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Biomedical subjects

Steven S Coughlin

Publications and source records attributed to Steven S Coughlin.

At least 19 recordsLinked to original sources
PubMed2007

Pain management in the last six months of life among women who died of ovarian cancer.

Previous studies indicate that the symptoms of many dying cancer patients are undertreated and many suffer unnecessary pain. We obtained data retrospectively from three large health maintenance organizations, and examined the analgesic drug therapies received in the last six months of life by women who died of ovarian cancer between 1995 and 2000. Subjects were identified through cancer registries and administrative data. Outpatient medications used during the final six months of life were obtained from pharmacy databases. Pain information was obtained from medical charts. We categorized each medication based on the World Health Organization classification for pain management (mild, moderate, or intense). Of the 421 women, only 64 (15%) had no mention of pain in their charts. The use of medications typically prescribed for moderate to severe pain ("high intensity" drugs) increased as women approached death. At 5-6 months before death, 55% of women were either on no pain medication or medication generally used for mild pain; only 9% were using the highest intensity regimen. The percentage on the highest intensity regimen (drugs generally used for severe pain) increased to 22% at 3-4 months before death and 54% at 1-2 months. Older women (70 or older) were less likely to be prescribed the highest intensity medication than those under age 70 (44% vs. 70%, P<0.001). No differences were found in the use of the high intensity drugs by race, marital status, year of diagnosis, stage of disease, or comorbidity. Our finding that only 54% of women with pain were given high intensity medication near death indicates room for improvement in the care of ovarian cancer patients at the end of life.

Adult↗
PubMed2006

Ethical issues in epidemiologic research and public health practice.

A rich and growing body of literature has emerged on ethics in epidemiologic research and public health practice. Recent articles have included conceptual frameworks of public health ethics and overviews of historical developments in the field. Several important topics in public health ethics have also been highlighted. Attention to ethical issues can facilitate the effective planning, implementation, and growth of a variety of public health programs and research activities. Public health ethics is consistent with the prevention orientation of public health. Ethical concerns can be anticipated or identified early and effectively addressed through careful analysis and consultation.

Journal Article↗
PubMed2006

Rural/nonrural differences in colorectal cancer incidence in the United States, 1998-2001.

BACKGROUND: Few studies of colorectal cancer incidence by rural, suburban, and metropolitan residence have been published. METHODS: The authors examined colorectal cancer incidence among men and women in U.S. counties classified as rural, suburban, and metropolitan for the period 1998-2001. They examined rural/suburban/metropolitan differences in incidence by age, race, Hispanic ethnicity, stage at diagnosis, histology, and percentage of the total county population below the poverty level, using data from the CDC's National Program of Cancer Registries, the NCI's Surveillance, Epidemiology, and End Results Program, and the 2000 U.S. Census. RESULTS: A total of 495,770 newly diagnosed or incident cases of colorectal cancer were included in this analysis (249,919 among men and 245,851 among women). Over the period 1998-2001, the colorectal cancer incidence rates among men tended to be lower among those who resided in rural areas, for each of the subgroups examined, with the exception of Asians and Pacific Islanders and those living in more affluent counties. Among women aged 75 years and older, the colorectal cancer incidence rates tended to be lower among rural than metropolitan or suburban residents, though the differences were slight. In multivariate analysis, the incidence of colorectal cancer was higher in metropolitan, suburban, and rural areas for blacks than that for whites (incidence rate ratios [RR] = 1.12, 1.07, and 1.06, respectively, all P < 0.015). CONCLUSIONS: This study suggests that black men who reside in metropolitan areas have a higher risk of colorectal cancer than black men who reside in rural areas. This finding suggests the need for diverse approaches for reducing colorectal cancer when targeting rural compared with metropolitan areas.

Adult↗
PubMed2006

CDC-funded intervention research aimed at promoting colorectal cancer screening in communities.

