The role of nurse- and community-led interventions
- Despite updated lung cancer screening recommendations, progress in improving health outcomes for many underserved communities remains inadequate due to systemic barriers, including limited access to healthcare and lack of awareness of screening benefits.
- Latinx individuals are notably impacted, as they’re less likely to receive early diagnoses and treatment for lung cancer.
- Nurses can play a vital role in implementing culturally tailored, community-based interventions to promote smoking cessation and increase lung cancer screening awareness, ultimately improving health equity among underserved populations.
AS NOTED BY ZAVALA and colleagues, systemic issues contribute to health disparities in the diagnosis and treatment of lung cancer, particularly among various ethnic and racial minorities across the United States. For example, according to the American Lung Association (ALA), Latinx individuals diagnosed with lung cancer are 17% less likely to be diagnosed at early stages through screening initiatives and 30% more likely to forgo treatment entirely.
Rural states also lag in lung cancer prevention efforts. For example, Iowa ranks second in the nation for the incidence of newly detected cancers, adjusted for age, as highlighted in the 2025 Iowa Cancer Registry’s Cancer in Iowa report. Lung cancer stands as the third most diagnosed cancer and remains the most lethal, accounting for 22.7% of cancer-related deaths in the state.
To reduce mortality through early detection and timely intervention, the U.S. Preventive Services Task Force (USPSTF) recommends screening high-risk individuals for lung cancer with annual low-dose computed tomography (CT) scans. According to the American Association for Cancer Research, despite evidence supporting the effectiveness of annual lung cancer screening in decreasing lung cancer fatalities, in 2024, only about 16% of high-risk individuals in the United States adhered to these recommendations. Factors such as insurance coverage, access to healthcare, and awareness of the benefits of screening influence uptake rates.
Estimates indicate significantly lower screening rates for Latinx individuals due to several systemic barriers. Based on 2022 Behavioral Risk Factor Surveillance System data, the rate of Latinx individuals who complete lung cancer screening in the United States stood at 7.7% of those eligible. The most recent report from the National Health Interview Survey showed that nearly one in four Hispanic (the term used in the survey’s federal reporting classification) adults between ages 18 and 64 (24.8%) lacked health insurance in 2022, making it nearly impossible for them to receive lung cancer screening.
According to the ALA, approximately 90% of lung cancers in the United States can be directly linked to cigarette smoking; tobacco use stands as the primary preventable risk factor for premature death within the Latinx population. However, many members of this community face several barriers compared to non-Latinx Whites, including reduced access to healthcare, fewer opportunities to receive guidance on quitting tobacco, limited awareness of available smoking cessation resources, diminished participation in tobacco cessation programs, and underuse of pharmacotherapy options to aid smoking cessation. Reducing the overall risk for lung cancer and improving screening awareness within Latinx communities that lack access to services require the development and implementation of prevention and cessation interventions culturally tailored to meet their needs.
Iowa: A case in point
Many states face challenges enacting and funding effective tobacco control and lung cancer screening programs. For example, although the 2025 ALA State of Tobacco Control report highlights progress nationally, Iowa received an “F” grade for its tobacco prevention efforts. Reasons for this grade include weak smoke-free laws, inadequate funding for cessation programs, and the absence of comprehensive tobacco retail licensing regulations. According to the Campaign for Tobacco-Free Kids, Iowa allocates less than 20% of the Centers for Disease Control and Prevention (CDC) recommended funding level for tobacco prevention and cessation initiatives.
In addition, although the USPSTF recommends annual low-dose CT lung cancer screenings for high-risk populations, state legislative support and funding to expand access to these services, particularly among medically underserved and minority communities, remains insufficient. Current bills to increase Medicaid reimbursement for lung cancer screening and to expand state funding for tobacco cessation programs have stalled in the Iowa legislature due to competing budget priorities and political opposition. These funding and policy gaps hinder the state’s ability to reduce tobacco use and the lung cancer burden equitably, especially among Latinx and other underserved populations that already face substantial health disparities.
Given the recommendations from leaders in lung cancer healthcare, the stagnation in screening rates, and the high rates of smoking in Iowa, local communities require more information to ensure they’re adequately served. Collins and colleagues note that nurses can implement community-based interventions, use best practices in community engagement, and develop culturally tailored solutions to significantly improve the delivery of this care. (See Nursing’s role in lung cancer screening and prevention)
Nursing’s role in lung cancer screening and prevention
According to the American Association of Colleges of Nursing and the American Association of Nurse Practitioners, nurses and nurse practitioners are expected to provide up-to-date, evidence-based interventions for those in their care. This includes raising awareness about lung cancer, facilitating screenings, and promoting smoking cessation. Furthermore, the American Nurses Association Code of Ethics for Nurses recently introduced Provision 10, which emphasizes a commitment to global health. This provision requires nurses to engage in initiatives that identify and address issues within global communities, particularly among rural and minority populations.
