Feasibility, acceptability, and preliminary impact of a text messaging intervention to increase the uptake of lung cancer screening among Latinos: single-arm pilot study

Introduction

Lung cancer is the leading cause of cancer-related death among men and women in the USA, with almost 125,000 lung cancer deaths expected to occur in 2025 (1). Lung cancer screening with low-dose computed tomography reduces mortality by 20%, primarily by enabling the detection of lung cancer at an early stage (2,3). Despite these proven benefits and strong recommendations from the U.S. Preventive Services Task Force (USPSTF) (2-4), lung cancer screening rates remain low in the USA (5-7). A recent analysis of Behavioral Risk Factor Surveillance System data from 20 USA states reported an overall uptake rate of 20.7% (7). Significant disparities in lung cancer screening rates exist based on race, ethnicity, socioeconomic status, and geographic location (7-12). Among Latinos, the largest minority group in the USA (13), the lung cancer screening rate is particularly low, at just 14% (12). Barriers to lung cancer screening among Latinos are complex and multifactorial, including language and literacy challenges, concerns about cost, mistrust of the healthcare system, and limited awareness of lung cancer screening (14-17). Adding to the disparities within the Latino community, lung cancer incidence and mortality rates among Cuban and Puerto Rican men are nearly double those of Mexican men (18), reflecting differences in tobacco use (19) and highlighting the importance of acknowledging ethnic heterogeneity. Although lung cancer screening rates are low and significant heterogeneity exists within Latinos, there is an overall strong interest in screening when access is facilitated (15-17).

Advancements in mobile health technologies have created opportunities to enhance healthcare delivery, including cancer screening. Studies have shown the effectiveness of text messaging interventions in increasing the uptake of breast, cervical, and colorectal cancer screenings (20). However, to the best of our knowledge, no study has assessed the effectiveness of text messaging interventions on lung cancer screening uptake. Notably, Latinos have the highest rate of text messaging use in the USA (21). and have expressed strong interest in participating in cancer prevention studies using text messages (22-29). Thus, we developed A todo pulmón (Spanish, for at the top of one’s lungs), a text messaging intervention to increase the uptake of lung cancer screening among Latinos. A todo pulmón was informed by the Health Belief Model and was developed based on formative interviews with Latinos to understand their perspectives on lung cancer screening (17,30).

Objective

The purpose of this study was to assess the feasibility, acceptability, and preliminary impact of A todo pulmón. We present this article in accordance with the TREND reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1205/rc).

Methods

Study design

This single-arm pilot study assessed the feasibility, acceptability, and preliminary impact of A todo pulmón, a text messaging intervention to increase the uptake of lung cancer screening among Latinos (n=40). Sample size was determined based on established guidelines for pilot studies (31). Guided by a community-based participatory research approach (32), a community advisory board (CAB) played an active role in co-developing the intervention, recruiting participants, and interpreting the results. The members of the CAB were Latino leaders who represented multiple sectors and countries/regions from Latin America and the Caribbean. The intervention and assessments were informed by the Health Belief Model (30). All study components (i.e., recruitment materials, eligibility screening, consent form, baseline and follow-up assessments, and the intervention) were available and administered in English or Spanish, as preferred by the participant. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Review Board of University of Rochester Medical Center (URMC) (No. STUDY00009079) and informed consent was obtained from all individual participants.

Recruitment and participants

Recruitment was conducted between July 2024 and January 2025 using clinic- and community-based strategies. Clinic-based strategies involved referrals from the Wilmot Tobacco Cessation Program and identification of eligible individuals via the electronic health record (EHR) at URMC. More details on how we conducted recruitment via the patient portal can be found in Chávez-Iñiguez et al. (33). Community-based strategies involved promoting the study at local events (e.g., health fairs) and through media outlets (e.g., presentation on a Spanish-language radio show aimed at the Latino community) in collaboration with the Ibero-American Action League and the Cancer Support Community at Gilda’s Club, two local community-based organizations. Both the Ibero-American Action League and the Cancer Support Community at Gilda’s Club have longstanding histories of organizing community events and health promotion efforts, including cancer prevention initiatives (e.g., tobacco cessation). Through these partnerships, community health workers at both organizations used study flyers and eligibility criteria to identify and refer potential participants to the research team.

