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4.1 Applying the Power 9® Principles in Clinical Care
4.2 Belong in Clinical Care
- Faries MD, Corrêa Fernandes C, Phillips E, West T, Stout R. Religion and spirituality in lifestyle medicine. Am J Lifestyle Med. 2024 Aug 29:15598276241276770. https://doi.org/10.1177/15598276241276770
- Koenig HG, VanderWeele T, Peteet JR. Handbook of religion and health. Oxford University Press; 2023. https://doi.org/10.1093/oso/9780190088859.001.0001
- Lucchetti G, Peres F, Damiano R. Spirituality, religiousness and health. Religion, spirituality and health: a social scientific approach from research to clinical practice. Springer; 2019. https://doi.org/10.1007/978-3-030-21221-6
- Williams DR, Sternthal MJ. Spirituality, religion and health: evidence and research directions. Med J Aust. 2007;186(S10):S47-S50. https://doi.org/10.5694/j.1326-5377.2007.tb01040.x
- VanderWeele TJ. Chapter 22: Religion and health: a synthesis. In: Spirituality and religion within the culture of medicine: from evidence to practice. Oxford University Press; 2017:357-401.
- Lucchetti G, Lucchetti ALG, Koenig HG. Impact of spirituality/religiosity on mortality: comparison with other health interventions. EXPLORE. 2011;7(4):234-238. https://doi.org/10.1016/j.explore.2011.04.005
- Li S, Stampfer MJ, Williams DR, VanderWeele TJ. Association of religious service attendance with mortality among women. JAMA Intern Med. 2016;176(6):777-785. https://doi.org/10.1001/jamainternmed.2016.1615
- Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. Evidence-based practice: step by step: the seven steps of evidence-based practice. Am J Nurs. 2010;110(1):51-53. https://doi.org/10.1097/01.naj.0000366056.06605.d2
- Dominguez LJ, Veronese N, Barbagallo M. The link between spirituality and longevity. Aging Clin Exp Res. 2024 Feb 11;36(1):32. https://doi.org/10.1007/s40520-023-02684-5
- Beuttner D. Blue Zones Power 9. “Belong”. Blue Zones. https://www.bluezones.com/2016/11/power-9/. Accessed August 4, 2025.
- Best M, Butow P, Olver I. Do patients want doctors to talk about spirituality? A systematic literature review. Patient Educ Couns. 2015 Nov;98(11):1320-8. https://doi.org/10.1016/j.pec.2015.04.017
- Fisher C. Exploring the role of spirituality and religion in patient-centered care: a qualitative study. J Relig Health. 2019;58(6):2038-2050. https://doi.org/10.4103/apjon.apjon_48_18
- Puchalski C, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3(1):129-137. https://doi.org/10.1089/jpm.2000.3.129
- Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001 Jan 1;63(1):81-9. https://pubmed.ncbi.nlm.nih.gov/11195773/
- Vermandere M, De Lepeleire J, Smeets L, Hannes K, Van Mechelen W, Warmenhoven F, van Rijswijk E, Aertgeerts B. Spirituality in general practice: a qualitative evidence synthesis. Br J Gen Pract. 2011 Nov;61(592):e749-60. https://doi.org/10.3399/bjgp11X606663
- Jones JM. U.S.church membership falls below majority for first time. Gallup Politics. https://news.gallup.com/poll/341963/church-membership-falls-below-majority-first-time.aspx. Published March 29, 2021. Accessed August 4, 2025.
- Association of Clinical Pastoral Education. ACPE. https://acpe.edu. Accessed August 4, 2025.
- Loma Linda University Health. Soul Spirituality History Tool. https://connect.lifestylemedicine.org/viewdocument/soul-spiritual-history-tool?CommunityKey=6b906252-0eec-425d-a19a-019845925cc3&tab=librarydocuments. Published 2015. Accessed October 16, 2025.
- Buettner D, Skemp S. Blue Zones: Lessons from the world's longest lived. Am J Lifestyle Med. 2016 Jul 7;10(5):318-321. https://doi.org/10.1177/1559827616637066
- Shanshan L, Stampfer MJ, Williams DR, VanderWeele TJ. Religious service attendance and mortality among women. JAMA Intern Med. 2016 Jun 1;176(6):777. https://doi.org/10.1001/jamainternmed.2016.1615
- Marshall J. Are religious people happier, healthier? Pew Research Center. https://www.pewresearch.org/short-reads/2019/01/31/are-religious-people-happier-healthier-our-new-global-study-explores-this-question/. January 31, 2019. Accessed August 4, 2025.
- Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin Proc. 2001;76(12):1225-1235. https://doi.org/10.4065/76.12.1225
- Fastame MC, Ruiu M, Mulas I. Mental health and religiosity in the Sardinian Blue Zone: Life satisfaction and optimism for aging well. J Relig Health. 2021;60(4):2450-2462. https://doi.org/10.1007/s10943-021-01261-2
- De Felicis J. The halo effect of sacred spaces. https://www.bluezones.com/2022/07/the-halo-effect-of-sacred-spaces/. Accessed August 4, 2025.
- Blue Zones. Religion May Reduce Stress and Increase Longevity. https://www.bluezones.com/2017/07/religion-may-reduce-stress-increase-longevity/. Accessed August 4, 2025.
- Simão T, Caldeira S, De Carvalho E. The effect of prayer on patients’ health: systematic literature review. Religions. 2016;7(1):11. https://doi.org/10.3390/rel7010011
- Koncz A, Demetrovics Z, Takacs ZK. Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis. Health Psychol Rev. 2021;15(1):56-84. https://doi.org/10.1080/17437199.2020.1760727
- Goodwin E, Kraft K. Mental health and spiritual well-being in humanitarian crises: the role of faith communities providing spiritual and psychosocial support during the COVID-19 pandemic. J Int Humanit Action. 2022;7(1):21. https://doi.org/10.1186/s41018-022-00127-w
- Vitorino LM, Lucchetti G, Leão FC, Vallada H, Peres MFP. The association between spirituality and religiousness and mental health. Sci Rep. 2018;8(1):17233. https://doi.org/10.1038/s41598-018-35380-w
- Dalal S, Singh S. Gratitude in action: effect of gratitude on mental health. J Health Man. 2025;27(1):100-107. https://doi.org/10.1177/09720634241304985
- Brewer LC, Bowie J, Slusser JP, et al. Religiosity/spirituality and cardiovascular health: the American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study. J Am Heart Assoc. 2022;11(17):e024974. https://doi.org/10.1161/JAHA.121.024974
- Fong CJ, Adelugba SF, Garza M, et al. A scoping review of the associations between sense of belonging and academic outcomes in postsecondary education. Educ Psychol Rev. 2024;36(4):138. https://doi.org/10.1007/s10648-024-09974-y
- Chung SJ, Ersig AL, McCarthy AM. The influence of peers on diet and exercise among adolescents: a systematic review. J Pediatr Nurs. 2017;36:44-56. https://doi.org/10.1016/j.pedn.2017.04.010
4.3 Wine at 5 in Clinical Care
- American Heart Association. Is drinking alcohol part of a healthy lifestyle? https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/alcohol-and-heart-health. Published May 7, 2024. Accessed September 17, 2025.
- Centers for Disease Control and Prevention. About moderate alcohol use. https://www.cdc.gov/alcohol/about-alcohol-use/moderate-alcohol-use.html. Updated January 14, 2025. Accessed September 17, 2025.
- American Cancer Society. Alcohol use and cancer. https://www.cancer.org/cancer/risk-prevention/diet-physical-activity/alcohol-use-and-cancer.html. Accessed September 17, 2025.
- World Health Organization. No level of alcohol consumption is safe for our health. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health. Published January 4, 2023. Accessed September 17, 2025.
- National Institute on Alcohol Abuse and Alcoholism. Understanding alcohol drinking patterns. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-drinking-patterns. Accessed September 17, 2025.
- U.S. Department of Agriculture; U.S. Department of Health and Human Services. Guidance on alcoholic beverages in the Dietary Guidelines for Americans. DietaryGuidelines.gov. https://www.dietaryguidelines.gov/alcohol/info. Accessed September 17, 2025.
