This is a secondary analysis of self-report data collected from participants who completed an undergraduate-level biology course with integrated mindfulness practice (Biology 3: Mindful Physiology). Assessment was conducted within 5 weeks after course completion (on average, 8 days post-course completion).

Students enrolled in Biology 3: Mindful Physiology were invited to participate in this study at the end of the course term (late May 2023) via e-mail. Participants were included if they were (a) enrolled in Biology 3: Mindful Physiology in the Spring 2023 academic term and (b) able to read, write, and speak in English. Of the 48 students enrolled in the class, 75% (N = 36) provided written consent to participate. They reviewed the study information sheet, informing them that participation would not influence their course grades and that the instructor would not know their enrollment status until course grades were finalized. Dartmouth College Committee for the Protection of Human Subjects approved the study protocol (Protocol No. 00032736).

Mindful Physiology (BIOL 3) was an undergraduate-level biology course open to students of all majors at Dartmouth College (New Hampshire, USA; Supplementary material 1). The course met 17 times over the 9.5-week Spring 2023 term (3/28/2023–5/30/2023). Each 110-min class session included ~20 min of group mindfulness practice. The course was taught by Professor Diane Gilbert-Diamond, ScD, a lay practitioner who practices mindfulness in the Plum Village Tradition of Thích Nhất Hạnh. This course aimed to foster a greater understanding of and appreciation for the biological mechanisms inside and around our bodies, promote scientific literacy and increase students' familiarity and capacity for mindfulness practice.

Students completed online questionnaires remotely after course completion (late May to mid-July 2023) administered via RedCap, an electronic data management platform hosted at Dartmouth College (Harris et al., 2009, 2019). We extracted class attendance, assignment and assessment completion, and mindfulness practice logs from class records for consented students.

We extracted participant class years (i.e., freshman, sophomore, junior, and senior) from the course registration system. Students self-reported their gender identities in the course survey administered at the course's first session.

Summary statistics were computed to understand the distribution of the primary outcomes and covariates. Next, we examined if the out-of-class practice time changed over the term with a linear mixed-effect model with a fixed effect by time and random intercepts by the participant. Chi-squared goodness of fit tests against a uniform distribution were performed to decide if the observed responses on the other survey items were likely due to chance. Paired Wilcoxon signed-rank tests were performed to assess whether dispositional mindfulness (MAAS item and total scores) self-reported for pre- and post-class differed significantly. Cronbach's α was computed to evaluate the internal consistency of the self-report instruments in our sample. Lastly, we examined the dose-response relation between the duration of mindfulness practice and dispositional mindfulness via linear mixed-effect models accounting for the time trend and repeated sampling. We performed the analyses at a two-sided alpha level of 0.05 and created the figures in RStudio software version 2023.06.2+561 (R Core Team, 2022).

Thirty-six undergraduate students participated in our study. Seventeen percent were 1st-year students, 33% were sophomores, 22% were juniors, and 28% were seniors (Table 1). Fifty-three percent identified with the “she/her” pronouns, 42% with “he/him,” and 3% with “she/her/they/them.”

The acceptance of the course was high. All participants found the course enjoyable and relevant to their lives (Figure 1A). All agreed that the class increased their understanding of their physiology and its interconnectedness to the world, and they would recommend the class to a friend (Figure 1, items B1, B3, and A4). Ninety-one percent expressed wanting to take another academic course incorporating mindfulness practice (Figure 1, item A5).

All agreed that the course enhanced their knowledge about the biological mechanisms underlying the positive health impacts of mindfulness practice (Figure 1B). Many believed that that course had increased their appreciation for their bodies (100%), knowledge of how to live healthfully (91%), and motivation to live healthfully (88%; Figures 1B, C).

Participants engaged well with the course content throughout the term. All completed the six in-class assessments, and 97% completed all three problem sets (Table 1). Of the 17 class sessions offered, 64% attended at least 16 sessions, 14% attended 15, and 22% attended between 11 and 14 sessions.

Participants practiced mindfulness for an average of 30 h (SD = 12) during the term (Table 1). They practiced weekly in class for an average of 66 min (SD = 27). Seventy-eight percent attended the 4-h retreat, 11% attended the 2-day (14-h) retreat, and 6% attended both. Two students participated in alternate activities due to scheduling conflicts with the retreat.

Outside of class, participants practiced mindfulness for an average of 20 min (SD = 17) per day (Table 2). The out-of-class practice time was stable throughout the course (p = 0.60 for the time fixed effect coefficient in a linear mixed-effect model, Figure 2). They explored, on average, 6 (SD = 2) types of mindfulness exercises on their own (Table 1). Mindful movement was the most common out-of-class practice in this sample, and 94% of the participants described practicing self-led mindful movement activities, e.g., mindful walks and runs (Table 2). Sitting meditation was the second most common practice, and 42% of the participants described practicing with an app. Participants also described practicing mindfulness through breathing (N = 27), deep relaxation (N = 22), journaling (N = 13), and art and music (N = 17).

