ContextSixty-three percent of cancer survivors continue to work, or return to work after treatment. Among this population, work ability and challenges encountered in the workplace by young adult cancer survivors have not been well established.PurposeThe purposes of the study are to describe what is currently known about work-related issues for young adult cancer survivors diagnosed between ages 15 and 39, to identify gaps in the research literature, and to suggest interventions or improvements in work processes and occupational settings.MethodsA narrative review of articles using PubMed, CINAHL, and PsychInfo was conducted without date limitations. Search phrases included young adult cancer survivors, long-term cancer survivors, young adults affected by cancer, further combined with key terms employment, work, and occupationally active. Inclusion criteria for publications were young adult cancer survivors initially diagnosed between the ages of 15 and 39, data about work or employment was presented, and articles written in English.ResultsTwenty-three publications met the inclusion criteria. Work-related issues included the potential for reduced work productivity from cancer-changed physical and cognitive functional ability that affected income, and resulted in distress. Coping style, support systems, and changing perspectives about work and life in general were also influential on career decisions among young adult cancer survivors.ConclusionsMore research is needed to study interventions to better manage health changes in young adult cancer survivors within the context of the workplace. Since financial hardship has been shown to be especially high among young cancer survivors, employment is essential to ensure payment of cancer-associated costs and continued medical care.Implications for Cancer SurvivorsWhile young adult cancer survivors may initially grapple with cancer-related physical and psychosocial changes that impact work productivity or influence choice of occupation, employment appears to enhance overall quality of life.

This dissertation features the three-manuscript option. Objective. Work provides personal satisfaction, meaningfulness, and financial stability to adolescent and young adult (AYA) cancer survivors. However, progressive health changes because of cancer and its treatments, may compromise safety and diminish ability to work. Workplace regulations and processes also influence productivity and employment sustainability for AYA cancer survivors. This dissertation explored interactions, and factors influencing interactions, among employed AYA cancer survivors, five years or more after treatment, and occupational and environmental health professionals (OEHPs) within the workplace. Methods. Data were collected and analyzed using constructivist grounded theory. Individual interviews generated data from twelve AYA cancer survivors (age 15-39 at diagnosis). The sample of AYA cancer survivors (n = 12) was obtained from the California iii Surveillance Program in Los Angeles. During interviews, AYA cancer survivors identified OEHPs they encountered in the workplace. Then, twelve OEHPs were interviewed based upon the specified professional categories. Qualitative analysis developed theoretical frameworks based upon the narratives of the participants. Results. Data revealed the complexity of employment issues surrounding AYA cancer survivors during a career. Disclosure of a cancer survivor identity was central to the frameworks. Four processes were identified: Weighing the risks of revealing the survivor-self, sustaining work ability, weighing advocacy, and accessing or providing support. Additionally, employment challenges were organized into themes: Evading the cancer card, working around limitations, and powering-through for AYA survivors. On the other side of legal protection, OEHPs were becoming agents of change by discovering AYA cancer survivors, navigating systems to provide support, and identifying changes needed. Conclusion. This dissertation illuminated the unique experiences of AYA cancer survivors and OEHPs in the workplace. Availability of services provided by OEHPs facilitated AYA cancer survivors' work ability if services were available, known to survivors, and if survivors were willing to reveal needs. Education about OEHP services by employers would improve interactivity and provide a supportive work environment for survivors. Education for workers is needed to enhance sensitivity and improve communication with employees who have a history of cancer. Legislation is needed to promote long-term work ability among AYA cancer survivors by protecting confidential communication to promote greater utilization of OEHP services.

Shared commutes to work, such as vanpooling, benefit the environment and provide economic gain for riders in terms of fuel costs, parking fees, and personal vehicle wear and tear. Although ride sharing is commonly believed to promote health through stress reduction, published evidence on this topic is limited, and findings vary. This study explored the perceived health and well-being of vanpoolers using a qualitative, descriptive design. Five focus groups of vanpoolers and two individual interviews with drivers were conducted (N=40 participants). Stress, change in sleep patterns, and interpersonal relationships emerged as major themes. Employee insights about the impact of vanpooling on work productivity and how employer commitment to the vanpool program influences the vanpool experience also were important findings.

ePing health care workers healthy can be a challenge for the occupational and environmental ealth nurse. The health care work force (e.g., physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, hospital volunteers, administrative staff) (Centers for Disease Control and Prevention [CDC], 1997) is compo sed of more than 9 million workers (Bureau of Labor Statistics, U.S. Department of Labor, 1997) from all socioeconomic and education levels, with variable English language skills (Salazar, 1997). As technology improves and the life span extends, the trend in delivery of health care services is shifting from hospitals to community clinics, provider offices, and home and residential care facilities (Salazar, 1997). The complexity of a rapidly growing diverse work force in a variety of health care settings underscores the need for a dynamic health surveillance program. However, historically several reasons have been cited in the literature for not providing health surveillance for health care workers (McDiarmid, 1996; National Institute for Occupational Safety and Health [NIOSH), 1998): • Safety and health policies in hospitals were developed mainly for clients, not workers.

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