Barriers and Facilitators to Accurate Smoking History and Equitable Lung Cancer Screening Uptake Among Hispanic and Latino Populations.

Abstract

To employ a community-based qualitative study to identify multilevel barriers and facilitators to smoking disclosure, ascertainment, documentation, and lung cancer screening (LCS) referral among Hispanic and Latino communities. This qualitative study included 38 participants (22:16, 54 ± 13 years): Hispanic and Latino patients (n = 26) eligible for LCS, community-based primary care providers (n = 7), and community-based organization leaders (n = 5). Semistructured interviews were conducted between November 2023 to October 2024, in English, Spanish, and Portuguese. Professionally transcribed and translated audio recordings were analyzed in Dedoose using a hybrid inductive-deductive qualitative analysis. Six themes emerged across three levels. Patient-level themes included (1) interpersonal and cultural reinforcement of smoking: smoking was modeled and normalized through family and social networks and (2) intrapersonal stress and life events: smoking was used for emotional regulation or cessation after major life changes. Provider-level themes included (3) gaps in provider-patient communication and trust: brief or judgmental counseling reduced patient comfort with disclosing smoking and limited accurate smoking ascertainment and (4) language and cultural incongruence: mismatches during clinical encounters disrupted meaningful dialogue, negatively impacting both ascertainment and documentation. System-level themes included (5) structural access barriers: insurance, transportation, or scheduling challenges limited engagement with cessation and LCS, disrupting documentation and follow-up and (6) underreporting in medical documentation, revealed breakdowns in electronic health record systems. Barriers to accurate smoking history and LCS are complex, spanning interpersonal, cultural, linguistic, and clinician and system domains. With upcoming Healthcare Effectiveness Data and Information Set Tobacco Use Screening and Cessation Intervention implementation, improving smoking history disclosure, ascertainment, and documentation are essential for equitable LCS referral and improve lung cancer outcomes through early detection.