Quality nursing care is rooted in evidence, and nurses must recognize that some populations face multiple barriers—poverty, lack of transportation, language obstacles, and mistrust of healthcare systems—that hinder their access to care. As a result, those most affected by these health determinants frequently are the least likely to receive the critical care they need, including lung cancer education and screening.
Community-engaged interventions
The ALA and the National Cancer Institute (NCI) have created toolkits for use in community settings with the goal of improving screening awareness, impacting smoking cessation, and delivering quality care. The ALA Tobacco Cessation and Lung Cancer Screening Toolkit: Community-Based Organizations and Partners provides outreach recommendations for building awareness within specific communities, including Latinx communities, and suggestions for team creation, client education, and provider development.
Using various metrics, such as research integrity and impact, NCI evaluates programs used for different populations. The guide, No lo deje para mañana, deje de fumar hoy: GuÍa para Dejar de Fumar, for example, has shown significant impact with its focus on smoking cessation, relaxation exercises, and a journal for client use.
When nurse-led action groups use these toolkits and community-engaged frameworks to address population-specific needs, they can apply best practices in community engagement. For example, they can create a community advisory team, perform in-depth community assessments, and deliver community-led, evidence-based interventions.
Sayani notes that nurse- and community-led intervention models, which can address specific barriers within any given state and within at-risk communities, must be part of the solution. Koskan and colleagues describe the use of community health workers, or promotoras (trusted community members or advocates within a Latinx community), to co-create and deliver health information.
Within this approach, interventions aim to increase lung cancer screening and smoking cessation rates as well as foster leadership, advocacy, and empowerment within the community. Nurses—particularly those in community, public health, and academic roles—can help lead initiatives that combine clinical expertise with culturally sensitive outreach strategies in line with their professional obligations.
For example, nurses can train and supervise community health navigators to conduct culturally tailored outreach, provide tobacco cessation counseling, and facilitate referrals for lung cancer screening in trusted community settings such as churches, community centers, and barbershops. In this model, as Reyes and colleagues describe, nurses oversee screening education, ensure clinical quality, and coordinate follow-up care through partnerships with primary care clinics and public health systems, thereby strengthening screening uptake while building community trust and leadership capacity.
Outreach strategies for the Latinx population
The American Lung Association Addressing Tobacco Use in Hispanic or Latino Communities Toolkit offers suggestions for reaching out to Latinx communities with strategies that meet unique needs.
Learn youth-specific terminology in appropriate language or culture.
Learn unique terms, products, and images that represent tobacco products.
Seek out information about appropriate demographic characteristics and patterns of smoking within populations.
Understand the diverse identification of communities prior to giving medical advice and tailor it to those values.
Recognize the impact of specific stressors, including communication barriers, isolation, social injustice, and finances.
Consider that family and social values can be important motivators, but individuals may lack local support.
Learn about the spiritual connections and differences within the population.
Don’t assume that everyone is religious.
Use population appropriate media and terminology.
Provide education on the physical effects of nicotine.
Encourage participation in research to learn more about patterns of nicotine use.
Engage communities in evidence-based interventions.
Source: American Lung Association, Addressing Tobacco Use in Hispanic and Latino Communities Toolkit
Potential impact
Proposed interventions must foster collaboration, advocacy, leadership, and mentorship within a given community. The co-creation of intervention strategies and use of the community health worker model empowers communities to take an active role in promoting lung cancer screening and smoking cessation. By providing tailored education and support, a nurse- and community-led smoking cessation project can increase health awareness and knowledge, while strengthening the leadership and visibility of community health nursing within a population.
Iowa’s failing grade in the 2025 State of Tobacco Control report underscored the urgent need for stronger policy measures that prioritize tobacco use prevention, smoking cessation, and early cancer detection efforts, especially among underserved communities. Sustainable improvements will require coordinated partnerships among healthcare providers, community- and faith-based organizations, and social service agencies, to align outreach, screening, treatment, and policy advocacy efforts.
Examples of these initiatives include expanding Medicaid coverage and state funding to reimburse low-dose CT lung cancer screening for eligible high-risk adults, implementing tobacco taxation or smoke-free workplace legislation in rural counties, and funding community health worker and navigator programs to provide culturally tailored smoking cessation counseling and screening navigation. Policy reform also could involve mandating insurance coverage for tobacco cessation pharmacotherapy, integrating lung cancer screening metrics into accountable care and value-based payment models, and allocating state tobacco settlement funds toward prevention programs in immigrant and rural communities.
