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Despite increasing emphasis on disease prevention and health promotion and evidence demonstrating the effectiveness of such services, high morbidity and mortality rates in Appalachia suggest a problem with appropriate utilization of preventive services in this region. Also, growth in managed care programs signify a greater role for managed care organizations (MCOs) in preventive care. The overall goal of this study was to assess the preventive care behavior of Appalachians, evaluate strategies used by MCOs to ensure appropriate utilization of preventive services, and identify barriers/facilitators to the provision/utilization of such services. In phase I of this study, secondary data analysis of CDC's Behavioral Risk Factor Surveillance System helped compare trends in utilization of mammograms, breast physical exams, Pap smears, and cholesterol and blood pressure screenings between Appalachians and Non-Appalachians. Also, effects of demographic, lifestyle, and healthcare access factors on utilization of such services were examined along with the development of profiles of individuals at high risk for heart disease and breast and cervical cancers. Results indicate that more Appalachians underutilize cholesterol screenings, mammograms, breast physical exams, and Pap smears as compared to Non-Appalachians. Healthcare access factors are strong predictors of receiving such screenings, while inadequate testing seems common among non-whites, the poor, less educated, and uninsured. Risk profiles show Appalachians to be at greater risk for developing heart disease and breast and cervical cancers. Phase I information was used for Phase II in which a mail survey helped gather data from a national sample of 1012 Directors of MCOs. Data from 175 respondents indicated case management to be the strategy of choice to ensure appropriate utilization of preventive services followed by prospective and concurrent utilization review programs. Cost sharing was perceived as the least effective strategy. Strong barriers to the provision of preventive services include inability of them to generate short term savings and high disenrollment rates in MCOs. Improved health status through early intervention and high consumer awareness are important facilitators to the utilization of such services. This study confirms the underutilization of preventive services in Appalachia, and concludes that MCOs, through case management and utilization review programs, could ensure appropriate utilization.