adults 2023\u20132024. NEJM Evidence. https:\/\/doi.org\/10.1056\/EVIDpha2500339","DOI":"10.1056\/EVIDpha2500339"},{"key":"e_1_3_2_4_1","unstructured":"National Association of State Mental Health Program Directors. (2023). Trauma addictions mental health and recovery. https:\/\/smokingcessationleadership.ucsf.edu\/sites\/smokingcessationleadership.ucsf.edu\/files\/2023-11\/TAMAR_Manual_9.29v3.pdf"},{"key":"e_1_3_2_5_1","author":"Substance Abuse and Mental Health Services Administration","year":"2014","unstructured":"Substance Abuse and Mental Health Services Administration. (2014). Trauma-informed care in behavioral health services [Treatment Improvement Protocol (TIP) series 57. HHS Publication No. (SMA) 13-4801].","journal-title":"Trauma-informed care in behavioral health services"},{"key":"e_1_3_2_6_1","volume-title":"Eliminating tobacco-related disease and death: Addressing disparities\u2014A report of the surgeon general","author":"U.S. Department of Health and Human Services","year":"2024","unstructured":"U.S. Department of Health and Human Services. (2024). Eliminating tobacco-related disease and death: Addressing disparities\u2014A report of the surgeon general. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health."}],"container-title":["Health Promotion Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15248399261449740","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15248399261449740","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15248399261449740","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T07:21:32Z","timestamp":1780039292000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15248399261449740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":5,"alternative-id":["10.1177\/15248399261449740"],"URL":"https:\/\/doi.org\/10.1177\/15248399261449740","relation":{},"ISSN":["1524-8399","1552-6372"],"issn-type":[{"value":"1524-8399","type":"print"},{"value":"1552-6372","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"article-number":"15248399261449740"}}