Source: SANSUM DIABETES RESEARCH INSTITUTE submitted to
FARMING FOR LIFE: AN INNOVATIVE COMMUNITY BASED PROGRAM THAT WILL CHANGE THE FACE OF FOOD INSECURITY AND ACCESS, WHILE CONCURRENTLY IMPROVING LOCAL HEALTH, AND OPENING NEW OUTLETS FOR LOCAL PRODUCE.
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
NEW
Funding Source
Reporting Frequency
Annual
Accession No.
1016337
Grant No.
2018-33800-28404
Project No.
CALW-2018-01793
Proposal No.
2018-01793
Multistate No.
(N/A)
Program Code
LN.C
Project Start Date
Sep 1, 2018
Project End Date
Aug 31, 2022
Grant Year
2018
Project Director
Kerr, D.
Recipient Organization
SANSUM DIABETES RESEARCH INSTITUTE
2219 BATH ST
SANTA BARBARA,CA 93105
Performing Department
Research and Innovation
Non Technical Summary
Farming for Life is a comprehensive program that will alter the current food production and access trajectory by bringing together healthcare, agriculture, and social services organizations to systematically address issues of food insecurity, health, and local food production. This program will build a bridge between healthcare, social services, and agriculture to mitigate the heavy burdens of chronic disease and food insecurity while simultaneously enhancing the capacity of local farmers to continue supplying the community with fresh produce. Participants will be referred to Farming for Life by their primary care physicians, where they will collect weekly supplies of vegetables free of charge. The vegetables will be sourced directly from local farms and will be distributed through existing distribution infrastructure at local social services organizations. Program evaluations will occur every six months to ensure that the food needs of participants are being met and disease risks are being reduced. Furthermore, a portion of the agricultural production for the program will be completed by a New Farmers Training Program that seeks to enhance local agriculture for generations to come. This program meets the stated goals of the CFP by uniting several sectors of the food system--farms, food access organizations, and healthcare facilities--to strengthen the capacity and health of the community. Farming for Life represents a long-term sustainable solution to the issues of food insecurity and chronic disease burden by engaging local farmers to play a primary role in improving the quality of life of those in the community they serve. The ultimate goal of Farming for Life is to encourage health insurance providers to adopt vegetable prescriptions as a medical treatment for those withtype 2 diabetes.
Animal Health Component
0%
Research Effort Categories
Basic
(N/A)
Applied
70%
Developmental
30%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70460992090100%
Goals / Objectives
Farming for Life will integrate sectors of the County that until now have operated in isolation--growers, food distributors, healthcare professionals and the low-income community:GOAL 1: Reduction in the concurrent medical and financial burden of diabetes and food insecurity Vegetable prescriptions have already proven to positively impact health. Providing fresh vegetables free of charge for participants and their families will reduce local food insecurity by increasing access to produce at no financial impact to Santa Barbara County's low-income residents.GOAL 1 Objectives:A reduction in the burden of type 2 diabetes (T2D) among participants. It has been previously shown that increased vegetable consumption reduces Hemoglobin A1c among patients with T2D. As such, a reduction in Hemoglobin A1c for all participants in Farming for Life is the primary intended health outcome. Changes in Hemoglobin A1c can only be measured at intervals of at least twelve weeks, therefore measurements will be taken and recorded every three months throughout program implementation.We intend to observe a reduction in food insecurity as indicated by survey responses. Relative food insecurity will be calculated throughout programming through the use of the USDAFood Security Module.An improvement in overall diabetes management will occur among participants as indicated by changes in responses to Diabetes Self-Management Surveys to be administered throughout programming. This includes reductions in blood pressure, Body-Mass Index (BMI) and waist circumference among program participants.A reduction in medical costs among participants: Diabetes places an enormous financial burden on its sufferers