The primary purpose of this proposal is to provide the candidate with the means, mentorship and structure to achieve the following goals. The intermediate goal is to measure the psychological, quality of life and resource effects of screening for lung cancer using low dose spiral computed tomography (CT), as well as factors affecting adherence to follow up recommendations. The long term goal is to become an independent health services researcher focusing on evaluation of cancer screening programs and promotion of individual decision making in cancer screening. The candidate will further develop and utilize research skills in psychological measurement and analysis, cancer epidemiology and cancer screening techniques, and assessment of health care resource utilization through medical claims databases. The career development program will incorporate formal course work, tutorials with experts in specific methodological fields, clinical training through preceptorships and the National Cancer Institute Cancer Prevention and Control summer course, conferences and seminars, and research. The major goal of the proposed research is to measure the psychological and resource utilization consequences for individuals participating in a lung cancer screening program, and adherence to follow up recommendations from screening. The clinical benefits of screening lung CT are as yet uncertain. However, screening CT detects abnormalities in approximately 40% of all screened individuals. To evaluate and improve screening lung CT programs, and to promote informed decision making concerning screening, it is essential to determine the non-clinical effects of screening. The proposed research will recruit patients from an NCI-funded SPORE project on the clinical outcomes of screening lung CT (Joel Weissfeld, P.I., Pittsburgh Lung Screening Study). Self-administered surveys of psychological characteristics and medical care use, medical claims data, and data from the PLuSS study will be collected over time. The proposed K07 research will determine 1) the psychological and resource effects of participating in lung cancer screening, 2) how these effects vary with screening results and individual characteristics, and 3) whether individuals adherence to recommended follow up after screening and what factors affect non-adherence.