Abstract C032: A hospital farm: Using urban agriculture to address nutrition, physical activity, and food insecurity in cancer survivors
Authors: Ma Hilary Y , Mody Avni P , Lustgarten Janelle , Ronning Lisa , Verm Rebecca , Garcia-Prats Thomas , Seitzinger Michelle 
Published: September 2020

Abstract
Purpose: Lyndon B Johnson (LBJ) Hospital, a safety net hospital, serves the racially/ethnically diverse (60% Hispanic) and low-socioeconomic status urban population of Harris County, Texas. A number of chronic disease outcomes including cancer are worse than national statistics, of which a major determinant is modifiable behaviors related to energy balance – nutrition and physical activity. A lack of educational opportunities promoting healthy living and a high prevalence of food insecurity further exacerbate the problem. In response, we are building a farm on the campus of LBJ Hospital. We report the current status and future plan of this long-term project. Methods: The 1.5-acre farm broke ground in April 2018. In the context of cancer, the 2 objectives are: 1) to educate survivors about nutrition and gardening as physical activity, and 2) to reduce cancer incidence by engaging the community through educational activities and satellite gardens. We assembled a task force consisting of a medical oncologist, a nurse, dieticians, a farmer and population health experts to design a skill-based curriculum. Funding thus far comes from philanthropy and a competitive grant. Results: A full-time farmer was hired in March 2019 to oversee daily operations and to be the liaison with community groups. To date, 34 raised garden boxes have been built, 1/4-acre main plot is expected to yield 250kg of produce/week in fall/winter 2019, 32 fruit trees have been planted, and a nursery is planned. An evidence-based curriculum has been developed: 5 1-hour learning modules integrate nutrition (culinary techniques, culturally-sensitive recipes) with gardening (basic soil biology, seasonality). A 12-month pilot is to begin in fall/winter 2019. Outpatients with hypertension, diabetes or cancer will be eligible for the class. Participant questionnaires will be administered at baseline, completion and after to assess the primary endpoints of knowledge in nutrition (food groups, labeling, etc.), change in consumption of fruits and vegetables (amount, frequency), change in physical activity level (intensity, duration, frequency), and adoption of gardening as physical activity (duration, frequency). Secondary endpoints will be rate of adherence to medical appointments, change in weight, blood pressure control, change in hemoglobin A1c, and quality of life. Food insecurity will be identified using the Hager 2-item screen. We have solidified partnerships with city government officials and community organizations – local high school, churches, county public health department, local food bank and farms. Conclusion: The hospital-based farm is a multi-level intervention targeting energy balance as a root cause of chronic diseases including cancer and food insecurity as a social determinant of health on the patient and community levels. In the upcoming 12-month pilot, we hypothesize the integrated nutrition/gardening classes will increase consumption of fruits and vegetables and uptake of gardening as physical activity.
Citation Format: Hilary Y Ma, Avni P Mody, Janelle Lustgarten, Lisa Ronning, Rebecca Verm, Thomas Garcia-Prats, Michelle Seitzinger. A hospital farm: Using urban agriculture to address nutrition, physical activity, and food insecurity in cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C032.