PROJECT SUMMARY Breast cancer is the most diagnosed cancer in the world with the largest survivorship group. The rise of breast cancer survivors (BCS) living longer, healthier lives merits attention to important areas of cancer survivorship such as employment and physical activity. Employment is associated quality of life, health insurance, treatment adherence and recovery, and financial security. Cancer-related fatigue and cognitive impairment are two frequent barriers to working, but current literature shows they are alleviated by physical activity (PA). Limited studies have shown disproportionate adverse health outcomes among Black BCS living in the rural South and much is still unknown. Common drivers behind these adverse outcomes experienced by Black BCS include discrimination and accessibility to exercise opportunities. Therefore, we will: (1) identify work disparities, (2) determine the relationships between PA and work outcomes, and the role of fatigue, cognition, discrimination, and accessibility to exercise opportunities, using structural equation modeling and mediation analysis, and (3) use semi-structured interviews to better understand the PA-work life relationship and identify barriers and facilitators of desired program elements to apply to multilevel tailored intervention design. The proposed research strategy will build the foundation for tailored, comprehensive intervention design to reduce cancer health and employment disparities and help ALL cancer survivors live longer, healthier lives. The proposed training period will allow applied learning and formal training in (1) cancer disparity research, (2) mediation analysis with structural equation modeling, (3) qualitative research for intervention design. These training opportunities will enhance my research capability to establish independence leading to significant contributions in the fight towards eliminating health inequities for cancer survivors. I have assembled an exceptional mentoring team, in an outstanding training environment to achieve my training goals and career transition. This K01 will equip me with the skills to become a leader in cancer disparities and behavioral health.

PROJECT NARRATIVE Breast cancer survivors are the largest group of cancer survivors and are at high risk for unemployment, especially health disparity populations, leading to financial toxicity and poor health outcomes. Despite the numerous benefits of employment for cancer survivors, cancer-related fatigue and cognitive impairment are common barriers to working; these barriers can be alleviated with physical activity, but discrimination and accessibility to exercise opportunities often experienced by Black cancer survivors living in the rural south can adversely impact these outcomes. This study proposes an innovative approach to explore the relationship between physical activity and work disparities, and the impact of fatigue, cognitive limitations, discrimination, and accessibility to exercise opportunities, and gain preliminary information to develop a future intervention targeting physical activity and work-life barriers in breast cancer survivors at risk of unemployment and physical inactivity.