PROJECT SUMMARY/ABSTRACT
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.