that additionally magnifies the effects of food insecurity. Increased healthcare costs due to diabetes render it more difficult for low-income families to purchase healthy food, leading to inadequate diet and further exacerbation of the disease. Prescribing vegetables to individuals with diabetes impedes this costly and deadly cycle.GOAL 2: Increase the reach and influence of local agricultural producers by sourcing exclusively from farms within Santa Barbara County Farming for Life was envisioned and developed to augment the vegetable prescription concept-- magnifying its impact by creating a multi sector collaborative program that also responds to Santa Barbara County's lack of locally sourced produce and the need for new permanent outlets for locally farmed goods. Phase 1 will source produce only from farms within ten miles of the distribution site. For subsequent phases and program expansion, food will be sourced from additional farms within the city and county, and numerous distribution sites will be utilized to maintain ease of access for program participants.GOAL 2 Objective:By utilizing only locally grown foods, Santa Barbara County farms will be permanently integrated into the community life and healthcare landscape of this County. As discussed earlier, SBC is and has been a prolific agricultural region for centuries, but the community nonetheless remains disconnected from local agriculture, and farmers are forced to outsource their produce. Farming for Life addresses the need and demand for local bounty.County partnerships will minimize "food mileage" of all prescribed produce.Sourcing exclusively from local farmers will change the County's current food-system's supply and demand, assisting local farmers financially, and incentivizing young farmers to enter the field of agriculture.This goal will be determined by analyzing the financial impact of purchasing wholesale vegetables from local farmers.GOAL 3: Training for New Farmers Farming for Life creates a path of farm sustainability that will incentivize young farmers to move into the agricultural industry. According to the United States Department of Agriculture, the average age for a farmer is now 58 and has been on the rise for 30 years. There are currently six times more farmers age 65 and older than there are farmers age 34 and under, according to one study. There are fewer than 6,400 farmers ages 25 to 34 in California. Farming for Life will incorporate a new farmer training component, hosted at program partner Fairview Gardens. Fairview Gardens has committed to designating a portion of its land exclusively to Farming for Life. This plot will be tended by farmers-in-training as part of the New Farmer Training Academy with the goal of providing young farmers with the education and skills necessary to prepare them for a productive and lucrative career in local agriculture with the added emphasis on producingfoods for the express purpose of improving community health. The New Farmer Training Academy will be monitored for outcome success through several skill-building metrics being developed by Fairview Gardens to assess overall competency of farmers-in-training who complete the program.GOAL 3 Objectives:The next generation of farmers will be trained with an emphasis on mitigating food insecurity and local disease. Through training as part of Farming for Life, new farmers will develop relationships and continue to collaborate with partner organizations for the benefit of community members and for the sustainability of their farms.This goal will be determined through the various assessments and "graduation" requirements set forth by Fairview Gardens for their New Farmer Training Academy.GOAL 4: A pathway will be created and secured for stricter guidelines, a health protocol and programmatic insurance coverage By incorporating research activities and an institutionally reviewed protocol into Farming for Life, outcome data will be generated and distributed by an organization with a track record of providing groundbreaking data poised to influence government and private insurance providers.GOAL 4 Objectives:Insurance coverage of program components is key to Farming for Life's sustainability and the replication of the program regionally and nationally.This goal will be realized year by year by initiating and continuing discussions with local insurance providers as well as continuously providing them with data updates.
