Laura S. Redwine

Background: Transforming the health care system to a whole health model is a critical mission of the Osher Collaborative. This transformation will take a multifaceted approach, including changes to the education of the next generation of health care providers. One of these changes is the inclusion of culinary medicine in the curriculum. Objective: By exploring and comparing culinary medicine education programs for health professionals across five Osher Centers that share a philosophy of integrative health, this research sought to identify common themes and practical innovations that can inform the development and scalability of culinary medicine models for health professionals. Methods: This multi-method study used a structured 22-item survey to characterize culinary medicine curricula for health professional education at each surveyed Osher Center. The authors compiled the responses to explore commonalities and distinctions across sites using descriptive quantitative methods to summarize program structures and formats. A subset of authors then thematically grouped the open-ended responses using qualitative descriptive thematic analysis. Narrative program descriptions served as qualitative case exemplars to illuminate characteristics between sites. Results: Data show culinary medicine programs across the five Osher Centers target numerous academic audiences within health professions, indicating a need for curricula that expose health professionals throughout their educational journey. While program duration and modalities vary, all emphasize experiential learning, interprofessional teaching teams, and translation of nutrition knowledge into practical, patient-centered skills focused on whole-person health. Conclusion: The culinary medicine programs developed alongside the Osher Collaborative’s mission for whole health transformation offer a model that prioritizes measurable outcomes in nutrition and lifestyle education and are aligned with key elements identified in recent scoping reviews of culinary medicine education within medical schools. This strategy equips future health professionals with evidence-based skills to advance prevention and whole-person care while expanding effective, sustainable practices across clinical and community settings.

Objective: While obesity is a public health threat, many providers feel ill-prepared to advise patients on diet and nutrition for disease prevention. Miami, Florida, has a unique mix of ethnicities and cultures, and more than half of its residents are born outside the US, which creates additional barriers to providing adequate dietary advice. This study aimed to develop and refine a “food-as-medicine” and community service program in this culturally diverse region to improve future health care providers' knowledge, skills, and self-care practices. Methods: Feasibility was assessed using Bowen et al.'s framework, examining demand, acceptability, practicality, and implementation. Preliminary efficacy was determined by assessing student learning. A panel of four medical students provided consultation for developing this course. Twenty-four medical and six physical therapy (PT) students attended, and 21 completed both the pre- and post-surveys. The course consisted of four 2.5-hour classes, including lectures on diet/nutrition, social drivers of health, case studies, and chef-led cooking activities. Attendees subsequently provided diet/nutrition workshops to children in the community. Results: Most students (87%) attended at least three class sessions and the community service activity. Nutrition subscales, knowledge ( P = 0.018), health equity awareness ( P < 0.05), and dietary advice confidence ( P < 0.05) improved. PT and medical students did not differ in attitudes toward the importance of nutrition for disease prevention or the survey subscales. Conclusions: Strong participation, improved understanding, and confidence in dietary advice confirmed the feasibility and preliminary effectiveness of integrating a “food-as-medicine” program into medical and PT curricula, enhancing nutrition awareness and developing referral competencies for obesity-related chronic disease prevention.

Introduction: There is a growing demand for more thoughtful and holistic healthcare. Whole-person integrative medicine (IM) is cost-effective and clinically effective for enhancing health and well-being. However, existing knowledge gaps in IM among healthcare professionals prevent the application of IM practices in patient care. This project aimed to develop and refine an IM elective to improve health education and learning, thereby enhancing future physicians’ knowledge, skills, and self-care practices. Methods: Three separate cohorts of third- and fourth-year medical students ( n = 18) participated in a four-week immersive IM elective. Weekly and postelective evaluations were used to assess changes in attitudes, behaviors, and self-reported IM knowledge for each cohort. Descriptive analyses were performed, and just-in-time student feedback was used to iteratively refine the IM curriculum. Results: Students attended at least 85% of class days. Anonymous weekly course evaluation ratings for meeting course expectations, education depth, and usefulness for patient care ranged between 4 and 5 on a Likert scale, with 5 as the most favorable. Postcourse evaluations and the impact of the course on attitudes related to patient care, personal lifestyle, and self-awareness also ranged from 4 to 5. Knowledge scores significantly improved ( p < .01), with moderate to large effect sizes (Hedges g's > 0.8). Conclusions: The implementation of an immersive elective curriculum in IM resulted in high levels of satisfaction, changes in attitudes and behaviors, as well as knowledge scores. Just-in-time feedback and curricular revisions made this curriculum effective for student training. We consider this our first step in integrating IM into the required curriculum for all students, ensuring that, as educators, we close the knowledge gap in IM among future physicians. Empowered with that knowledge, we anticipate them serving their future patients with a more holistic and patient-centered approach.

The practice of mindful eating brings awareness to food choices, brings attention to the eating experience, and encourages selecting and preparing food that is both satisfying and nourishing. We examined mindful eating in breast cancer survivors following a 9-week, multidisciplinary virtual teaching kitchen intervention called Survivors Overcoming and Achieving Resiliency (SOAR). SOAR engaged participants through weekly cooking classes that also taught multiple domains of mindfulness. Participants (n = 102) were breast cancer survivors and completed the Mindful Eating Questionnaire (MEQ) prior to and after completion of the intervention. Linear regression analyses examined relationships between the aspects of mindful eating and body mass index (BMI). Wilcoxon (paired) rank sum tests evaluated the significance of the change in the MEQ total sum and subscales scores. A total of 102 participants completed both the pre- and post-intervention surveys. The mean change between the pre- and post-SOAR MEQ summary scores was 0.12 (sd = 0.30; Wilcoxon p-value = 0.0003). All MEQ subscale scores significantly increased with the exception of the distraction subscale. The MEQ summary scores increased for participants across both BMI stratifications. The SOAR teaching kitchen represents one of the first interventions that is tailored for breast cancer survivors and combines behavioral strategies from mindful eating training to nutritional knowledge and culinary medicine pedagogy in a virtual teaching kitchen. Further research is needed to examine whether mindful eating practices among cancer survivors result in sustainable healthy eating behaviors and food choices consistent with the cancer risk reduction guidelines.