Once potentially eligible individuals were identified, study staff administered the eligibility screening. Eligibility was based in part on USPSTF criteria: (I) having a 20-pack-year smoking history; (II) being between the ages of 50 and 80 years; and (III) currently smoking or having quit within the past 15 years (4). Additional study eligibility criteria included: (I) not having completed their annual lung cancer screening; (II) self-identifying as Hispanic/Latino; (III) speaking English and/or Spanish; (IV) having access to a functioning cellphone with unlimited text messaging; (V) no history of lung cancer; (VI) living within the Rochester, New York area; and (VII) willingness to complete a baseline and a Month 3 follow-up assessment. Eligible individuals were scheduled for a baseline survey appointment.

Measures and assessments

After obtaining informed consent, study staff administered the baseline assessment that captured seven domains: (I) sociodemographic characteristics (i.e., age, gender, sexual orientation, marital status, educational attainment, language preference, country of birth, and years living in the USA); (II) social determinants of health (i.e., employment status, health insurance type, and food insecurity) (34); (III) healthcare access (i.e., presence of a primary care provider and receipt of a check-up within the past 12 months); (IV) health status (i.e., self-rated physical health) (35); (V) smoking-related behaviors (i.e., age of smoking initiation, current smoking status, time to first cigarette, and cigarettes per day); (VI) lung cancer screening awareness (assessed with two items: “have you heard of lung cancer screening?” and “do you know whether you are eligible?”, yes/no); and (VII) beliefs about lung cancer screening [measured with the Lung Cancer Screening Health Beliefs Scale (36,37), which evaluates key constructs including perceived risks of lung cancer, perceived benefits of, perceived barriers to, and self-efficacy for lung cancer screening].

At 11 to 15 weeks post-enrollment, study staff administrated the Month 3 assessment that captured six domains: (I) self-reported lung cancer screening uptake, (II) beliefs about lung cancer screening (measured with the Lung Cancer Screening Health Beliefs Scale) (36,37); (III) satisfaction with the intervention (assessed with a single item: “in general, how satisfied are you with the text messaging program?”, 1= “extremely unsatisfied” to 5= “extremely satisfied”); (IV) perceived helpfulness (assessed with a single item: “in general, how much did the text messaging program help you get screened?”, 1= “not at all” to 5= “a lot”); (V) perception on the number of messages sent (assessed with a single item: “How would you rate the amount of text messages?”, Just the right amount/Less messages would be better/More messages are needed); and (VI) recommendation intent (assessed with a single item: “would you recommend the text messaging program to a friend or family member”, yes/no).

In collaboration with the URMC Lung Cancer Screening Program, we reviewed the EHRs to determine whether participants had completed the shared decision-making process and undergone screening. Shared decision-making was defined as a structured conversation in which patients and their clinicians discuss screening indications, potential benefits and harms, and the patient’s values and preferences to reach a collaborative decision (38). Shared decision-making is required for lung cancer screening to be reimbursed under the current guidelines of the Centers for Medicare and Medicaid Services (39).

Intervention

This study builds on prior work developing culturally appropriate text messaging interventions to promote smoking cessation (22-25), physical activity (26), and vaping cessation among Latinos (27-29). A todo pulmón is a text messaging intervention to increase the uptake of lung cancer screening among Latinos. The intervention was informed by the Health Belief Model and developed using findings from formative qualitative interviews conducted with Latinos to understand their perspectives on lung cancer screening (17,30). Educational and motivational text messages were created to address the perceived benefits, barriers, and cues to action that emerged from these interviews. Additional details regarding the formative interview findings are available in Alaniz-Cantú et al. [2024] (17). For example, Latinos identified cost as a barrier to screening, which informed the development of a message stating, “Most insurance companies pay for lung cancer screening. If you are not covered or do not have insurance, we can still help you get tested”. Family was described as a cue to action for screening. Thus, we developed a message stating, “My first grandson was born last year. When I first saw him, I realized that I needed to get on top of my health. I quit smoking and decided to get screened for lung cancer. Knowing that I don’t have cancer made me so happy. This abuela will be around to see her grandson grow—Pedra, 70 years old”.

