NC Works4Health: Reducing Chronic Disease Risks in Socioeconomically Disadvantaged, Unemployed Populations

项目摘要/摘要 这项研究的总体目标是适应和测试多级干预措施的有效性，以减少慢性病 社会经济上处于不利地位的失业人口的疾病风险，很容易被 社区。研究表明，失业事件会加剧人们对健康的投入。 妥协行为、心理困扰、体重加速增加和高血压--所有这些 这会增加慢性病的风险。尽管在社会经济上处于不利地位的成年人通常会收到公众 通过社会服务部提供的援助福利、就业培训和就业安置服务 就业(DSS-E)计划，如果发生失业；这些计划不包括以预防为重点的内容 以减少因失业事件而产生的慢性病风险。此外，DSS-E努力提供帮助 成功获得新工作并在新工作中表现出色的人往往会受到与福利相关的隐性偏见的阻碍 在雇用DSS-E客户的工作环境中，工作支持不足。我们将使用 随机、2×2析因设计，在两个水平(个人和雇主)测试干预措施，以及 他们的共同作用，在DSS-E客户和雇用这一群体的雇主中。在第一年，我们将把辅修 适应每一级的现有干预措施，以确保它们与 失业情况，以及失业和失业救济金人员的入职经历。在个人层面，600名DSS-E客户将 被随机分配到一组，在接受慢性病预防的同时接受通常的DSS-E 计划(CDPP)，包括在线指导和个人生活方式指导会议，或一个小组， 仅接受通常的DSS-E服务。在雇主层面，将有50-80名雇主被分配到 使用自适应、偏向硬币随机化方法进行干预或控制手臂，以确保 四种处理条件。雇主干预结合了内隐偏见意识培训 受雇DSS-E客户的主管，以及主管和DSS-E招聘之间的定期、结构化的互动。 每个水平的干预措施都是为了减轻心理、行为和临床上的相关性 失业和结构性疾病引起的慢性病发病、发病率和共病的风险 工作场所中可能加剧这些风险的因素。这项拟议的研究建立在 研究团队和主要利益攸关方之间长期的学术界合作伙伴关系 卫生、社会服务、就业和经济发展部门。这项研究的发现将 推动针对这一弱势目标人群的慢性病预防科学，并将通知全国 公共卫生努力解决健康的社会决定因素，减少慢性病负担 社区层面。

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.