- Ma H, Li X, Zhou T, et al. Alcohol consumption levels as compared with drinking habits in predicting all-cause mortality and cause-specific mortality in current drinkers. Mayo Clin Proc. 2021;96(7):1758-1769. https://doi.org/10.1016/j.mayocp.2021.02.011
- Barbería-Latasa M, Bes-Rastrollo M, Pérez-Araluce R, Martínez-González MÁ, Gea A. Mediterranean alcohol-drinking patterns and all-cause mortality in women more than 55 years old and men more than 50 years old in the "Seguimiento Universidad de Navarra" (SUN) Cohort. Nutrients. 2022;14(24):5310. https://doi.org/10.3390/nu14245310
- Ortolá R, García-Esquinas E, León-Muñoz LM, et al. Patterns of alcohol consumption and risk of frailty in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2016;71(2):251-258. https://doi.org/10.1093/gerona/glv125
- US Department of Health and Human Services. Alcohol and cancer risk: The U.S. surgeon general’s advisory. 2025. https://www.hhs.gov/surgeongeneral/reports-and-publications/alcohol-cancer/index.html. Accessed July 14, 2025.
- Zhao J, Stockwell T, Naimi T, Churchill S, Clay J, Sherk A. Association between daily alcohol intake and risk of all-cause mortality: a systematic review and meta-analyses. JAMA Netw Open. 2023 Mar 1;6(3):e236185. https://doi.org/10.1001/jamanetworkopen.2023.6185. Erratum in: JAMA Netw Open. 2023 May 1;6(5):e2315283. https://doi.org/10.1001/jamanetworkopen.2023.15283.
- National Academies of Sciences, Engineering, and Medicine. Review of Evidence on Alcohol and Health. The National Academies Press; 2020. https://nap.nationalacademies.org/catalog/28582/review-of-evidence-on-alcohol-and-health. Accessed October 16, 2025.
- Anderson BO, Berdzuli N, Ilbawi A, Kestel D, Kluge HP, Krech R, Mikkelsen B, Neufeld M, Poznyak V, Rekve D, Slama S, Tello J, Ferreira-Borges C. Health and cancer risks associated with low levels of alcohol consumption. Lancet Public Health. 2023 Jan;8(1):e6-e7. https://doi.org/10.1016/S2468-2667(22)00317-6
- Ortolá R, Sotos-Prieto M, García-Esquinas E, Galán I, Rodríguez-Artalejo F. Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors. JAMA Netw Open. 2024;7(8):e2424495. https://doi.org/10.1001/jamanetworkopen.2024.24495
- Gea A, Bes-Rastrollo M, Toledo E, Garcia-Lopez M, Beunza JJ, Estruch R, Martinez-Gonzalez MA. Mediterranean alcohol-drinking pattern and mortality in the SUN (Seguimiento Universidad de Navarra) Project: a prospective cohort study. Br J Nutr. 2014 May 28;111(10):1871-80. https://doi.org/10.1017/S0007114513004376
- Martínez-González MA. Should we remove wine from the Mediterranean diet?: a narrative review. Am J Clin Nutr. 2024 Feb;119(2):262-270. https://doi.org/10.1016/j.ajcnut.2023.12.020.
- Gea A, Bes-Rastrollo M, Toledo E, et al. Mediterranean alcohol-drinking pattern and mortality in the SUN (Seguimiento Universidad de Navarra) Project: a prospective cohort study. Br J Nutr. 2014;111(10):1871-1880. https://doi.org/10.1017/S0007114513004376
- Morales G, Martínez-González MA, Barbería-Latasa M, Bes-Rastrollo M, Gea A. Mediterranean diet, alcohol-drinking pattern and their combined effect on all-cause mortality: the Seguimiento Universidad de Navarra (SUN) cohort. Eur J Nutr. 2021;60(3):1489-1498. https://doi.org/10.1007/s00394-020-02342-w
- Ma H, Li X, Zhou T, et al. Alcohol consumption levels as compared with drinking habits in predicting all-cause mortality and cause-specific mortality in current drinkers. Mayo Clin Proc. 2021;96(7):1758-1769. https://doi.org/10.1016/j.mayocp.2021.02.011
- Campanella A, Bonfiglio C, Cuccaro F, Donghia R, Tatoli R, Giannelli G. High adherence to a Mediterranean alcohol-drinking pattern and Mediterranean diet can mitigate the harmful effect of alcohol on mortality risk. Nutrients. 2023;16(1):59. https://doi.org/10.3390/nu16010059
- Minzer S, Estruch R, Casas R. Wine intake in the framework of a Mediterranean diet and chronic non-communicable diseases: a short literature review of the last 5 years. Molecules. 2020;25(21):5045. https://doi.org/10.3390/molecules25215045
4.4 Examples in Clinical Care
Loma Linda Case Example
- Loma Linda University Health. Wholeness resources. https://lluh.org/wholeness-institute/wholeness-resources. Accessed August 5, 2025.