The CAB reviewed all text messages to ensure cultural and linguistic relevance. Each text message closed with a call to action, prompting participants to contact the URMC Lung Cancer Screening Program, along with the program’s phone number. Participants were also encouraged to send questions or concerns at any time. Text messages were delivered to each subject individually using “Mosio” (40), a Health Insurance Portability and Accountability Act (HIPAA)-compliant, web-based platform designed for clinical trials and behavioral health research that supports automated and bidirectional text messaging. Messages were scheduled according to participants’ preferred days and times. Study staff monitored the text messaging platform daily and, following a standardized triage protocol, responded within 48 hours.

A todo pulmón delivered one message per week for 12 weeks (total of 12 messages). Readability was assessed with established metrics (41-43). English messages averaged a Flesch-Kincaid Grade Level of 5.1 (~5th-grade comprehension). Spanish messages scored 77 on the Fernández Huerta index and 72.8 on Índice de Legibilidad de Flesch-Szigriszt (INFLESZ), denoting “somewhat easy” (11–12-year-old) and “easy” (9–11-year-old) reading levels, respectively.

Outcomes

Outcomes included feasibility, acceptability, and preliminary impact. Feasibility was measured by the eligibility rate (defined as the proportion of individuals screened who were eligible), enrollment rate (defined as the proportion of eligible individuals who enrolled), and follow-up rate (defined as the proportion of participants who completed the follow-up assessment at Month 3). Acceptability was measured by satisfaction with the intervention, perceived helpfulness of the intervention, and whether they would recommend the intervention to a friend or family member. Preliminary impact was measured using self-reported and EHR-verified lung cancer screening completion, and documentation of shared decision-making.

Statistical analysis

Data were analyzed using the IBM Statistical Package for the Social Sciences (SPSS) version 30.0.0. Frequencies were calculated for categorical variables and means and standard deviations for continuous variables. Analyses of self-reported and EHR-verified lung cancer screening completion, as well as documentation of shared decision-making, were conducted using an intent-to-treat approach (44). Participants who were lost to follow-up were considered as not having completed screening. Analyses of lung cancer screening beliefs, satisfaction with the intervention, perceived helpfulness of the intervention, and willingness to recommend the intervention were conducted using a complete cases approach (45). Changes in lung cancer screening beliefs from baseline to follow-up were assessed using a paired sample t-test. A one-sided P<0.05 was considered statistically significant.

Compensation

Participants received a $30 VISA^® card for completing the baseline assessment and a $50 VISA^® card for completing the Month 3 follow-up assessment. Compensation was not contingent upon the uptake of lung cancer screening.

Results

Figure 1 depicts the recruitment cascade. We identified 140 Latino adults as potentially eligible, 75 were assessed for eligibility, and 44 met the eligibility criteria (eligibility rate =58.7%, 44/75). Of those eligible, 40 consented to participate, completed the baseline assessment, and were enrolled in the text messaging program (enrollment rate =90.9%, 40/44).

Figure 1 Study design flow diagram.

Participants had a mean age of 59.1 years [standard deviation (SD) =6.5; Table 1]. Half of the participants were female (50%), the majority identified as heterosexual (95%), and nearly half (45%) were single. Spanish was the preferred language for 57.5% of participants. Most participants were born in Puerto Rico (47.5%). On average, participants had lived in the USA for 35.4 years (SD =19.5). A notable proportion (27.5%) reported being unable to work or disabled, while 25% were employed full-time. Medicaid was the most common form of health insurance (32.5%). Sixty percent of participants reported experiencing food insecurity within the past year. Most participants (90%) reported having a primary care provider, yet only 15% had a checkup in the past year. In terms of perceived health, 37.5% rated their health as fair. Participants began smoking at an average age of 16.3 years (SD =4.6), and 55% were currently smoking. One in five participants (20%) reported smoking their first cigarette within five minutes of waking, and 25% reported smoking between 1 and 10 cigarettes per day. Only 35% of participants had heard of lung cancer screening, and 27.5% knew they were eligible.

Thirty-five participants completed the Month 3 follow-up assessment (retention rate =87.5%, 35/40). The self-reported lung cancer screening rate was 20% (8/40). EHR review revealed that 32.5% of participants (13/40) completed the shared decision-making process, and 25% (10/40) underwent lung cancer screening.