BACKGROUND: Although strong scientific evidence has shown that screening for colorectal cancer saves lives, most U.S. adults who are at the recommended age are not being screened. Prior studies suggest that barriers to routine screening vary by race, ethnicity, socioeconomic status, urban/rural residence, health insurance status, and factors related to health care providers and the health care environment. Relatively few studies, however, have identified and tested intervention approaches to promote routine colorectal cancer screening among diverse populations. METHODS: The Division of Cancer Prevention and Control at CDC has funded ongoing projects to develop and test interventions to promote routine colorectal cancer screening among medically underserved populations in Appalachia, the Lower Rio Grande Valley in Texas, the High Plains region of Colorado, and other U.S. communities. RESULTS: This article provides an overview of colorectal cancer screening intervention studies currently funded by CDC that focus on a wide range of populations, including medically underserved persons who live in predominately rural areas, Hispanic and non-Hispanic persons, urban African Americans, persons with low health literacy, and persons enrolled in managed care organizations. CONCLUSIONS: These CDC-funded intervention research projects are likely to contribute importantly to evidence about what works to promote colorectal cancer screening in diverse U.S. communities. .

Black or African American↗
PubMed2006

Cervical cancer screening among women in metropolitan areas of the United States by individual-level and area-based measures of socioeconomic status, 2000 to 2002.

BACKGROUND: Few studies have examined cancer screening among women residing in metropolitan areas in relation to both individual-level and area-based measures of socioeconomic status (SES). To learn more, we examined self-reported rates of Papanicolaou (Pap) testing among women living in metropolitan areas in relation to individual-level measures of SES (household income and education), and area-based measures of SES (percentage of residents living in poverty, percentage with low education, and percentage working class). METHODS: Data were obtained from women who were interviewed by telephone during 2000 and 2002 as part of the Behavioral Risk Factor Surveillance System (BRFSS). Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas. Only BRFSS respondents who resided in 35 metropolitan statistical areas with a population of >or=1.5 million in 2000 were included in this analysis. Analyses were limited to women ages >or=18 years with no history of hysterectomy (n = 49,231). Area-based measures of SES were obtained by using county-level information from the 2000 U.S. Census. RESULTS: Only 75.4% [95% confidence interval (95% CI), 73.8-77.1%] of 3,947 women ages >or=18 years who had a reported household income of <15,000 dollars per year had received a Pap test in the previous 3 years, compared with 92.2% (95% CI, 91.2-93.1%) of 18,698 women with a household income of >or=50,000 dollars. Overall, 77.5% (95% CI, 75.7-79.3%) of women without a high school education had received a Pap test compared with 91.7% (91.0-92.3%) of college graduates. In multivariate analysis, we also found education level to be positively associated with Pap testing rates, especially among women residing in areas where a relatively low percentage of residents had a low education level (P < 0.0001). CONCLUSIONS: Individual-level measures of SES may be modified by county-level measures of SES. Analyses of cancer screening rates by measures of income, educational attainment, and other factors may help health officials to better direct their finite resources to areas of greatest need.

Adult↗
PubMed2005

Racial and ethnic disparities in breast cancer rates by age: NAACCR Breast Cancer Project.

OBJECTIVE: To examine age-specific rates of breast cancer incidence among racial and ethnic groups in the United States. METHODS: Subjects were 363,801 women diagnosed with invasive breast cancer diagnosed during 1994--1998 and reported in the North American Association of Central Cancer Registries (NAACCR) data set. Variables analyzed included race, ethnicity, 5-year age group (from 10 years through 85+years), and stage at time of diagnosis (localized, regional, distant). Incidence rates per 100,000 women were calculated for each 5--year age group and stratified by stage. Rate ratios and 95% confidence intervals were calculated by comparing each racial group with whites and Hispanics with non-Hispanics. RESULTS: Black women experience significantly higher breast cancer incidence up to the age of 40 years and significantly lower incidence after age 50 compared with white women of the same ages. This is called the 'crossover' effect. This shifting burden of higher incidence occurs at ages 35--39 for localized stage and at ages 55--59 for regional stage. For distant stage, black women of all ages experience higher incidence compared with white women. Similar crossover effects do not exist for American Indian (AI) or Asian/Pacific Islander (API) women compared with white women. Both AI and API women have significantly lower incidence of breast cancer compared with white women, and Hispanic women have significantly lower incidence compared with non-Hispanic women. CONCLUSIONS: This study highlights racial and ethnic differences in breast cancer incidence rates among US women. The crossover effect between black and white women, particularly the lower incidence of localized stage disease diagnosed in older black women, is a significant phenomenon that may be associated with screening practices, and has implications for public health planning and cancer control initiatives to reduce racial/ethnic disparities.

Adolescent↗
PubMed2005

Cancer survivorship: a new challenge in comprehensive cancer control.