Journal of Integrative and Complementary Medicine

The COVID-19 pandemic has disproportionately impacted multiple racial and ethnic minority groups, including Latinos residing in rural communities. Low rates of vaccination and testing combined with social determinants of health have contributed significantly to this disparate impact. Given the needs and constraints unique to rural Latino migrant and immigrant communities, this qualitative study examined multilevel barriers and strategies that affect COVID-19 vaccination and testing uptake among these communities in southwest Florida. Four focus groups (n = 25) were conducted between March and April 2021 with various key stakeholders, including rural Latino community members, local leaders, and community health workers (‘Promotoras de Salud’). Themes that aligned with barriers to COVID-19 vaccination and testing included fear, lack of control, misinformation, lack of accessibility, and institutional/policy issues; themes that aligned with strategies to improve COVID-19 vaccination and testing uptake included faith, taking care of self, and community and family resilience. Recommendations for improving future pandemic responses for rural Latino communities include incorporating multiple levels of intervention, such as consideration of the role of the family, involving trusted community members, and ensuring the development and implementation of fair and consistent policies.

Previous adolescent and young adult (AYA) research suggests patients undergoing hematopoietic stem cell transplantation (HSCT) experience severe physiological stress. The goal of this study was to identify unmet needs, interests, and preferences for mindfulness to inform the development of a mindfulness-based stress reduction intervention. Semi-structured interviews were conducted at three time points: prior to (n = 20), immediately after (n = 13), and three months post HSCT (n = 16) in the same AYA patients. Interviews assessed stress reduction strategies used, interest in mindfulness, and current quality of life. Three major thematic categories emerged from interview data across all time points: Concerns, Coping Strategies, and Mindfulness Activities. Prior to HSCT, two additional themes emerged including: Hope for the Future and Getting the Body Moving-Physical Activity. Most participants were not familiar with the term “mindfulness” prior to HSCT; but after being provided the definition of mindfulness, participants expressed interest in an online mindfulness-based intervention (e.g., ZOOM), stating: “I think it’s necessary” and “It would definitely be useful”. Participants suggested an intervention immediately following HSCT may decrease isolation concerns stating: “[in the hospital] You kind of feel like a hamster in a cage” and “you obviously have a lot of time to just be sitting by yourself in a hospital room”. The results suggest that a mindfulness-based online intervention is of interest to AYA HSCT patients and may be beneficial in decreasing physiological stress and improving quality of life.

Objective: This study aimed to investigate the role of systemic inflammation in reduced cognitive functioning in patients with early-stage heart failure (HF) while determining associations with other cardiovascular risk factors. Methods: Patients with stage B HF (n = 270; mean [standard deviation] age = 66.1 [10.1] years) were examined cross-sectionally for relationships among cardiovascular disease (CVD) and psychological risk factors, C-reactive protein (CRP), and Montreal Cognitive Assessment (MoCA) scores. A subsample (n = 83) at high risk for stage C HF (B-type natriuretic peptide levels ≥65 pg/ml) were followed up for 12 months for relationships between CRP levels and cognitive function. Results: Baseline smoking (χ ² = 6.33), unmarried (χ ² = 12.0), hypertension (χ ² = 5.72), greater body mass index (d = 0.45), and physical fatigue (d = 0.25) were related to higher CRP levels (p values < .05). Cross-sectionally, CRP levels were negatively related to MoCA scores, beyond CVD (ΔR ² = 0.022, β = −0.170, p < .010) and psychological risk factors (ΔR ² = 0.016, β = 0.145, p < .027), and related to mild cognitive impairment criteria (odds ratio = 1.35, 95% confidence interval [CI] = 1.00–1.81, p = .046). Across 12 months, B-type natriuretic peptide high-risk patients with CRP levels ≥3 mg/L had lower MoCA scores (23.6; 95% CI = 22.4–24.8) than did patients with CRP levels p = .024). Conclusions: Patients with stage B HF and heightened CRP levels had greater cognitive impairment at baseline and follow-up, independent of CVD and potentially psychological risk factors. Low-grade systemic inflammation may be one mechanism involved in cognitive dysfunction at early stages of HF.

Latino migrant farmworkers are at great risk of obesity and its concomitant negative health impacts. Obesity interventions for this underserved, minority population are limited. We expanded upon our prior intervention work in childhood obesity to develop a multi-family, behavioral intervention, ADAPT. We conducted three phases in the development of the ADAPT program: Phase 1, a needs assessment, Phase 2, in-depth focus groups with Latino parents, their children, and stakeholders, and Phase 3, a feasibility and acceptability trial to inform program optimization. Acceptability and feasibility of ADAPT promoting healthier eating and physical activity behaviors was found. Each phase of the project led to implementation changes to ADAPT, resulting in greater intervention optimization. Participants reported key facilitators and barriers to our intervention, expressing great interest in participation. They particularly liked our mindfulness session. We are currently examining the feasibility of integrating mindfulness to optimize ADAPT efficacy.