Changes in lung cancer screening health beliefs were observed between baseline and Month 3. Perceived benefits total scale scores increased significantly from 20.6 (SD =2.8) to 21.5 (SD =2.6; P=0.05). Perceived barriers total scale scores decreased significantly from 33.6 (SD =7.7) to 30.2 (SD =9.3; P=0.03). Self-efficacy total scale scores increased significantly from 19.8 (SD =4.2) to 22.0 (SD =4.6; P=0.004). Perceived risks total scale scores decreased from 7.7 (SD =2.1) to 7.2 (SD =2.4), but this change was not statistically significant (P=0.09).

Regarding the intervention, 39.4% of participants (13/33) reported being extremely satisfied, and 51.5% (17/33) reported being satisfied. When rating the number of messages in the text message program, 56.6% (19/33) indicated that it was just the right amount, 9.1% (3/33) that fewer messages would be better, and 33.3% (11/33) that more messages are needed. All participants found the intervention to be helpful (100%, 33/33) and indicated they would recommend the intervention to a friend or family member (100%, 33/33).

Discussion

This single-arm pilot study assessed the feasibility, acceptability, and preliminary impact of A todo pulmón, a text messaging intervention to increase the uptake of lung cancer screening among Latinos. We demonstrated that Latinos can be efficiently recruited and retained in a lung cancer screening study. Additionally, our study shows that, among Latinos, A todo pulmón is acceptable and holds a promising preliminary impact. The findings underscore the importance of this study, as two-thirds of participants had never heard of lung cancer screening, and nearly three-quarters were unaware of their eligibility.

While the enrollment rate observed in this study (90.9%) is promising and consistent with previous cancer prevention studies among Latinos (26,28), the eligibility rate was relatively low (58.7%). The primary reason for ineligibility was not meeting the 20 pack-year smoking history threshold. This finding is consistent with smoking-related behaviors commonly observed among Latinos, who frequently report light (fewer than 10 cigarettes per day) and non-daily smoking (46). In recognition of such smoking patterns, the USPSTF updated its lung cancer screening guidelines in 2021, lowering the eligibility criterion from 30 to 20 pack-years (4). However, even with these more inclusive criteria, Latinos remain less likely than White individuals to be eligible for screening (47).

This study provides valuable insights into the growing body of literature on text messaging interventions aimed at promoting lung cancer screening. Although text messaging has been used to assess eligibility (48,49), few studies have explored its use as a strategy to actively engage, motivate, and support individuals in completing the screening process. While no direct comparators exist regarding the specific content and duration of the A todo pulmón intervention, our results fall within the range previously reported in the literature. For example, Adler et al. conducted a two-arm pilot randomized controlled trial (RCT) among 198 patients in an emergency department setting (50). One hundred and three participants received a text messaging intervention combined with a “basic referral”, which included a verbal recommendation, written instructions to follow up with their primary care provider (if they had one), and the contact information of the lung cancer screening program. This approach resulted in an 8% self-reported or EHR-verified lung cancer screening rate by day 150. Wen et al. conducted a two-arm pilot RCT among 36 Asian immigrants (51). Twenty participants received Connect4LungHealth, a text messaging intervention combined with weekly check-in phone calls from community health workers. Connect4LungHealth resulted in a 40% lung cancer screening rate at Month 3. The results of these pilot studies highlight the variability in intervention components and population engagement strategies. The 25% EHR-verified lung cancer screening rate generated by A todo pulmón is particularly encouraging, especially considering that our intervention relied solely on text messages and warrants further investigation.

Among participants, more than half (56.6%) reported that the current number of text messages included in the intervention were adequate, whereas one-third (11/33) suggested that additional messages were needed. Previous text messaging interventions designed to increase cancer screening uptake have ranged from a single message to a maximum of seven messages, in some cases delivered in the same week (one per day) and in other cases over multiple weeks. In contrast, our intervention delivered one weekly message over 12 weeks, resulting in a total of twelve messages and representing the highest message frequency identified in our literature review. Nevertheless, a substantial proportion of participants expressed interest in receiving additional messages, suggesting that future interventions may benefit from increased message frequency or extended program duration to engage Latino individuals with lung cancer screening services more effectively. Our findings also support opportunities to incorporate additional text message content addressing barriers to lung cancer screening not covered in the original intervention (e.g., lack of transportation).