Cancer survivors are a growing population in the United States because of earlier cancer diagnosis, the aging of society, and more effective risk reduction and treatment. Concerns about the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families are increasingly being recognized and addressed by public, private, and non-profit organizations. The purpose of this paper is to discuss how survivorship fits within the framework of comprehensive cancer control. We summarize three national reports on cancer survivorship and highlight how various organizations and programs are striving to address the needs of cancer survivors through public health planning, including the challenges these groups face and the gaps in knowledge and available services. As cancer survivorship issues are being recognized, many organizations have objectives and programs to address concerns of those diagnosed with cancer. However, better coordination and dissemination may decrease overlap and increase the reach of efforts and there is limited evidence for the effectiveness and impact of these efforts.

Humans↗
PubMed2005

Comparison of racial/ethnic disparities in adult immunization and cancer screening.

BACKGROUND: Racial/ethnic disparities in adult influenza and pneumococcal vaccination are marked and poorly understood. The purpose of this study was to contrast these disparities with disparities in other clinical preventive services--mammography and colorectal cancer screening--that are targeted to older populations. METHODS: Data from the 2000 National Health Interview Survey were analyzed in 2004 to determine to what degree race/ethnicity remains a predictor of the receipt of each service after adjusting for personal and health characteristics, socioeconomic status (SES), and access to and utilization of care variables. RESULTS: Blacks and Hispanics were significantly less likely to report receipt of nearly all preventive services examined. Among whites, 57%, 67%, 67%, and 40% reported pneumococcal vaccination, influenza vaccination, mammography, and colorectal cancer screening, respectively. Among blacks, those proportions were 31%, 48%, 60% and 33%, respectively; among English-speaking Hispanics, 35%, 60%, 60%, and 30%, respectively; and among Spanish-speaking Hispanics, 24%, 49%, 52%, and 19%, respectively. After adjusting for personal and health characteristics, socioeconomic factors, and measures of access to and utilization of care, blacks and English- and Spanish-speaking Hispanics remained significantly less likely than whites to report the receipt of pneumococcal vaccination; blacks remained significantly less likely to report influenza vaccination than whites; and Spanish-speaking Hispanics remained significantly less to report colorectal cancer screening than whites. CONCLUSIONS: Most racial/ethnic disparities seen in breast and colorectal cancer screening are explained by differences in SES. In contrast, racial/ethnic disparities in adult immunization persist, and especially for pneumococcal vaccination, suggesting that different barriers may be involved.

Adolescent↗
PubMed2005

Physician recommendation for papanicolaou testing among U.S. women, 2000.

OBJECTIVE: Many women in the U.S. undergo routine cervical cancer screening, but some women have rarely or never had a Papanicolaou (Pap) test. Studies of other cancer screening tests (for example, mammograms) have shown that physician recommendation to get a screening test is one of the strongest predictors of cancer screening. METHODS: In this study, we examined whether women in the U.S. had received a physician recommendation to get a Pap test using data from the 2000 National Health Interview Survey. Reported reasons for not receiving a Pap test were also explored. RESULTS: Among women aged > or =18 years who had no history of hysterectomy, 83.3% [95% confidence interval (CI), 82.4-84.1%] of the 13,636 women in this sample had had a Pap test in the last 3 years. Among 2,310 women who had not had a recent Pap test, reported reasons for not receiving a Pap test included: "No reason/never thought about it" (48.0%; 95% CI, 45.5-50.7), "Doctor didn't order it" (10.3%; 95% CI, 8.7-12.0), "Didn't need it/didn't know I needed this type of test" (8.1%; 95% CI, 6.7-9.6), "Haven't had any problems" (9.0%; 95% CI, 7.6-10.5), "Put it off" (7.4%; 95% CI, 6.2-8.7), "Too expensive/no insurance" (8.7%; 95% CI, 7.3-10.2), "Too painful, unpleasant, embarrassing" (3.5%; 95% CI, 2.5-4.6), and "Don't have doctor" (1.7%; 95% CI, 1.2-2.4). Among women who had had a doctor visit in the last year but who had not had a recent Pap test, about 86.7% (95% CI, 84.5-88.6) reported that their doctor had not recommended a Pap test in the last year. African-American women were as likely as White women to have received a doctor recommendation to get a Pap test. Hispanic women were as likely as non-Hispanic women to have received a doctor recommendation to get a Pap test. In multivariate analysis, factors positively associated with doctor recommendation to get a Pap test included being aged 30 to 64 years, having been born in the U.S., and having seen a specialist or general doctor in the past year. CONCLUSION: These findings suggest that lack of a physician recommendation contributes to underuse of Pap screening by many eligible women. Given research that shows the effectiveness of physician recommendations in improving use, increased physician recommendations could contribute significantly to increased Pap screening use in the U.S.