Project Methods
EffortsWork with local medical providers to provide medical prescriptions for organic vegetablesMeasure Hemoglobin A1c, other health metrics, food security surveys, other assorted surveys as governed by the program protocolPurchase all vegetables wholesale from local farmers or accept vegetable donations if so desired by the farmers in order to increase the capacity and outreach of all local farmers in Santa Barbara CountyMaintain all collected data from the aforementioned efforts in a singular research database to be used in publications or disseminated upon request.Initiate discussions with local health insurance providers in order to influence coverage adoption of vegetable prescriptions for all patients for whom this would be an acceptable medical interventionCatalog all vegetable collection for every visit for each individualCollect photographs of meals prepared by participantsEvaluationAnalyze changes in all aforementioned health metrics to assess overall program successUSDA Food Security Module--designed to measure and numerically define food insecurity for all patientsNHANES Consumer Behavior Survey--measures financial impact of grocery shopping and other food shopping for all participantsAcculturation Survey--determines country of origin of individuals' parents as well as the individuals' places of birth (in order to analyze whether recency of immigration plays a role in food insecurity and/or risk of diabetes.Internally-Developed Food Behavior and Health Survey--measures relative subjective importance of various eating and health habits for each participantAnalyze metrics for all graduating candidates of the New Farmer Training Academy (developed by Fairview Gardens)Analyze vegetable collection visits from the program inventory system in order to determine patterns of consumption and or purchasing inadequacies.Maintain database of meal photos from participants

Progress 09/01/19 to 08/31/20

Outputs
Target Audience:Thirty-one percent of Santa Barbara County's (SBC) 423,895 residents are food insecure. Paradoxically, local food insecurity is not commensurate with local food abundance. Approximately 40% of the County is comprised of agricultural lands, with nearly 1,600 farms and ranches; encompassing 700,000 acres of row crops, orchards, vineyards, and rangeland. Last year $515 million in vegetable products were grown in the County. Despite the prolific local growing sector, 99% of what is grown in the County is exported, and 98% of what locals eat is imported. These statistics are alarming considering that 48% of SBC's low-income households are food insecure. It is well known that achieving a healthy diet is much more difficult for these families. People who are food-insecure often engage in strategies to extend the value of their much-needed dollar, often opting for low-cost, high-calorie foods that lead not only to nutritional deprivation, but also to obesity. Currently more than half of all SBC residents are overweight or obese. Obesity is the primary cause of type 2 diabetes (T2D). Nationally, diabetes has risen to the 3rd leading cause of premature death, now killing more people each year than AIDS and breast cancer combined. In Santa Barbara County, the incidence of diabetes has increased by 41% over the past decade--exceeding incidence levels in the state. An estimated 47% of local adults have pre-diabetes. Nearly 18% of the County's Latino population has full-blown diabetes, versus approximately 10% of local non-Latino Whites (Latinos represent 45% of the County population). This deadly epidemic is so widespread in SBC that it is now appearing in teenagers and children in the county. Data from the National Health and Nutrition Examination Survey (NHANES) demonstrates that 28% of people with diabetes are food insecure, above the national rate of food insecurity (18%). Food insecurity is more common among Latino Americans (25%) than non-Latino Whites (8%). Food-insecure adults are two to three times more likely to have diabetes than adults who are food-secure, even after controlling for important risk factors such as income, employment status, physical measures, and lifestyle factors. Furthermore, food-insecure pregnant women have a heightened risk for gestational diabetes - a major cause of birth defects and other post-partum medical concerns in babies born in the US. It thus becomes apparent that there is a vicious cycle present among low-income residents of Santa Barbara County. Low income families are often food insecure, which leads to diet-related chronic illness, which can further exacerbate food insecurity because of heightened healthcare costs. This is the target audience reached by SDRI during this reporting period. Changes/Problems:As communicated to the program points of contact in May 2020, COVID-19 has required increased SDRI staff time to safely implement the program. SDRI has been able offset the increase in direct salaries and wages with reductions in materials and supplies as well as subcontractors. Specifically, SDRI ironed out the logistics for efficient, effective, and safe provision of goods and services to program participants based on locating the program onsite at SDRI via sequential, non-overlapping scheduling to ensure social distancing. This has enabled SDRI to cover many activities previously fulfilled by the