This K07 proposal in cancer prevention, control, and population sciences will enable the applicant to integrate two areas--business management and clinical psychology--into a research career on cost-efficient dissemination of primary and secondary cancer prevention interventions. The goals are to: a) gain experience in interventions for hard-to-treat smokers; b) build knowledge of statistical methods in economic research; c) apply methods from management science to research on cost- efficiency; and, d) develop a programmatic line and research on dissemination and cost-efficiency of interventions for cancer prevention and control. Cancer prevention through smoking cessation involves a paradox. Low cost/low intensity/low efficacy public health approaches have greater reach, while high cost/high intensity/low reach clinical interventions have greater efficacy. The difference in efficacy is greatest for hard-to-treat smokers who have greater levels of nicotine dependence, depression and problem alcohol use. Recently, some have called for integration of these contrasting intervention approaches through use of tailored stepped-care models that maximize cost- efficient allocation of healthcare resources. The research plan in this career development proposal calls for two studies that e amine costs and efficiencies of targeting subsets of smokers. Study 1 will use data from adult respondents to the 1997-1999 the National Health Interview Surveys (N = +/- 100,000) and the 1993 National Mortality Followback Survey (N = 22,957) to examine the medical utilization of subgroups of smokers who have high-risk alcohol consumption, sedentary lifestyle or depression. The costs of medical utilization will be estimated with data from the Medical Expenditure Panel Survey. Study 1 hypothesizes that smoking interacts with other health risk factors to predict greater costs for subgroups of smokers. Study 2 will examine the cost-effectiveness and operational efficiency of a telephone based tailored smoking intervention. Study 2 hypothesizes that tailored interventions will be more cost-effective than more standardized ones, particularly among smokers with other high-risk factors. Study 2 will also use tools from management science to evaluate clinical system factors affecting intervention efficiency. These studies will inform future dissemination research on cost-efficient and effective smoking cessation interventions that address the economic imperatives of healthcare delivery systems while maximizing the benefit to public health.