Adolescent↗
PubMed2005

Physician recommendation for colorectal cancer screening by race, ethnicity, and health insurance status among men and women in the United States, 2000.

In this study, the authors examined whether men and women in the United States had received a physician recommendation to get a colorectal cancer screening test, by race, ethnicity, and health insurance status using data from the 2000 National Health Interview Survey. Among men and women who had had a doctor visit in the past year but who had not had a recent fecal occult blood test, about 94.6% (95% CI 94.0-95.2) reported that their doctor had not recommended the test in the past year. African Americans, Hispanics, and American Indians/Alaska Natives were less likely to report receiving a recommendation for endoscopy compared to Whites.

Colorectal Neoplasms↗
PubMed2004

Colorectal carcinoma mortality among Appalachian men and women, 1969-1999.

BACKGROUND: Colorectal carcinoma screening can reduce mortality, but residents of poor or medically underserved areas may face barriers to screening. The current study assessed colorectal carcinoma mortality in Appalachia, a historically underserved area, from 1969 to 1999. METHODS: All counties within the 13-state Appalachian region, which stretches from southern New York to northern Mississippi, were used to calculate annual death rates for the 31-year period. Joinpoint regression analysis was used to examine trends by age and race for the Appalachian region and the remainder of the United States. Five-year rates for 1995-1999 age-adjusted to the 2000 U.S. standard population were calculated by race and age group for the Appalachian region and elsewhere in the United States. RESULTS: Trend analysis showed that colorectal carcinoma death rates among both racial and gender groups studied had declined in recent years. Despite this, the rates for white males and white females were still significantly higher in Appalachia than in the rest of the country at the end of the study period, 1999. Five-year colorectal carcinoma death rates among white males (ages < 50, 50-59, and 70-79 years) and white females (ages < 50, 50-59, 70-79, > or = 80 years) were significantly higher in Appalachia than elsewhere in the United States, whereas rates among black females 60-69 and 70-79 years old were significantly lower in Appalachia. CONCLUSIONS: The Appalachian region may benefit from targeted prevention efforts to eliminate disparities in the colorectal carcinoma death rates among subgroups. Further studies are needed to determine whether the higher death rates in specific Appalachian subgroups are related to a higher incidence of the disease, the cancer being at a later stage at diagnosis, poorer treatment, or other factors.

Black or African American↗
PubMed2004

Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults.

Several studies have suggested that diabetes mellitus may alter the risk of developing a variety of cancers, and the associations are biologically plausible. To learn more about the relation between diabetes and cancer mortality, the authors examined associations with selected cancers in a large, prospective US cohort of 467,922 men and 588,321 women who had no reported history of cancer at enrollment in 1982. After 16 years of mortality follow-up, diabetes was significantly associated with fatal colon cancer in men (multivariate relative risk (RR) = 1.20, 95% confidence interval (CI): 1.06, 1.37) and women (RR = 1.24, 95% CI: 1.07, 1.43) and with pancreatic cancer in men (RR = 1.48, 95% CI: 1.27, 1.73) and women (RR = 1.44, 95% CI: 1.21, 1.72). For men, diabetes was significantly associated with liver cancer (RR = 2.19, 95% CI: 1.76, 2.72) and bladder cancer (RR = 1.43, 95% CI: 1.14, 1.80). In addition, diabetes was significantly associated with breast cancer in women (RR = 1.27, 95% CI: 1.11, 1.45). These associations were not explained by high body mass. Our findings suggest that diabetes is an independent predictor of mortality from cancer of the colon, pancreas, female breast, and, in men, of the liver and bladder.

Adult↗
PubMed2004

Breast cancer screening practices among women in the United States, 2000.