two sub-awardees, whose capacity has continuously fluctuated and evolved as a result of COVID-19 and other factors unrelated to and unanticipated by SDRI. What opportunities for training and professional development has the project provided?Farming for Life sources vegetables from farms that directly engage young farmers to grow and process the produce provided to participants. These young farmers are partially responsible for the cultivating, picking and distributing of vegetables. Farm collaborators have learned from SDRI about the health benefits of fresh vegetables for type 2 diabetes, including which vegetables are and are not beneficial to the health of this population. The farmers have also gained insight into consumer preferences for vegetables. At the same time, SDRI staff continue to learn about seasonality and agriculture, less known vegetables and fruits, and optimal produce transport and storage. Study staff have also learned to apply continuous glucose monitors, take fingerstick HbA1c tests, and properly assess height, weight, waist circumference, blood pressure, sleep, mood, pain, tortilla and soda consumption, vegetable consumption, and food insecurity. Finally, participants and the general public have been able to read about the connection between vegetables and vegetable-based diets and health outcomes, with a focus on diabetes, in SDRI's bilingual web resource that presents free, easily-accessible, evidence-based clinical research relevant to Latinos regarding diabetes at https://latinodiabetes.sansum.org/. How have the results been disseminated to communities of interest?Results have been published for the scientific, clinical, and industry sectors: KerrD, BaruaS, GlantzN, etal. Farming for life: impact of medical prescriptions for fresh vegetables on cardiometabolic health for adults with or at risk of type 2 diabetes in a predominantly Mexican-American population. BMJ Nutrition, Prevention & Health 2020;0. http://dx.doi.org/10.1136/bmjnph-2020-000133 Results have been presented for the scientific, clinical, and industry sectors: Kujan M, Glantz N, Conneely C, Chen V, Kerr D. Medical Prescriptions of Fresh Vegetables Improve Clinical and Psychosocial Outcomes for Adults with or at Risk of Type 2 Diabetes (T2D) American Diabetes Association, Chicago, IL, June 2020. Diabetes. 2020; 69 (Supplement 1): 708-P. https://plan.core-apps.com/tristar_ada20/abstract/7d4d4092-0328-49a7-8490-e46f4aeb5efb Results have been posted at https://latinodiabetes.sansum.org/, SDRI's bilingual web resource that presents free, easily-accessible, evidence-based clinical research relevant to Latinos regarding diabetes (as well as COVID-19: https://latinodiabetes.sansum.org/covid-19-latino-diabetes/). What do you plan to do during the next reporting period to accomplish the goals?Within the next reporting period we hope to: Achieve enrollment of up to 300 individuals in the Farming for Life program to further reduce the concurrent medical and financial burden of diabetes and food insecurity in Santa Barbara County. Once COVID restrictions are lifted, we plan to (re)open additional distribution sites to increase the geographic reach of Farming for Life and better meet program participants where they are at. Scale the Food as Medicine concept, including "precision foods" by adding an educational component to Farming for Life delivered by trained, trusted, bilingual community members, as well as continuing to grow collaborations with local farmers, clinicians, and insurance companies. Preliminary research data generated by Farming for Life has indicated the value vegetable prescription programs may have for health payers and government entities. Through increasing the number of individuals enrolled in Farming for Life during the next reporting period, we will continue to expand this database.

Impacts
What was accomplished under these goals? GOAL 1: Reduction in the concurrent medical and financial burden of diabetes and food insecurity Approximately 202 individuals are enrolled in Farming for Life, with enrollment continuing daily. Every participant receives 21 servings of fresh, locally-sourced vegetables on a weekly basis at a no cost to them. With the advent of COVID-19, vegetables are distributed at SDRI, where rigorous safety precautions are taken. We have partnered with Santa Barbara City College and, when COVID restrictions are lifted, will distribute vegetables from SBCC campus with the goal of promoting consumption of fresh, local produce and reduce food insecurity among college students. To measure program impact on participant health, we compared participant health metrics before and after receiving vegetables for 3 months. For 159 participants (122 female, 75% of Mexican heritage, 31% with non-insulin treated type 2 diabetes and the rest at risk of type 2 diabetes, average age 52.5 years), food insecurity was significantly reduced: the proportion with either low or very low food security was 35% at enrollment, which dropped significantly to 13% after 3 months. Frequency of vegetable consumption increased significantly, with just 15% consuming vegetables at least once daily prior to initiation of produce prescriptions, and 50% doing so after receiving produce prescriptions for 3 months. Additionally, participants reduced their daily consumption of tortillas from an