CARE researchers conduct economic, geospatial, and policy evaluations related to health outcomes and behaviors in a community setting. Additionally, CARE researchers are working to better understand the health and well-being of food pantry clients in order to inform new interventions and increased connectivity between the population and health care systems. In 2016, 12.5% of US Households and 14.3% of Texas Households were food insecure. Food insecurity is defined by the U.S. Department of Agriculture (USDA) as having inconsistent access to adequate food due to lack of financial and other resources. People in food insecure households face ongoing challenges in meeting basic needs like food, rent, medicine and regular access to health care. ERG facilitates the Community Assistance Research Initiative (CARE), which fosters multidisciplinary research relationships across academic and community organizations, to address relevant research questions related to food insecurity.
Current interests include:
behavioral economics and health behavior
health and food insecurity
peer effects in health behaviors
neighborhoods and health
Current and Past Projects
Multisector Solution to Build a Culture of Health
Food as Medicine
Aging into Medicare
Using the CCL Database linked to Parkland Health and Hospital System electronic health records, this project will explore the impact of Medicare access on foodbank use and food security over time among households utilizing the foodbank. This project will also examine differing trajectories of foodbank use and food security by pre-existing chronic conditions and multimorbidity.
Funding: University of Kentucky Poverty Research Center
SNAP-AC
This project is being led by Crossroads Community Services and will implement a randomized controlled trial of a behavioral-economics informed intervention to improve the scarcity context of budgetting decisions made by low-income households. Our hypothesis is that by better coordinating use of SNAP and food pantry assistance, households will be better able to smooth food consumption throughout the month and achieve better food security.
Food Security Status in Seniors over their Life Course
Life histories were recorded for 200 seniors recruited from CARE non-profit partners to identify life course patterns of resource, health, and economic insecutrity.
Funding: USDA Food and Nutrition Services and Center for Poverty Research
From Food to Finances
From Food to Finances adapts highly effective financial coaching philosophy to build a coaching program that assists individuals in setting and attaining goals during periods of acute insecurity or crisis. The resulting Resource Coaching program was developed through collaboration of CARE researchers, Crossroads Community Services, and Ascend Dallas.
Funding: Communities Foundation of Texas North Texas Cares
Medically tailored groceries and food resource coaching for patients of a safety-net clinic
This project combines Resource Coaching with medically tailored groceries to help low-income Parkland patients improve management of chronic disease. A randomized controlled trial is underway to test efficacy of the interventions for improving food security and health.
Funding: American Heart Association
Housing and chronic disease management
Housing is critical for acquiring and building wealth necessary for economic security, which in turn is a factor in most causal pathways through which social determinants of health impact health outcomes. For most homeowners, housing wealth comprises the majority of their wealth holdings and for renters, stable housing is essential for maintaining employment and income. We examine the relationships between housing and individuals' ability to manage chronic conditions. Stable housing and housing wealth can provide resources needed for behavior changes necessary for successful disease management. Importantly, the same groups who continue to experience inequities in housing also experience inequities in chronic disease outcomes. This project investigates the causes and consequences of these potentially self-reinforcing patterns of inequity.
Publications
McKillop, C., Leonard, T., Pruitt, S., Tiro, J. In Press. Do traditional economic theories of free riding behavior explain spatial clustering of HPV vaccine uptake? SSM: Population Health
Shuval, K., Leonard, T., Drope, J., Katz, D.L., Patel, P., Shepard, M.M., Amir, O., Grinstein, A. (In Press) Physical Activity Counseling in Primary Care: Insights from Public Health & Behavioral Economics. CA: A Cancer Journal for Clinicians.
Leonard, T., Ayers, C., Das, S., Neeland, I., Powell-Wiley, T.M. 2017. Do Neighborhoods Matter Differently for Movers and Non-Movers?: Analysis of Weight Gain in the Longitudinal Dallas Heart Study. Health & Place. 44: 52-60.
Leonard, T., Hughes, A.E., Pruitt, S.L. 2017. Understanding how low-socioeconomic status households cope with health shocks: An analysis of multi-sector linked data. The Annals of the American Academy of Political and Social Science. 669(1): 125-145.
De Oliveira A, Leonard T., Shuval K, Sugg-Skinner C, Eckel C, Murdoch JC. 2016. Economic Preferences and Obesity among a Low-Income African American Community. Journal of Economic Behavior & Organization. 131: 196-208.
Berrigan, D., A. Hipp, P.M. Hurvitz, P. James, M. Jankowska, J. Kerr, F. Laden, T. Leonard, R. McKinnon, T.M. Powell-Wiley, E. Tarlov, S.N. Zenk. (2015). Geospatial and Contextual Approaches to Energy Balance and Health. Annals of GIS. 21(2): 157-168.
Shuval, Kerem, T. Leonard, B.T. Nguyen, T.H. Ngo, A. L. Yaroch. 2015. Behavioral Economics and Fruit and Vegetable Intake: The Fair Park Study. Health Behavior & Policy Review. 2(2): 92-99.