Funding opportunities exist within competitive grant programs offered by the ALA, the Robert Wood Johnson Foundation, and local philanthropic organizations (In Iowa those include the Mid-Iowa Health Foundation and the Iowa Cancer Consortium). Future large-scale studies and grant-funded projects will help to rigorously evaluate the effectiveness of community-engaged interventions in improving lung cancer outcomes and to identify scalable strategies for broader implementation. (See Grant opportunities)
Grant opportunities
In addition to local grant programs, consider the following sources of funding to help support smoking cessation programs:
- American Lung Association. Awards and grants opportunities: lung.org/research/awards-and-grants-opportunities
- The Robert Wood Johnson Foundation. Active funding opportunities: rwjf.org/en/grants/active-funding-opportunities.html
Culturally competent care
Addressing disparities in smoking cessation and lung cancer screening within any population demands innovative, culturally tailored interventions that combine clinical expertise with community engagement and empowerment. Nurse-led initiatives that follow established frameworks (such as those offered by the ALA and NCI) demonstrate strong potential to improve knowledge, increase screening rates, and reduce smoking prevalence through culturally relevant, evidence-based strategies.
However, sustained impact requires collaborative action across legal, healthcare, and community sectors, and those receiving services; meaningful progress can’t rest solely on community initiatives. Policymakers and healthcare providers must act urgently to dismantle systemic barriers that perpetuate disparities in tobacco use and lung cancer outcomes. Policy reforms should prioritize funding for community-based prevention programs, support expansion of the community health worker model, and enforce stronger tobacco control measures. Healthcare systems must invest in culturally competent care models and ensure the promotion and accessibility of preventive services, such as lung cancer screening, for all individuals, regardless of race, ethnicity, language, and socioeconomic status.
Olivia Croskey is faculty at the University of Iowa College of Nursing in Iowa City. Karrey Shannon is a community health nurse at Johnson County Public Health in Iowa City. Jimmy Reyes is interim clinical director and researcher at Proteus Agricultural Health Clinic in Des Moines. Susan Vileta is a health educator at Johnson County Public Health.
American Nurse Journal. 2026; 21(3). Doi: 10.51256/ANJ032624
References
American Association for Cancer Research. Disparities in cancer screening for early detection. 2024. cancerprogressreport.aacr.org/disparities/cdpr24-contents/cdpr24-disparities-in-cancer-screening-for-early-detection
American Lung Association. Addressing tobacco use in Hispanic and Latino communities toolkit. lung.org/getmedia/1063c716-425d-4684-8647-14a37a72580a/Hispanic_Latino_Communities_Toolkit_ENG.pdf
American Lung Association. State of tobacco control: Iowa highlights. 2025. lung.org/research/sotc/state-grades/highlights/iowa
American Lung Association. Tobacco cessation and lung cancer screening toolkit: Community based organizations and partners. lung.org/getmedia/031f4222-2afa-4af2-9a7b-9b8f757f8de5/LungCancerScreening_Community.pdf
American Nurses Association Code of Ethics for Nurses. 2025. codeofethics.ana.org/provisions
Campaign for Tobacco-Free Kids. Broken promises to our children: A state-by-state look at the 1998 Tobacco Settlement. December 18, 2024. tobaccofreekids.org/what-we-do/us/statereport
Cohen RA, Martinez ME. Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–June 2023. National Center for Health Statistics. December 2023. cdc.gov/nchs/data/nhis/earlyrelease/insur202312.pdf
Iowa Cancer Registry. Cancer in Iowa report. 2026. shri.public-health.uiowa.edu/cancer-data/reports/iowa-cancer-reports
Iowa Department of Health and Human Services. Iowa BRFSS brief: 2023 survey findings. January 2025.
https://hhs.iowa.gov/media/15344/download?inline
Kratzer TB, Bandi P, Freedman ND, et al. Lung cancer statistics, 2023. Cancer. 2024;130(8):1330-48. doi:10.1002/cncr.35128
National Cancer Institute. No lo deje para mañana, deje de fumar hoy: GuÍa para Dejar de Fumar” 2024. hr.fiu.edu/wp-content/uploads/2020/11/Quitting-Smoking-Spanish.pdf
Olazagasti C, Seetharamu N. Disparities in lung cancer screening rates among the Hispanic/Latinx population. Lung Cancer Manag. 2021;10(3):LMT51. doi:10.2217/lmt-2021-0004
Reyes, J., Radske-Suchan, T., Moses, A., McClain, S., & Chevan, J. (2025). Empowering health navigators and communities: Meeting a growing need in Iowa’s immigrant communities. American Journal of Nursing, 125(10), 58–60. https://doi.org/10.1097/AJN.0000000000000154
Sayani A, Ali MA, Dey P, et al. Interventions designed to increase the uptake of lung cancer screening: An equity-oriented scoping review. JTO Clin Res Rep. 2023;4(3):100469. doi:10.1016/j.jtocrr.2023.100469
U.S. Preventive Services Task Force. Lung cancer: Screening. March 9, 2021. uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
Zavala VA, Bracci PM, Carethers JM, et al. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer. 2021;124(2):315-32. doi:10.1038/s41416-020-01038-6
Key words: health disparities, lung cancer, smoking cessation, underserved populations