- Adventist Health Study. Adventist Health Study. https://adventisthealthstudy.org/. Accessed August 5, 2025.
- Rea B, Worthman S, Shetty P, Alexander M, Trilk JL. Medical education transformation: lifestyle medicine in undergraduate and graduate medical education, fellowship, and continuing medical education. Am J Lifestyle Med. 2021;15(5):514-525. https://doi.org/10.1177/15598276211006629
- Loma Linda University Health. Preventive Medicine Residency. https://lluh.org/health-professionals/gme/resident-fellow/preventive-medicine-residency. Accessed August 5, 2025.
- American College of Lifestyle Medicine. Lifestyle Medicine Residency Curriculum (LMRC) https://lifestylemedicine.org/residency-lmrc/. Accessed August 5, 2025.
- Loma Linda University Health. Residents learn how to fight cancer with food. https://www.youtube.com/watch?v=_ylgMKEOA4Q. September 7, 2022. Accessed August 5, 2024.
- Loma Linda University Health. Lifestyle Medicine Intensivist Fellowship. https://lluh.org/health-professionals/gme/resident-fellow/lifestyle-medicine-intensivist-fellowship/meet-us. Accessed September 30, 2025.
- Kelly JH, Lianov L, Shurney D, et al. Lifestyle medicine intensivist competencies: 2023 expert consensus update. Am J Lifestyle Med. 2023;18(1):141-149. https://doi.org/10.1177/15598276231192846
- School of Medicine of Loma Linda University. Alumni Journal. Summer 2024. https://scholarsrepository.llu.edu/cgi/viewcontent.cgi?article=1042&context=sm-alumni-journal. Accessed October 16, 2025.
- Trilk JL, Worthman S, Shetty P, et al. Undergraduate medical education: lifestyle medicine curriculum implementation standards. Am J Lifestyle Med. 2021;15(5):526-530. https://doi.org/10.1177/15598276211008142
- American College of Lifestyle Medicine. Comprehensive lifestyle medicine curricula for medical schools. https://lifestylemedicine.org/project/ume-curriculum-certification/. Accessed August 5, 2024.
- American College of Lifestyle Medicine. Introduce lifestyle medicine in your health profession school. https://lifestylemedicine.org/project/application-for-universities. Accessed August 5, 2024.
- Annam R, Florian R, Johnson S, Mondala M, Wilson A, Rea B. Expanding the lifestyle medicine inpatient consultation services at Loma Linda University Health: a transformative tool for chronic diseases management in tertiary care settings. Am J Lifestyle Med. 2023;17(5):686-689. https://doi.org/10.1177/15598276231172172
- Cramer T, Wilson A, Rea B. Lifestyle medicine inpatient consultation services at Loma Linda University Health: a novel approach in a tertiary care center. Am J Lifestyle Med. 2018;12(3):227-229. https://doi.org/10.1177/1559827618754860
- Cramer T, Rea B. The lifestyle medicine outpatient clinic at Loma Linda University Health. Am J Lifestyle Med. 2018;12(5):425-427. https://doi.org/10.1177/1559827618766487
- Grega ML, Shalz JT, Rosenfeld RM, et al. American College of Lifestyle Medicine Expert Consensus Statement: lifestyle medicine for optimal outcomes in primary care. Am J Lifestyle Med. 2023;18(2):269-293. https://doi/org/10.1177/15598276231202970
- Florian R, Johnson S, Phaeton B, Wilson A, Caswell S, Cramer S. Research to radicchio: process implementation of a therapeutic whole food plant-based (WFPB) inpatient menu within a large academic healthcare system. ijdrp. 2024;6(2):11. https://doi.org/10.22230/ijdrp.2024v6n2a449
- Loma Linda University Health. Living Whole Wellness Program. https://myllu.llu.edu/livingwhole/programs/. Accessed August 5, 2025.
- Loma Linda University Health. Institute for Community Partnerships (ICP). https://llu.edu/academics/centers-institutes/institute-for-community-partnerships-icp. Accessed August 5, 2025.