Powell-Wiley, T., R. Cooper-McCann, C. Ayers, D. Berrigan, M. Lian, M. McClurkin, R. Ballard-Barbash, S. Das, C. Hoehner, T. Leonard. 2015. Change in Neighborhood Socioeconomic Status and Weight Gain: Dallas Heart Study. American Journal of Preventive Medicine. 49(1): 72-79.
Shuval, K., Si, X, Nguyen, B., Leonard, T. 2015. Utilizing Behavioral Economics to Understand Adherence to Physical Activity Guidelines among a Low-Income Urban Community. Journal of Physical Activity and Health 12: 947-953.
Leonard, T., C. McKillop, J. Carson, K. Shuval. 2014. Neighborhood Effects on Food Consumption. Journal of Behavioral and Experimental Economics. 51, 99-113
Powell-Wiley, T.M., C. Ayers, P. Agyemang, T. Leonard, D. Berrigan, R.B. Barbash, M.Lian, S.R. Das , Hoehner, C.M. 2014. Neighborhood-Level Socioeconomic Deprivation Predicts Weight Gain in a Multi-Ethnic Population: Longitudinal Data from the Dallas Heart Study. Preventive Medicine. 66:22-27.
Pruitt, S.L., Leonard, T., Zhang, S., Schootman, M., Halm, E.A., Gupta, S. 2014. Physicians, Clinics, and Neighborhoods: Multiple Levels of Influence on Colorectal Cancer Screening. Cancer Epidemiology Biomarkers and Prevention. 23(7): 1346-1355.
Shuval, K., Hebert, E., Siddiqi, Z., Leonard, T., Craddock, S., Tiro, J., McAllister, K, Skinner, C.S. 2013. Impediments and Facilitators to Physical Activity and Perceptions of Sedentary Behavior among Urban Community Residents: The Fair Park Study. Preventing Chronic Disease. 10.
Shuval, K., Gabriel, K., Leonard, T. 2013. TV Viewing and BMI by Race/Ethnicity and Socio-Economic Status. PLoS ONE 8(5): e63579. doi:10.1371/journal.pone.0063579
Leonard, T., K. Shuval, A. De Oliveira, C. Skinner, C. Eckel, J. Murdoch. 2013. Health Behavior and Behavioral Economics: Economic Preferences and Physical Activity Stages of Change in a Low-Income African American Community. American Journal Of Health Promotion, 27:4, 211-221.
Shuval, K., Leonard, T., Skinner, C., Caughy, M., Kohl, H., Murdoch, J. 2013. Sedentary Behaviors And Obesity Among A Low Income, Ethnic Minority Population. Journal of Physical Activity and Health. 10:1, 132-136.
Sharma, H. V., & Leonard, T. 2024. Food choices at a client choice food pantry: Do low-income pantry users respond to changed opportunity costs?. Food Policy, 126, 102653
Hollis-Hansen, K., Haskins, C., Turcios, J. Bowen, M.E., Leonard, T., Lee, M.J., Albin, J., Wadkins-Chambers, B., Thompson, C., Hall, T. & Pruitt, S.L. 2023. A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients. BMC Public Health 23, 2389. https://doi.org/10.1186/s12889-023-17355-3
Pezzia, C., Rogg, M., Leonard, T. 2023. Food Security Status in Seniors over their Life Course. Applied Economic Policy and PerspectivesPezzia, C., Rogg, M.C., Leonard, T. 2022. Social, Resources, and Institution Disruptions and the Evolving Lives of Economically Vulnerable Older Adults: Implications for Policies and Programs in the New Normal. RSF: The Russel Sage Foundation Journal of the Social Sciences. 8(8), 88-103.
Higashi, R.T., Sood, A., Conrado, A.B., Shahan, K.L., Leonard, T., Pruitt, S.L. 2022. Experiences of increased food insecurity, economic and psychological distress during the COVID-19 pandemic among Supplemental Nutrition Assistance Program-enrolled food pantry clients. Public Health Nutrition. 25(4):1027-1037
Martinez-Miller, E., Leonard, T., Pruitt, S. 2022. Aging into Medicare among a senior food pantry population: an assessment of food security, health, and food pantry use over time. Applied Economic Perspectives and Policy. 44(2): 687-701
Leonard, T. Andrews, D. Pruitt, S. 2022. Impact of Changes in the Frequency of Food Pantry Utilization on Client Food Security and Wellbeing. Journal of Applied Economic Perspectives & Policy. 44(2), 1049-1067.
Funders
Medically tailored groceries and food resource coaching for patients of a safety-net clinic.
American Heart Association
Food to Finances
Communities Foundation of Texas North Texas Cares
Food Security Status in Seniors over their Life Course
Center for Poverty Research & USDA Food and Nutrition Service
Advancing Community Partnerships to Increase Food Access in Southern Dallas
BUILD Health Challenge
Linking Food Pantries with SNAP Benefits: The SNAP-Appointment (SNAP-A) Program
Carruth Fund at Communities Foundation of Texas
A Multisector Solution to Build a Culture of Health among Food Insecure Populations in Dallas County
Robert Wood Johnson Foundation
Ranking the Association between Food Insecurity and Indicators of Population Health: Exploring Heterogeneity by Counties and States
University of Kentucky Center for Poverty Research/Feeding America