In line with the philosophy of mindful living encouraged in the class reading Peace is Every Step (Hanh, 1992), many participants incorporated mindfulness into daily tasks. Examples are mindful eating and drinking (N = 27, 75%), mindfully socializing with others (N = 10, 28%), and housekeeping (N = 9, 25%; Table 2). Seventy-five percent also described practicing mindfulness in nature.

Participants reported that their attention to the present moment and capacity for mindfulness improved after taking the class, with an average of 1.2 unit within-person increase in the MAAS score (SD = 0.8, p = 1.82 × 10⁻⁶ from paired Wilcoxon signed rank exact test, N = 30; Figure 3).

We observed a statistically significant increase in each MAAS item score (p < 0.00001 from paired Wilcoxon signed rank exact test; Figure 4). Many reported a drop in their tendency to walk mindlessly and operate on auto-pilot (Figure 4, items 4 and 7). Participants also found themselves less likely to get caught up in their thoughts about the past or the future (Figure 4, item 13). We did not observe an association between total hours practiced and dispositional mindfulness evaluated via the MAAS (p = 0.379; Table 3).

Participants answered that the course positively or very positively influenced their physical health (Figure 5A), including a greater capacity to engage in healthy physical activity (74%), get quality and adequate sleep (71%), and eat more healthfully (62%). The tendency of eating to cope with negative emotion dropped (p < 0.00001 from paired Wilcoxon signed-rank test, Figure 4, emotional eating).

Participants noticed positive mental and social wellbeing changes from taking this course (Figures 5B, C). Examples were more compassion toward self (88%) and for others (85%), improved self-esteem (68%), and greater capacity for managing non-academic (82%) and academic stressors (79%). Many believed the course enhanced their sense of community in the classroom (88%) and on campus (71%).

The Mindful Physiology course showed high acceptability (Figure 1). Students attained academic objectives (i.e., increased understanding of human physiology) while enjoying the learning process. Unlike conventional college courses, this course invited students to practice mindfulness related to the lecture topics. Practicing inside and outside of class allowed students time to relax, cultivate joy, and reflect on and appreciate their own physiology. Research suggests that positive academic emotions, such as joy and gratitude, can increase student motivation for learning (Pekrun et al., 2017). Studies also show that learners are more willing to invest time and effort when learning is fun (Pekrun et al., 2002; Villavicencio and Bernardo, 2013). Enjoyment (i.e., positive emotion related to curiosity and interest in learning) has been shown to strongly predict academic achievement (Villavicencio and Bernardo, 2013). Future studies should investigate whether integrating mindfulness into curricula fosters positive academic emotions and benefits learning outcomes.

Participants engaged well with the course, as indicated by their class attendance, assignment, and assessment completion rates (Table 1) and consistent engagement with out-of-class mindfulness practice (Figure 2). The vast majority attended the mindfulness retreat(s) and practiced mindfulness inside and outside the class (Table 1). A qualitative review suggests that the course's approach of offering students options in the type and duration of their out-of-class practice was conducive to participant engagement with mindfulness training (Bamber and Schneider, 2022). The flexibility and autonomy potentially allowed students to fit mindfulness training into daily routines and increase motivation to practice (Table 2). Additionally, the preference for self-directed or group practice varied, with more students favoring self-directed activities. For example, participants reported engaging in more self-directed mindful walks than structured mindful movement classes (e.g., instructor-led yoga classes), and more sitting meditations guided by mobile apps than in-person at the school's wellness center (Table 2). While we did not interrogate why students chose various activities, we hypothesize that students may prefer the scheduling flexibility of self-directed activities.

Students resonated with practicing mindfulness in everyday activities (integrated practice, e.g., cleaning mindfully and brushing their teeth mindfully (Table 2). Introducing students to various ways to practice may make mindfulness more accessible and sustainable. Several studies conducted among college students report that weaving mindfulness into daily tasks, such as dishwashing, may increase state mindfulness and positive emotion (Hanley et al., 2015; Hindman et al., 2015; Cebolla et al., 2017). Integrated practice may also reduce the anxiety and guilt felt by students when they cannot find time for isolated sitting meditations (Bamber and Schneider, 2022). A follow-up study of an 8-week college mindfulness program found integrated practice sustainable; a year after, most students reported practicing mindfulness in everyday activities, e.g., mindful eating and mindful walks, while very few continued practicing isolated meditation practices (Galante et al., 2021). Importantly, Galante et al. found a dose-response benefit regardless of whether the practice was integrated or isolated. Introducing options and the flexibility to create one's own practice routine may encourage more sustainable and enjoyable mindfulness practice for college students.

