CCSG Pilot: Sociological Barriers and Facilitators to Lung Cancer Screening Among Black Adults Who Use Various Combustible Tobacco Products: Assessing the Equity Impact of the USPSTF Lung Cancer Screening Recommendations

Abstract Understanding socioecological barriers and facilitators to lung cancer screening in the context of multiple combustible tobacco use in the Black community is crucial to not only promoting early detection but also racial health equity. Current United States Preventive Services Task Force (USPSTF) lung cancer screening recommendations may miss a key window of detection for Black adults who disproportionately use non- cigarette combustible tobacco products, serving as a potential contributor to racial disparities in lung cancer survival. The proposed study employs a mixed methods approach to describe historic and current combustible tobacco product use among Black adults living in Kentucky and to quantify the equity impact of current USPSTF guidelines for lung cancer screening. This study also aims to glean knowledge, attitudes, and intentions towards lung cancer screening and further undrstand socioecological barriers and facilitators to lung cancer screening in the Black community. We will survey (n=100) and conduct interviews (n=25) among Black adults ages 50 or older. We will create proxy measures for pack-years for each combustible tobacco product and develop race-specific criteria aimed at determining whether adults nearly meet, currently meet, or have previously met the threshold for lung cancer screening recommendations. We will conduct thematic analysis to identify and interpret patterns in the data underlying socioecological barriers and facilitators to lung cancer screening for this population. Findings from both quantitative and qualitative components of this study will be integrated to develop a model of recommendations for future efforts and interventions aimed to promote sufficient and sustained lung cancer screening. Successful completion of this pilot will allow us to 1) extend these research priorities that mitigate barriers and promote facilitators to lung cancer screening to other disparate populations and 2) test the equity impact of race-specific guidelines for lung cancer screening and propose culturally salient reconsiderations to early detection frameworks. Translational and clinical/population relevance: Exploring barriers and facilitators to lung cancer screening among older Black adults living in Kentucky will inform screening efforts and promote sufficient and sustained lung cancer screening adherence in this population. The quantitative piece of this study will improve our understanding of whether culturally salient, race-specific lung cancer screening recommendations are needed to increase the proportion of early detected cases and to reduce racial inequities in lung cancer outcomes. Inter-programmatic collaboration: The proposed pilot study promotes inter-programmatic collaboration between the Cancer Prevention and Control (CP) Program, represented by Drs. Mattingly, Burris, and Moore and the Translational Oncology (TO) Program, represented by Dr. Mullett. Shared resource facility usage: The project will utilize the Patient-Oriented and Population Sciences (POP) Markey Cancer Center’s Shared Resource Facilities. POP will assist with all recruitment, accrual tracking, survey deployment, and qualitative data management (i.e., transcription) under the direction of Dr. Jessica Burris.