Despite the availability of tobacco cessation services, many patients with trauma find difficulty in quitting tobacco use, and may rely on tobacco to regulate negative emotions or cope with trauma. Many providers are unaware of the link between trauma and tobacco use--some may perceive this as a lack of motivation from patients. Other providers may be concerned about upsetting patients, or may not have the capacity to address trauma during interactions with patients. This may prevent patients with trauma from exploring healthy coping mechanisms or accessing tobacco cessation services. In order to improve tobacco cessation outcomes, providers must adopt a trauma-informed approach and be equipped with the knowledge and strategies to collaborate with patients who have a history of trauma. Ideally, providers will foster mutuality and address patients' challenges with cessation in an affirming and motivational manner. 

The gap in integrating a trauma-informed approach to tobacco cessation arises from several factors. Healthcare providers often face time constraints, limiting their ability to fully acknowledge the needs of their patients and address trauma. Furthermore, providers' bias can hinder their effectiveness--there may be a tendency to refer patients who appear more motivated to quit tobacco use or more likely to succeed, overlooking those with increased difficulty and trauma. Providers may be unaware of potential treatments such as nicotine replacement therapy, and cannot share information about how to access and use these safely. Some health agencies may not prioritize tobacco use cessation efforts, and providers may not see this as a primary medical concern when working with patients. Healthcare systems may also lack the resources, engagement, and finances to implement a trauma-informed approach. Addressing these issues requires engaging with healthcare providers and prioritizing trauma-informed approaches to tobacco use cessation.