Our participants also favored nature-involved practices, such as mindful walking, running, or eating outdoors (Table 2). A review suggests that contact with nature (“green time”), even as briefly as 10 min of sitting or walking in a natural setting, is linked to improved psychological wellbeing markers in university students (Meredith et al., 2020). Studies also indicate that contact with nature is linked to greater happiness (Mayer et al., 2009) and lower anxiety (Mackay and Neill, 2010). Mindful attention when interacting with nature may augment its beneficial effects; an experiment by Nisbet et al. found that college students who walked outdoors for 20 min while being guided with mindfulness instructions reported a stronger sense of nature connectedness and positive emotions than those who walked indoors or outdoors without mindfulness instruction (Nisbet et al., 2019). Colleges can consider further incorporating nature along with mindfulness into college courses and events, increasing student access to natural space and encouraging “green time” to nourish students' emotional health.

The course increased student trait mindfulness measured via the MAAS self-reported for pre- vs. post-class (Figures 3, 4). A meta-analysis of 125 studies in diverse populations (N = 31,679, median age = 28.3 years, 91% non-clinical participants) supports that trait mindfulness is positively associated with healthy behaviors, such as healthy eating, sleep, and exercise, with correlations ranging from 0.08 to 0.14 (Sala et al., 2020). Epidemiological studies in college populations also suggest that more mindful students tend to exhibit more healthful behaviors; they eat more nutritiously, exercise more, and spend more time on self-care (Murphy et al., 2012; Lyzwinski et al., 2019) and report less problematic alcohol use and binge eating (Bodenlos et al., 2013, 2015; Giannopoulou et al., 2020). However, the literature is mainly cross-sectional. Understanding whether trait mindfulness prospectively promotes healthy behaviors thus requires further investigation in experimental and longitudinal studies.

We did not observe an association between reported mindfulness practice time and trait mindfulness measured via the MAAS (Table 3). However, the exposure variable of practice time is limited because it does not account for practice quality and is subject to measurement error from recalls. Future research can improve this aspect by asking students to evaluate the quality of their mindfulness practice with validated instruments, e.g., the PQ-M (Del Re et al., 2013). More frequent sampling via ecological momentary assessment (EMA) may reduce some measurement errors from recalls (Moore et al., 2016; Grégoire and Doucerain, 2022).

While we did not further interrogate, we hypothesize that other course components, such as course readings, physiology lectures, and mindfulness retreats, may also have contributed to the increase in student dispositional mindfulness. Potentially, the combination of learning about human physiology and connecting with the body through mindfulness practice positively affects trait mindfulness. Past research also indicates that the instructors'/facilitators' teaching style may influence the students' development of mindfulness skills (Hanh and Weare, 2017; Bamber and Schneider, 2022). For instance, participants from an 8-week mindfulness program expressed that teachers who modeled and practiced mindfulness inspired them to do the same (Shonin et al., 2014). Integrating mindfulness throughout the classroom has been shown to facilitate teaching and learning, as students are more present and engage better (Schwind et al., 2017). Future research should include structured qualitative interviews with participants to elucidate which course components contribute to changes in trait mindfulness.

Improvement in self-reported physical wellbeing and health behaviors was also pronounced in our study. More specifically, most students reported that the course had positive or very positive changes in their ability to get adequate and quality sleep, engage in healthy physical activity, and eat healthfully (Figure 5). In line with Bandura's social cognitive theory of individual behavioral change (Bandura, 1977, 1997), these behavioral changes may have been supported by students increased understanding of the physiological benefits of these behaviors, along with their increased confidence in their ability to engage in these behaviors (Figure 1). Other studies also show that increased self-efficacy and outcome expectations may induce successful physical activity and dietary behavior changes (Young et al., 2014; Luszczynska and Schwarzer, 2020; Sebastian et al., 2021).

Positive behavioral changes in participant sleep, nutrition, and exercise may also have derived from reduced perceived stress and better stress management skills (Figure 5B). Stress and health behaviors may present a bi-directional relationship (Donald et al., 2016; Querstret et al., 2020; Dark-Freudeman et al., 2022). For instance, evidence indicates that sleep is essential in modulating emotional stress and physiological stress responses (Minkel et al., 2014; Simpson et al., 2016; Vandekerckhove and Wang, 2017). However, acute and chronic stress, when insufficiently regulated, has been shown to disrupt sleep (Lo Martire et al., 2020). Similarly, exercise has been shown to help reduce stress, but high perceived pressure has been shown to impede one's motivation to exercise (Stults-Kolehmainen and Sinha, 2014). Reducing stress is thus vital to breaking this vicious cycle. With mindfulness training, students can experience less stress and cultivate more feelings of ease and calm, which may facilitate positive health behaviors. Further research should interrogate whether reductions in stress mediate the observed improvements in health behaviors and physical health.