average of 3 to 1.5, and their soda consumption from an average of 3 to 2 per month. It is notable that in Farming for Life participants, self-reported wastage of vegetables was below the estimated average for food waste in the United States. In terms of the medical burden of diabetes, we found clinically significant improvement in weight; waist circumference; blood pressure; Hemoglobin A1c (HbA1c, a measure of long-term blood glucose control); self-reported sleep, mood and pain. We also found that, for the 40 participants who wore continuous glucose monitors at enrollment and again 3 months later, time in range (70-180) mg/dl improved. All of these metrics point to reductions in the burden of diabetes and food insecurity in Farming for Life participants. (For additional details, see Kerr D, Barua S, Glantz N, et al. Farming for life: impact of medical prescriptions for fresh vegetables on cardiometabolic health for adults with or at risk of type 2 diabetes in a predominantly Mexican-American population. BMJ Nutrition, Prevention & Health 2020;0. http://dx.doi.org/10.1136/bmjnph-2020-000133) GOAL 2: Increase the reach and influence of local agricultural producers by sourcing exclusively from farms within Santa Barbara County All vegetables used in Farming for Life are sourced from farms within Santa Barbara County and are distributed from locations that previously did not offer weekly allotments of local vegetables. To increase the yield and variety of vegetables offered through the program, and to support new permanent outlets for locally farmed goods, we expanded our partner farms to include farms close to the county's urban center as well as farms in both the northern and southern regions of the county. We have steadily increased our orders to these local farms to cover the growing number of Farming for Life participants. Prior to the onset of the COVID-19 pandemic, we set up a vegetable distribution site at Santa Barbara City College (SBCC), a Hispanic-Serving Institution with an underserved student body in need of nutritional support. While SBCC campus has been temporarily shuttered due to COVID-19, SBCC participants have been able to pick up their vegetables at SDRI. Once the SBCC campus re-opens, we will reinstate our SBCC distribution center. Groundwork was also laid to distribute at the source - farms close to residential areas - to further reduce the distance and cost between farm and table. GOAL 3: Training for New Farmers Sub-contractor funds allocated to Fairview Garden has enabled the farm to continue educating young farmers on agricultural production. Fairview Gardens, under new leadership and with a new strategic plan, has prioritized training and education for school-aged children via a socially distanced, outdoor, nature-based experience that complements and extends beyond classroom-based learning. Their goal is to connect children and youth to the farm and environment through hands-on lessons and work projects in the garden. This next generation of farmers gains an appreciation of the natural world and local food systems, and how farmers can contribute to and benefit from both. GOAL 4: A pathway will be created and secured for stricter guidelines, a health protocol and programmatic insurance coverage Since inception, Farming for Life has generated health and food security data for over 200 participants. Even as we continue to capture data from the ever-growing number of participants, we analyze data on an ongoing basis and disseminate Farming for Life outcome results to influence government and private insurance providers as well as clinicians. In this reporting period, we established contact with a large insurance provider covering agricultural workers in this county and beyond, and are in early discussions with them to incorporate medical prescriptions for produce into paid prevention routines. Further, in this reporting period, we published evidence for the association between medical prescriptions for produce and health benefits in a peer-reviewed journal, and presented these at professional meetings. These professional forums a well-monitored/attended by practitioners who can incorporate "food as medicine" into their treatment therapies.?

Publications

  • Type: Journal Articles Status: Published Year Published: 2020 Citation: Kerr D, Barua S, Glantz N, et al. Farming for life: impact of medical prescriptions for fresh vegetables on cardiometabolic health for adults with or at risk of type 2 diabetes in a predominantly Mexican-American population. BMJ Nutrition, Prevention & Health 2020;0. http://dx.doi.org/10.1136/bmjnph-2020-000133
  • Type: Journal Articles Status: Published Year Published: 2020 Citation: Kujan M, Glantz N, Conneely C, Chen V, Kerr D. Medical Prescriptions of Fresh Vegetables Improve Clinical and Psychosocial Outcomes for Adults with or at Risk of Type 2 Diabetes (T2D) American Diabetes Association, Chicago, IL, June 2020. Diabetes. 2020; 69 (Supplement 1): 708-P. https://plan.core-apps.com/tristar_ada20/abstract/7d4d4092-0328-49a7-8490-e46f4aeb5efb


Progress 09/01/18 to 08/31/19

Outputs