The discrepancy between the self-reported and EHR-verified screening rates is primarily due to timing. The Month 3 follow-up assessments were conducted between weeks 11 and 15, during which several participants reported that their lung cancer screening appointments were scheduled in the coming days, still within the 15-week window. Although these screenings had not yet occurred when participants completed the follow-up assessment and were therefore not captured in the self-reported data, they were later confirmed through the EHR. This highlights the value of using EHR data to supplement self-reported measures and ensure more accurate tracking of screening completion. Equally important is the monitoring and reporting of the shared decision-making process. A participant’s decision not to undergo screening, when made through an informed and collaborative process, should be considered a meaningful outcome.

The preliminary and significant changes observed in perceived benefits, perceived barriers, and self-efficacy are encouraging and align with findings from prior studies (52). These constructs are central to the Health Belief Model and should be further examined as potential mediators of the intervention’s impact in a future RCT (30). In contrast, the small and non-significant change in perceived risk is not unexpected. Our intervention deliberately avoided increasing risk perception (e.g., high mortality rates, smoking-related harm). This intentional approach was developed in partnership with the CAB, informed by insights from our formative qualitative work in which Latino participants frequently described experiences of blame, stigma, and fear related to smoking and lung cancer (17).

While the study demonstrated a promising preliminary impact of the A todo pulmón intervention, more must be done to address the social determinants of health that participants encounter. For example, although transportation was not directly assessed in the Month 3 follow-up assessment, participants consistently described it during interactions with the research team as a major barrier to accessing lung cancer screening, despite the City of Rochester having multiple screening locations. Although Medicaid provides transportation benefits (39), only 32.5% of participants were enrolled, and among those, not all qualified for assistance. In many states, Medicaid-funded non-emergency transportation, such as taxi or rideshare services, is reserved for individuals with additional chronic conditions (e.g., cardiovascular disease, chronic obstructive pulmonary disease, severe arthritis), leaving others without viable options. These structural limitations highlight the need for lung cancer screening interventions to address transportation barriers.

Strengths and limitations

This study has several notable strengths. First, it builds on a longstanding history of cancer prevention research conducted with the Latino community (17,22-29), leveraging trust built over time. Second, this study is firmly rooted in principles of community-based participatory research (32). Our engaged and committed CAB played a critical role in shaping the study design and intervention to ensure cultural appropriateness and relevance. Third, the study was available in both English and Spanish. More than half of participants (57.5%) completed the study in Spanish. Fourth, the study included a diverse group of participants with varied sociodemographic variables and lived experiences related to social determinants of health, healthcare access, health status, and tobacco-related behaviors. Lastly, we strengthened the rigor of our outcomes by using both self-reported data and EHR verification.

Despite the strengths, this study has some limitations. First, the sample size was relatively small, which limits the generalizability of the results. However, enrolling forty participants was sufficient to explore the feasibility, acceptability, and preliminary impact of the intervention. Second, the absence of a comparison group limits the ability to draw conclusions about the efficacy of the intervention. Third, this was a single-site study, which may restrict the applicability of the findings to other settings. Lastly, the study has a relatively short follow-up period. The Month 3 assessment was sufficient to capture early reports of lung cancer screening. However, some participants reported having appointments scheduled beyond the survey date, suggesting that additional time may be necessary to observe the full impact of the intervention on screening uptake.

Conclusions

It is feasible to recruit and retain Latinos in a lung cancer screening study. A todo pulmón, a text messaging intervention to increase the uptake of lung cancer screening among Latinos, is acceptable and holds a promising preliminary impact. Additional testing in a formal randomized clinical trial is warranted to assess the efficacy of the intervention.

Acknowledgments

The authors are grateful to the individuals who participated in this study. Moreover, the authors acknowledge Christina Sisson and Erin Schmidt for the administrative support. Our abstract was selected for a poster presentation at the 18th AACR Conference on the Science of Cancer Health Disparities [2025] and was consequently published in the conference’s abstract issue.