Results from recent studies indicate that many women in the US undergo routine screening for breast cancer, but some groups of women are under-screened. In this study, we examined the breast cancer screening practices of white and black women in the United States, according to Hispanic ethnicity and other factors, using data from the 2000 National Health Interview Survey. Among women aged > or =40 years, 71.2% (95% confidence interval, CI: 70.0-72.4%) of the 8201 white women and 67.6% (95% CI: 64.5-70.6%) of the 1474 black women in this sample reported having a mammogram in the past two years. About 60.3% (95% CI: 56.7-70.3%) of 970 Hispanic women (including those who reported they were white or black) and 71.5% (95% CI: 70.3-72.7%) of 8705 non-Hispanic women reported having a mammogram in the past two years. About 74.8% (95% CI: 73.8-76.8%) of 8176 white women and 73.8% (95% CI: 71.1-76.6%) of 1471 black women aged > or =40 years had received a clinical breast examination in the past two years. About 60.1% (95% CI: 56.1-64.0%) of 969 Hispanic women (including those who reported they were white or black) and 75.6% (95% CI: 74.6-76.6%) of 8678 non-Hispanic women had received a clinical breast examination in the past two years. Women with lower incomes, those with less education, and recent immigrants were less likely to be screened. Women who had a usual source of health care and those with health insurance coverage were more likely to have been screened. These results underscore the need for continued efforts to ensure that uninsured women and those who are medically underserved have access to cancer screening services.

Adult↗
PubMed2004

Breast and cervical cancer mortality in the Mississippi Delta, 1979-1998.

BACKGROUND: Historically, the Mississippi Delta region has been medically underserved. This may lead to lower cancer prevention efforts and higher breast or cervical cancer mortality rates. METHODS: Death rates for 1979 through 1998 were calculated for Mississippi Delta women and for women living elsewhere in the US. RESULTS: Breast cancer mortality in the Delta was similar to that elsewhere in the US in recent years for both black and white women, but rates were lower in the Delta in the early years of the study period. Overall, cervical cancer mortality was similar in the two areas but rates declined more rapidly elsewhere in the US than in the Delta. Breast and cervical cancer mortality was higher among black women than among white women in both areas. Cervical cancer mortality was higher among white rural and black urban women in the Delta than their counterparts elsewhere. CONCLUSION: These results can guide prevention activities for reducing mortality from these diseases.

Breast Neoplasms↗
PubMed2004

Colorectal cancer screening practices among men and women in rural and nonrural areas of the United States, 1999.

BACKGROUND: Previous studies have suggested that men and women in rural areas are less likely than those in urban areas to receive routine cancer screening. METHODS: We examined the colorectal cancer screening practices of men (n = 23,565) and women (n = 37,847) aged > or = 50 years living in rural areas and other areas of the United States using data from the 1999 Behavioral Risk Factor Surveillance System (BRFSS). Geographic areas of residence were classified as rural areas and small towns, suburban areas and small metropolitan areas, and larger metropolitan areas using US Department of Agriculture (USDA) urban/rural continuum codes. RESULTS: The estimated median response rate across states was 55.2%. Approximately 16.2% (95% confidence interval [CI] = 15.3% to 17.2%) of persons aged > or = 50 years who resided in rural areas had received a fecal occult blood test in the past year, compared with 22.0% of those living in the larger metropolitan areas (95% CI = 21.4% to 22.7%). About 28.2% (95% CI = 27.1% to 29.4%) of those who resided in rural areas had received a sigmoidoscopy or colonoscopy in the past 5 years, compared with 35.2% of those in the larger metropolitan areas (95% CI = 34.5% to 36.0%). CONCLUSIONS: These results underscore the need for continued efforts to increase colorectal cancer screening in the United States. Special efforts may be required to increase screening in rural areas.

Age Distribution↗
PubMed2004

Breast and cervical cancer screening among Mississippi Delta women.

The purpose of the study was to determine breast and cervical cancer screening among women living in the Mississippi Delta region. Using data from the Behavioral Risk Factor Surveillance System for 1999--2000, we determined the prevalence of mammography (women 40 years and older, n = 6,028) and Pap testing (women 18 years and older, n = 6,502) within the past 2 or 3 years, respectively. We examined predictors of testing and compared results with those for women living elsewhere in the United States. Among Delta women, 69.4% (95% confidence interval [CI] 67.9% to 70.9%) had a mammogram and 85.5% (95% CI 84.3% to 86.6%) a Pap test. Mammography prevalence was lower among black and white Delta women than among black and white women elsewhere. Pap testingwas lower among older (65 years and older) Delta women or women who did not visit a doctor within the past year than among their counterparts elsewhere. Additional interventions are needed to meet the goals of Healthy People 2010 for all women.

Adolescent↗