The purpose of this cross-sectional study was to investigate how a personal and/or family history of skin cancer affects the frequency of engagement with a range of known skin-protective behaviors. The data for this study was collected using a self-report questionnaire during an in-person cancer fundraiser in Orange County, CA and was limited to adults over the age of 18. A total of 93 individuals completed the survey, however, two were excluded as they were less than 18 years of age. The sample population consisted of individuals who were majority white (55.2%), female (63.2%), and over the age of 35 (64.0%). Results reveal that individuals with a family history of skin cancer or have been diagnosed with skin cancer at some point in their life, engage more frequently in skin-protective behaviors compared to those with no prior diagnosis and those without a family history of skin cancer. Several trends emerged across other demographic characteristics that provide further insight into differences between those with and without a personal and/or family history of skin cancer. Further, results indicate that nearly 20% of individuals are not aware of their skin cancer risk. Lack of awareness of risk varied by race / ethnicity, with 12%, 45% and 27% of self-identified white, Hispanic/Latino and Asian respondents, respectively, reported that they don’t know their risk of skin cancer. Overall, the results generated by this study provide insights into the relationships between personal and family history of skin cancer and a range of well-established sun-protective behaviors and provide insights into opportunities for intervention.

Disease burden increases with age. Cancer and dementia are two age-related chronic diseases that most commonly occur in older adults. They are also amongst the top 10 leading causes of death and disability in this age group. Despite the increased risk of comorbidity at older ages, it is unlikely for cancer and dementia to present in the same person at the same time. Surprisingly, evidence suggests that rates of dementia are lower in older adults with a history of cancer and vice versa. However, whether this pattern of inverse association holds true for the oldest-old, remains unclear. The oldest-old represent the fastest growing age group of the world’s population yet have occupied only a small percentage of the population included in the published literature. The objective of this dissertation is to examine the relationship between cancer and dementia in the oldest-old using data from the 90+ Study at the University of California, Irvine.

An initial cross-sectional study was performed as a preliminary analysis using data from the 90+ study. A logistic regression model of 1525 oldest-old participants with a) no history of cancer or b) a history of cancer, were assessed for having dementia at baseline enrollment into the 90+ study. Results showed a 36% reduced odds of dementia in participants with a prior history of cancer at baseline. Building off these preliminary analyses, two studies were performed to further evaluate the overall research question about the relationship between cancer and dementia in the oldest-old. Both research questions utilized data from the 90+ study. Specifically, the study population consisted of 761 older adults who were dementia free at baseline enrollment into the 90+ Study between 2003 to 2018.

The first research objective was to measure the risk of dementia in the oldest-old with a prior history of cancer compared to the oldest-old who remained cancer free. Using cox proportional hazards we estimated the cause-specific hazard ratio to address questions of etiology between the two diseases. The second research objective was to examine cognitive performance over time in participants with a history of cancer compared to those who remained cancer free. A linear mixed model for repeated measures was used to capture multiple longitudinal continuous outcomes in each of the groups.

Self-reported history of cancer was associated with a reduced rate of all-cause dementia in people aged 90 years and older as a function of the cause-specific hazard ratio. It was not associated with AD dementia. Although, the magnitude and direction of the association was similar to previous studies who found an inverse association. Additionally, we examined the role of type of cancer on the association between cancer and dementia, but the influence could not be determined in any definitive manner. In regard to cognitive performance, participants with a history of cancer showed slower rates of decline compared to participants who remained cancer free in global cognition and verbal fluency cognitive domains. No association in any other cognitive domain was found, largely due to missing information.

This is the largest study to date on cancer and dementia in a well-characterized cohort of the oldest-old. The results suggest that a history of cancer is associated with slower rates of cognitive decline over time. This, coupled with the magnitude and direction of the association between cancer and dementia suggests that a history of cancer does influence cognitive performance over time in the oldest-old. Furthermore, the inverse association suggests that a history of cancer may delay or protect from dementia in this particular age group. This research into how age-related diseases influence the progression or prognosis of other age-related diseases is important when examining disease burden in the oldest age groups at highest risk for them. This research has the potential to influence healthcare screening practices in the oldest-old and how health care providers approach long-term and palliative care in patients with a history of cancer or diagnosed with dementia. Knowing whether a person in this age group is at greater or lesser risk of dementia as a result of their cancer history may influence how often they need to be screened for dementia and possibly whether or not signs of cognitive decline are attributed to dementia before ruling out other potential causes.

The constant influx of Latino immigrants throughout the decades has transformed the demographic composition of the United States, such that the Hispanic population has experienced a 592% growth since 1970. Given that chronic conditions affect minority groups earlier and at much higher rates than other populations, it is especially important to investigate health in the growing Latino community. Despite declining cancer incidence and mortality rates, Latina patients continue to have lower 5-year survival rates compared to their non-Hispanic white counterparts. Moreover, Hispanic adults are 1.7 times more likely to have been diagnosed with diabetes, 2.6 times more likely to be hospitalized for diabetes related end-stage renal disease, and 1.4 times more likely to die from diabetes compared to non-Hispanic white adults.

Given the central role of family in the Latino culture, social relationships may help attenuate adverse health outcomes by promoting overall health and wellness for those involved. Dominant paradigms examining the impact of close relationships on focus on the individual, often a patient, or dyadic perspective, frequently spousal or parent-child relationships. However, these models fail to consider the unique cultural influences of other members that are present in Hispanic families. Given that familism, a cultural value that emphasizes family over self, is one of the most prominent values in the Hispanic community, it is especially important to consider the role that social network members play in disease management.

To address these needs, a series of analyses examined the role of meaningful others, including medical providers and family members, on health behavior and health outcomes. Results from three separate datasets buttress the importance of such connections indicating that relationships matter for the overall health and wellness of Hispanic women. Research findings may have significant implications for the design of healthcare interventions that elicit change at the individual and social network levels with the goal of producing health equity for all.

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