Footnote

Reporting Checklist: The authors have completed the TREND reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1205/rc

Data Sharing Statement: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1205/dss

Peer Review File: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1205/prf

Funding: This study was supported by funding from the Prevent Cancer Foundation; the National Cancer Institute (NCI), part of the National Institutes of Health (NIH) (No. T32CA102618 to J.W.R.S.); the National Center for Advancing Translational Sciences (NCATS), part of the NIH (No. UL1TR000042); and the NCI, part of the NIH (No. P30CA272302).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1205/coif). All authors indicate that a Prevent Cancer Foundation grant provided all support for the present manuscript. J.W.R.S. reports grants from the National Cancer Institute. F.C.B. reports grants from the National Institute on Minority Health and Health Disparities and the National Cancer Institute, both part of the National Institutes of Health (NIH). M.P.R. reports grants from the National Cancer Institute, part of the NIH; receiving payment or honoraria for lectures, presentations, or educational events from the American Board of Internal Medicine, Cleveland Clinic, the University of Nebraska, and The Ohio State University; and support for attending meetings and/or travel from the National Lung Cancer Roundtable. L.C.B. reports participation on the New York State Tobacco Quitline Health Equity Advisory Board and leadership or fiduciary roles as Chair of the Stigma and Nihilism Task Group and with the American Cancer Society National Lung Cancer Roundtable. B.W.A. reports grants from the American Cancer Society and Strollin for the Colon. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Institutional Review Board of University of Rochester Medical Center (URMC) (No. STUDY00009079) and informed consent was obtained from all individual participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. American Cancer Society. Key statistics for lung cancer. 2025. [accessed 28 July 2025]. Available online: https://www.cancer.org/cancer/types/lung-cancer/about/key-statistics.html
2. National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.
3. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med 2020;382:503-13. [Crossref] [PubMed]
4. U.S. Preventive Services Task Force. 2021. [accessed 28 July 2025]. Lung cancer: Screening. Available online: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
5. Fedewa SA, Kazerooni EA, Studts JL, et al. State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States. J Natl Cancer Inst 2021;113:1044-52. [Crossref] [PubMed]
6. Jemal A, Fedewa SA. Lung Cancer Screening With Low-Dose Computed Tomography in the United States-2010 to 2015. JAMA Oncol 2017;3:1278-81. [Crossref] [PubMed]
7. Williams RM, Li T, Luta G, et al. Lung cancer screening use and implications of varying eligibility criteria by race and ethnicity: 2019 Behavioral Risk Factor Surveillance System data. Cancer 2022;128:1812-9. [Crossref] [PubMed]
8. Zahnd WE, Eberth JM. Lung Cancer Screening Utilization: A Behavioral Risk Factor Surveillance System Analysis. Am J Prev Med 2019;57:250-5. [Crossref] [PubMed]
9. Okereke IC, Nishi S, Zhou J, et al. Trends in lung cancer screening in the United States, 2016-2017. J Thorac Dis 2019;11:873-81. [Crossref] [PubMed]
10. Carter-Harris L, Slaven JE Jr, Monahan PO, et al. Understanding lung cancer screening behavior: Racial, gender, and geographic differences among Indiana long-term smokers. Prev Med Rep 2018;10:49-54. [Crossref] [PubMed]
11. Steiling K, Loui T, Asokan S, et al. Age, Race, and Income Are Associated With Lower Screening Rates at a Safety Net Hospital. Ann Thorac Surg 2020;109:1544-50. [Crossref] [PubMed]
12. American Cancer Society. Cancer facts & figures for Hispanic and Latino people. 2024. [accessed 28 July 2025]. Available online: https://www.cancer.org/research/cancer-facts-statistics/hispanics-latinos-facts-figures.html