Target Audience: Thirty-one percent of Santa Barbara County's (SBC) 423,895 residents are food insecure. Paradoxically, local food insecurity is not commensurate with local food abundance. Approximately 40% of the County is comprised of agricultural lands, with nearly 1,600 farms and ranches; encompassing 700,000 acres of row crops, orchards, vineyards, and rangeland. Last year $515 million in vegetable products were grown in the County. Despite the prolific local growing sector, 99% of what is grown in the County is exported, and 98% of what locals eat is imported. These statistics are alarming considering that 48% of SBC's low-income households are food insecure. It is well known that achieving a healthy diet is much more difficult for these families. People who are food-insecure often engage in strategies to extend the value of their much-needed dollar, often opting for low-cost, high-calorie foods that lead not only to nutritional deprivation, but also to obesity. Currently more than half of all SBC residents are overweight or obese. Obesity is the primary cause of type 2 diabetes (T2D). Nationally, diabetes has risen to the 3rd leading cause of premature death, now killing more people each year than AIDS and breast cancer combined. In Santa Barbara County, the incidence of diabetes has increased by 41% over the past decade--exceeding incidence levels in the State. An estimated 47% of local adults have pre- diabetes. Nearly 18% of the County's Latino population has full-blown diabetes, versus approximately 10% of local non-Latino Caucasians (Latinos represent 45.1% of the SBC population). This deadly epidemic is so widespread in SBC that it is now appearing in teenagers and children in the county. Data from the National Health and Nutrition Examination Survey (NHANES) demonstrates that 28% of people with diabetes are food insecure, above the national rate of food insecurity (18%). Food insecurity is more common among Latino Americans (25%) than non-Latino Caucasians (8%). Food-insecure adults are two to three times more likely to have diabetes than adults who are food-secure, even after controlling for important risk factors such as income, employment status, physical measures, and lifestyle factors. Furthermore, food-insecure pregnant women have a heightened risk for gestational diabetes - a major cause of birth defects and other post-partum medical concerns in babies born in the US. It thus becomes apparent that there is a vicious cycle present among low-incomeresidents of Santa Barbara County. Low-income families are often food insecure, which leads to diet-related chronic illness, which can further exacerbate food insecurity because of heightened healthcare costs. This is the target audience reached by SDRI during this reporting period. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Farming for Life engagesyoung farmersto produce the vegetables provided to participants. These young farmers are partially responsible for the growing, picking and distributing of vegetables. New Farmer Training and program engagement will increase as Farming for Life participant numbers increase. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Within the next reporting period we hope to: 1) Enroll up to 200 individuals in the Farming for Life program to further reduce the concurrent medical and financial burden of diabetes and food insecurity in Santa Barbara County. We plan to establishadditional distribution sites to increase the geographic scope of Farming for Life. 2) Establish relationships with additional local farms to increase the yeild and variety of vegetables offered through the program. Including an additional farm will also support our goal to increasenew permanent outlets for locally farmed goods. 3) The research data generated by Farming for Life will help show potentialvalue vegetable prescription programs may have for health payers and government entitys. Through increasing the number of individuals enrolled in Farming for Life during the next reporting period, we will be growing this databased.

Impacts
What was accomplished under these goals? GOAL 1: Reduction in the concurrent medical and financial burden of diabetes and food insecurity Approximately 75 individuals are enrolled in Farming for Life. Every participant recieves a large allotment of organic, locally sourced vegetables on a weekly basis at a no cost to them. We have recently partnered with Santa Barbara City College and willbegin distributing vegetables from SBCC campus this Augustwith the goal to promote consumption of local, organic vegetablesand reduce food insecurity among local college students. GOAL 2: Increase the reach and influence of local agricultural producers by sourcing exclusively from farms within Santa Barbara County All vegetables used in Farming for Life are sourced from farms within Santa Barbara County and are distributed from locations that previously did not offer weekly allotments of local, organic vegetables. GOAL 3: Training for New Farmers Sub-contractor funds allocated to Fairview Garden hasenabled the farm to continue educating young farmers on agricultural production. GOAL 4: A pathway will be created and secured for stricter guidelines, a health protocol and programmatic insurance coverage Farming for Life has generated health data for approximately 80 participants during this reporting period. As stated in our initial goals, we believe that as more data is collected, properly disseminated Farming for Life outcome resultsmay bepoised to influence government and private insurance providers.

Publications