The overall goal of this study is to adapt and test the effectiveness of a multilevel intervention to reduce chronic disease risks in socioeconomically disadvantaged, unemployed populations that can be readily adopted by communities. Studies have shown that an unemployment episode exacerbates engaging in health- compromising behaviors, psychological distress, accelerated weight gain, and higher blood pressure ? all of which increase chronic disease risk. Although socioeconomically disadvantaged adults often receive public assistance benefits, job training, and job placement services through Department of Social Services Employment (DSS-E) programs if job loss occurs; these programs do not include prevention-focused content to reduce the chronic disease risks that accrue with unemployment episodes. In addition, DSS-E efforts to help individuals succeed in securing and performing in a new job are often thwarted by implicit ?welfare?-related bias and insufficient job supports in the work environments that DSS-E clients are hired into. We will use a randomized, 2 x 2 factorial design to test interventions at each of two levels (individual, and employer), and their joint effects, in DSS-E clients and employers that hire this population. In Year 1, we will make minor adaptations to existing interventions at each level to ensure they are contextually relevant to the unemployment, and job-entry experiences of DSS-E populations. At the individual level, 600 DSS-E clients will be randomly assigned to a group that receives usual DSS-E in addition to a Chronic Disease Prevention Program (CDPP) that includes online instruction and individual lifestyle coaching sessions, or a group that receives usual DSS-E services only. At the employer level, between 50-80 employers will be allocated to an intervention or control arm using an adaptive, biased-coin randomization approach to ensure balance across the four treatment conditions. The employer intervention combines implicit bias awareness training for supervisors of hired DSS-E clients, and regular, structured, interactions between supervisors and DSS-E hires. The interventions at each level are designed to mitigate the psychological, behavioral, and clinically relevant risks for chronic disease onset, morbidity, and comorbidity that accrue with unemployment and structural factors in the workplace that can exacerbate these risks. This proposed research builds on the strengths of long-standing academic-community partnerships between the research team and key stakeholders across health, social service, employment, and economic development sectors. The findings from this study will advance the science of chronic disease prevention for this vulnerable target population, and will inform national public health efforts to address social determinants of health and reduce chronic disease burden at the community level.

Public Health Relevance

Particularly for socioeconomically disadvantaged adults, unemployment can trigger a cascade of stress-related coping and behavioral processes that increase risk factors for chronic disease. Many in this population (1) depend on social services-related employment programs that assist with securing jobs but do not address the heightened health risks that accrue during this period, and then (2) move into workplace environments where supervisor experiences can exacerbate or perpetuate these risks. Interventions to mitigate chronic disease risks while in employment programs at the individual level, and to provide supervisory supports at the employer level could have a positive, cumulative impact on reducing health inequities within communities.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Jones, Nancy Lynne
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University of North Carolina Chapel Hill
Schools of Nursing
Chapel Hill
United States
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