13. United States Census Bureau. Detailed races and ethnicities in the United States and Puerto Rico: 2020. 2023. [accessed 28 July 2025]. Available online: https://www.census.gov/library/visualizations/interactive/detailed-race-ethnicities-2020-census.html
14. Flores EJ, Irwin KE, Park ER, et al. Increasing Lung Screening in the Latino Community. J Am Coll Radiol 2021;18:633-6. [Crossref] [PubMed]
15. Percac-Lima S, Ashburner JM, Atlas SJ, et al. Barriers to and Interest in Lung Cancer Screening Among Latino and Non-Latino Current and Former Smokers. J Immigr Minor Health 2019;21:1313-24. [Crossref] [PubMed]
16. Rodríguez-Rabassa MS, Simmons VN, Vega A, et al. Perceptions of and Barriers to Lung Cancer Screening Among Physicians in Puerto Rico: A Qualitative Study. J Health Care Poor Underserved 2020;31:973-91. [Crossref] [PubMed]
17. Alaniz-Cantú EI, Goodwin K, Smith L, et al. Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study. Front Oncol 2024;14:1365739. [Crossref] [PubMed]
18. He Y, Pinheiro PS, Tripathi O, et al. Cancer Mortality among Hispanic Groups in the United States by Birthplace (2003-2017). Cancer Epidemiol Biomarkers Prev 2024;33:1598-609. [Crossref] [PubMed]
19. Kaplan RC, Baldoni PL, Strizich GM, et al. Current Smoking Raises Risk of Incident Hypertension: Hispanic Community Health Study-Study of Latinos. Am J Hypertens 2021;34:190-7. [Crossref] [PubMed]
20. Uy C, Lopez J, Trinh-Shevrin C, et al. Text Messaging Interventions on Cancer Screening Rates: A Systematic Review. J Med Internet Res 2017;19:e296. [Crossref] [PubMed]
21. Pew Research Center. Demographics of Mobile Device Ownership and Adoption in the United States (Mobile Fact Sheet). Published November 20, 2025. [Accessed May 28, 2026]. Available online: https://www.pewresearch.org/internet/fact-sheet/mobile/
22. Cartujano-Barrera F, Catley D, Chávez-Iñiguez A, et al. Evaluating Text Messaging Approaches to Promote Enrollment in Smoking Cessation Treatment Among Latino Adults: A Pragmatic Randomized Clinical Trial. Chest 2026;169:1732-9. [Crossref] [PubMed]
23. Cartujano-Barrera F, Cox LS, Catley D, et al. Decídetexto: Mobile Cessation Support for Latino Adults Who Smoke: A Randomized Clinical Trial. Chest 2025;167:619-29. [Crossref] [PubMed]
24. Cartujano-Barrera F, Sanderson Cox L, Arana-Chicas E, et al. Feasibility and Acceptability of a Culturally- and Linguistically-Adapted Smoking Cessation Text Messaging Intervention for Latino Smokers. Front Public Health 2020;8:269. [Crossref] [PubMed]
25. Cartujano-Barrera F, Arana-Chicas E, Ramírez-Mantilla M, et al. "Every day I think about your messages": assessing text messaging engagement among Latino smokers in a mobile cessation program. Patient Prefer Adherence 2019;13:1213-9. [Crossref] [PubMed]
26. Lara D, Alaniz-Cantú EI, Siddalingaiaha S, et al. Actívatexto: Feasibility and Acceptability of a Mobile Intervention That Promotes Smoking Cessation and Physical Activity among Latinos. Cancer Res Commun 2024;4:1016-23. [Crossref] [PubMed]
27. Orfin RH, Siddalingaiah S, Dontu V, et al. Development of a Vaping Cessation Text Messaging Intervention for Latino Young Adults: A Participatory Research Approach. Community Health Equity Res Policy 2024; Epub ahead of print. [Crossref]
28. Orfin RH, Ramos Santiago JW, Decena Soriano R, et al. Kick Vaping: Feasibility, acceptability, and preliminary impact of a vaping cessation text messaging intervention for Latino young adults. J Ethn Subst Abuse 2026;25:628-40. [Crossref] [PubMed]
29. Orfin RH, Alaniz-Cantú EI, Ramos-Santiago JW, et al. Assessing Text Messaging Interactivity with a Vaping Cessation Intervention Among Latino Young Adults: A Quantitative and Qualitative Analysis. Subst Use Misuse 2025;60:989-93. [Crossref] [PubMed]
30. Green EC, Murphy EM, Gryboski K. The health belief model. In: The Wiley encyclopedia of health psychology. 2020;211-4.