Participants also reported positive changes in their self-esteem and compassion for themselves and others after taking the class (Figure 5). Prior research supports that trait mindfulness positively relates to self-esteem (i.e., one's sense of self-worth) and that mindfulness training can increase self-esteem (Pepping et al., 2013) potentially via reduced negative thinking (Frewen et al., 2008) and self-criticism (Dundas et al., 2016; Noh and Cho, 2020). With mindfulness, one can practice challenging unhelpful thought patterns and embracing self-compassion and a growth mindset instead (Saraff et al., 2020). Studies show that exercises such as loving-kindness meditation and supportive touch (e.g., hand massage), which some participants reported practicing, can increase empathy (Boellinghaus et al., 2014; Goldstein et al., 2017). Future research should explore if specific types of mindfulness practice are particularly beneficial for emotional health in college students.

The increase in the sense of community was also notable in our participants (Figure 5C). Young adults may experience more loneliness, because they are often single and live alone (Hawkley et al., 2022; Ellard et al., 2023). Studies report that attitudes of interconnectedness, acceptance (i.e., openness and receptivity of the present-moment experience), and compassion cultivated through mindfulness practice may help alleviate loneliness (Teoh et al., 2021; Xie et al., 2023) and enhance interpersonal relationships (Lindsay et al., 2019). Interestingly, 28% of our sample described practicing mindful socialization (e.g., mindfully talking and listening to a friend, connecting with their pets) in their spare time (Table 2). Further studies should use validated instruments of social connectedness (Veazie et al., 2019; Ellard et al., 2023) to more rigorously explore the effects of practicing mindfulness overall and specifically while socializing on reducing loneliness.

This Mindful Physiology course introduced an innovative approach to teaching human physiology with incorporated mindfulness practice. We evaluated the course acceptability, engagement, and potential impacts on student wellbeing via questionnaires. Nevertheless, the pilot study has limitations, including small sample size (N = 36 out of 48 registered students), inadequate assessment of covariates (e.g., race/ethnicity, prior experience with meditation, health status, and major), absence of a comparison group, and absence of an assessment administered at baseline. Our study is further limited by potential bias from self-selection of the sample, potential measurement error in self-reports, and potential limited assessment on the non-judgment facet of mindfulness due to the unidimensional design of the MAAS (Baer et al., 2006; Baer, 2019). These limitations preclude us from making causal inferences and may limit our study's generalizability.

Future studies should consider conducting validated subjective questionnaires, such as the Warwick-Edinburg Student Wellbeing questionnaire (Tennant et al., 2007) and objective measurements, such as hair cortisol, heart rate, and accelerometry (Russell et al., 2012; Cain et al., 2013; Kim et al., 2018), with a pre-and post-intervention design, to assess changes in student health and behaviors. Further, qualitative studies with student participants can provide insights into the facilitators and barriers to practicing mindfulness in college life. Nonetheless, our study suggests that the course may have positively impacted students' physical and mental wellbeing and supports that larger-scale RCTs are warranted to confirm these benefits.

This study and others support that incorporating mindfulness into higher education can potentially improve student wellbeing. Although our class was based on the intersection of mindfulness and biology, the concepts (e.g., interconnectedness and impermanence) and skills (e.g., focused attention) introduced and cultivated through mindfulness practice are not unique to the discipline of biology. For instance, in a chemistry class, teachers may invite students to contemplate the idea of impermanence while observing a chemical reaction. In an ecology class, students may be invited to reflect on their role and the impact of their actions on the ecosystem to understand the idea of interbeing. Teachers may lead a brief mindfulness meditation in a language class to reduce language learning anxiety (Zeilhofer and Sasao, 2022). Simply reflecting on the class content and its relevance to daily life can improve learning outcomes (Priniski et al., 2018).

Incorporating mindfulness into higher education curricula may be challenging due to the need for a professor to feel comfortable in both their subject area and mindfulness practices. For professors interested in incorporating such an approach but less experienced with mindfulness practices, collaborations with mindfulness experts to co-design the curriculum may be feasible. In this course, monastics from the Plum Village Tradition engaged with students through in-class visits and on-campus retreats. Given the limited availability of monastic mindfulness experts and the potential burden of running retreats, future research should explore whether monastic engagement and mindfulness retreat attendance were necessary for the positive changes reported by the students. As the world faces a crisis in youth's mental health, further research into integrating mindfulness into academic courses can provide the necessary evidence to support or refute the approach of incorporating mindfulness to foster positive student learning and health outcomes.