Total of all reporting groups

4 participants had unknown race/ethnicity due to item non-response.

Operationalization of current homelessness is concordant with the definition in the HEARTH Act of 20091 and used by the US Department of Housing and Urban Development.

Whether participants had ever discussed lung cancer screening with their primary care provider prior to study enrollment (self-reported).

Score range 10-40; higher scores represent greater self-efficacy.

Based on a single-item assessment of self-rated health.

Defined as a score ≥13 on the 6-item Kessler Psychological Distress Scale (K6); 2 participants with status unknown due to item non-response.

Defined as a score ≥3 on the Alcohol Use Disorders Identification Test - Concise (AUDIT-C); 5 participants with status unknown due to item non-response.

Defined as a score ≥3 on the Drug Abuse Screening Test (DAST-10); 1 participant with status unknown due to item non-response.

Calculated by multiplying the number of years of smoking by the typical number of packs per day consumed during those years.

Participants must achieve the primary outcome and, if the result is abnormal (lung imaging reporting and data system lung imaging reporting and data system (Lung-RADS) category 3 or 4), also obtain the next recommended follow-up test within 1 month (4 weeks) of the advised timeframe based on the Lung-RADS framework. Radiology records will be obtained for participants who underwent LDCT for LCS to document the findings of the study, determine the Lung-RADS category associated with those findings, and ascertain the recommended diagnostic follow-up plan.

Participants who completed LDCT for LCS with Lung-RADS scores ≥3 meriting earlier than annual follow-up (typically 6 months for Lung-RADS 3, 3 months for Lung-RADS 4A, and immediate for Lung-RADS 4B/X). In the usual care without patient navigation arm, 1 participant received a Lung-RADS score of 4A. In the usual care with patient navigation arm, 6 participants received a Lung-RADS score of 3, 2 participants received a score of 4A, and 1 participant received a score of 4B.

Time between date of randomization and date of receipt of low-dose computed tomography (LDCT) for lung cancer screening (LCS) or date of censoring (6 months / 26 weeks)

Outcome summarized by 25th percentile achieving completion.

Participants assigned to this arm will be informed about lung cancer screening (LCS), provided educational materials on LCS and patient navigation, and offered access to an LCS navigator who will partner with participants and primary care providers (PCPs) to facilitate low-dose computed tomography (LDCT) completion and follow-up.

Patient Navigation: The navigator's principal role is to guide participants through the lung cancer screening (LCS) process. The navigator will work within the existing Boston Health Care for the Homeless (BHCHP) clinical structure and collaborate with participants' primary care providers (PCPs) to facilitate LCS low-dose computed tomography (LDCT) referral, completion, and timely follow-up by addressing participants' barriers to LCS completion and enhancing participants' self-efficacy. The navigator's secondary role is to offer brief tobacco counseling for participants who currently smoke.