31. Beets MW, von Klinggraeff L, Weaver RG, et al. Small studies, big decisions: the role of pilot/feasibility studies in incremental science and premature scale-up of behavioral interventions. Pilot Feasibility Stud 2021;7:173. [Crossref] [PubMed]
32. Israel BA, Schulz AJ, Coombe CM, et al. Community-Based Participatory Research: An Approach to Research in the Urban Context. In: Sandro Galea, Catherine K. Ettman, David Vlahov, eds. Urban Health. New York: Oxford Academic; 2019:272-82.
33. Chávez-Iñiguez A, De Los Reyes C, Ramos-Santiago JW, et al. Feasibility of Recruiting Latinos for a Lung Cancer Screening Study Through a Patient Portal. Thorac Cancer 2025;16:e70067. [Crossref] [PubMed]
34. Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics 2010;126:e26-32. [Crossref] [PubMed]
35. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.
36. Carter-Harris L, Slaven JE 2nd, Monohan P, et al. Development and Psychometric Evaluation of the Lung Cancer Screening Health Belief Scales. Cancer Nurs 2017;40:237-44. [Crossref] [PubMed]
37. Carter-Bawa L, Schofield E, Atkinson TM, et al. Development and psychometric evaluation of the Spanish version of the lung cancer screening health belief scale. Eur J Cancer Care (Engl) 2022;31:e13707. [Crossref] [PubMed]
38. Volk RJ, Myers RE, Arenberg D, et al. The American Cancer Society National Lung Cancer Roundtable strategic plan: Current challenges and future directions for shared decision making for lung cancer screening. Cancer 2024;130:3996-4011. [Crossref] [PubMed]
39. CMS.gov. Screening for lung cancer with low dose computed tomography. 2022. [accessed 28 July 2025]. Available online: https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=304
40. Mosio. Mosio Mobile Messaging for Clinical Research [Software]. 2025. Available online: https://www.mosio.com/
41. Kincaid JP, Fishburne RP Jr, Rogers RL, et al. Derivation of new readability formulas (automated readability index, fog count and flesch reading ease formula) for navy enlisted personnel. Institute for Simulation and Training 1975;56:1-36.
42. Fernández Huerta J. Medidas sencillas de lecturabilidad. Consigna 1959;214:29-32.
43. Barrio-Cantalejo IM, Simón-Lorda P, Melguizo M, et al. Validation of the INFLESZ scale to evaluate readability of texts aimed at the patient. An Sist Sanit Navar 2008;31:135-52. [Crossref] [PubMed]
44. McCoy CE. Understanding the Intention-to-treat Principle in Randomized Controlled Trials. West J Emerg Med 2017;18:1075-8. [Crossref] [PubMed]
45. Little RJA, Rubin DB. Statistical analysis with missing data. 3rd ed. Hoboken: Wiley; 2019.
46. Reyes-Guzman CM, Pfeiffer RM, Lubin J, et al. Determinants of Light and Intermittent Smoking in the United States: Results from Three Pooled National Health Surveys. Cancer Epidemiol Biomarkers Prev 2017;26:228-39. [Crossref] [PubMed]
47. Narayan AK, Chowdhry DN, Fintelmann FJ, et al. Racial and Ethnic Disparities in Lung Cancer Screening Eligibility. Radiology 2021;301:712-20. [Crossref] [PubMed]
48. Camacho FA, Gujar G, Chávez-Iñiguez A, et al. Verifying Eligibility for Lung Cancer Screening via TiMeToAct Text Message Intervention: A Quality Improvement Initiative. Chest 2025;167:1509-13. [Crossref] [PubMed]
49. McCutchan G, Engela-Volker J, Anyanwu P, et al. Assessing, updating and utilising primary care smoking records for lung cancer screening. BMC Pulm Med 2023;23:445. [Crossref] [PubMed]
50. Adler DH, Wood N, Fiscella K, et al. Increasing Uptake of Lung Cancer Screening Among Emergency Department Patients: A Pilot Study. J Emerg Med 2024;67:e164-76. [Crossref] [PubMed]
51. Wen KY, Barta J, Liang J, et al. A Community Health Worker-driven and integrated interactive text messaging intervention to promote smoking cessation and lung cancer screening uptake rates among high-risk Asian immigrants: a feasibility pilot RCT study. Transl Behav Med 2025;15:ibaf018. [Crossref] [PubMed]
52. Carter-Harris L, Slaven JE 2nd, Monahan PO, et al. Understanding lung cancer screening behaviour using path analysis. J Med Screen 2020;27:105-12. [Crossref] [PubMed]