QUALITATIVE EVALUATION OF A HIGH SCHOOL YOGA PROGRAM:FEASIBILITY AND PERCEIVED BENEFITS Lisa A. Conboy, MA, MS, ScD, 1# Jessica J. Noggle, PhD, 2 Jessica L. Frey, BA, 3 Ravi S. Kudesia, BA, 4 and Sat Bir S. Khalsa, PhD 2 This is the first published qualitative assessment of a yoga program applied in a high school setting. This qualitative inter- view study was nested in a randomized, controlled trial studying the effects of a yoga program offered in place of a semester of physical education classes at a rural public high school. Student interviews were conducted after taking part in a semester of the yoga program. A formal passive consent with information about the qualitative study was sent home to parents/guardians of all students in the parent study before the interviews. Most students enjoyed the yoga classes and felt benefits. Negative reports of yoga practice were associated with gender as most males sensed peer pressure against practicing yoga. Despite this finding, most students wanted to continue yoga and would continue if it were offered in school. Positive reports include a greater kinesthetic awareness, which some students associated with a greater respect for the body and improved self-image. Among students report- ing psychological benefits, many cited stress reduction; many used yoga to manage negative emotions; and some propagated more optimism. Most thought yoga could reduce interest in the use of drugs and alcohol and increase social cohesion with fam- ily and peers. We found that a yoga program is feasible in this sample of 9th and 10th graders, especially after benefits are perceived. We also found evidence that yoga may lead to emer- gent positive benefits in health behaviors not directly prescribed by the program. These results suggest that school-based yoga programs may be appropriate for promoting healthy behaviors at a societal level by focusing on the prevention of negative patterns during the adolescent transition. Key words: Yoga, high school, qualitative, complementary med- icine, adolescent (Explore 2013; 9:171-180. © 2013 Elsevier Inc. All rights reserved.) INTRODUCTION Yoga is a comprehensive mind-body practice that involves physical postures and movement, breathing exercises, relax- ation, and meditation to develop self-observation without judg- ment while the body moves and breathes, with the ultimate goal of unifying the self at physical, emotional, cognitive, spiritual, and social levels. 1-3 During the past decade, yoga has become extremely popular among Americans, including American youth. In 2007, 2.1% of children younger than 18 practiced yoga. 4 Although many adults seek yoga to improve psychologi- cal well-being and manage stress, 5 there is little information presently available examining why youth may practice. Most of the emerging scientific evidence for yoga as a therapeutic inter- vention is based on samples of adults rather than children. Basic research on adults practicing yoga and its component techniques has indicated effectiveness in reducing stress and arousal. 6-8 Yoga may be most effective in treating disorders that have a strong psychosomatic, psychological/psychiatric, or stress-re- lated component 9-11 ; for example, outcomes studies in adults have shown benefit of yoga for stress, 12,13 depression, 14,15 anxi- ety, 15-18 and insomnia. 19-21 Although much less research has been published on yoga for youth, emerging outcomes are sim- ilar to adults. For example, three recent systematic reviews indi- cate that mental health improvements in healthy children and adolescents included improved mood (particularly anxiety and negative emotional states) and reductions in stress. 22-24 Previous work with our program in 11th-and 12th-grade high school stu- dents randomly assigned to either a yoga program for 12 weeks during Physical Education (PE) or PE-as-usual showed signifi- cant pre/postimprovements in resilience to stress, negative af- fect, anxiety, and anger control relative to controls. 25 The practice of yoga is a complex holistic intervention in which each student can find his/her unique trajectory of change and improvement. Yoga practitioners frequently report nonspe- cific positive effects, those being changes in addition to or dif- ferent from what drew them to begin a practice. 26 Qualitative research, which collects data on the lived experiences of partic- ipants, is the perfect tool for exploring such complex, unique experiences, 27 enriching our scientific knowledge beyond what can be gained quantitatively. 28 The purpose of the present qual- itative analysis is to gain a deeper understanding of individual perspectives of students participating in the treatment arm of our yoga trial. Specifically, we collected student perspectives about: (1) the practice of yoga within the school curriculum, (2) per- ceived benefits of yoga, (3) participating in a research study. 1 Osher Research Center, Harvard Medical School, and Department of Biomedicine, New England School of Acupuncture, Boston, MA 2 Harvard Medical School, Division of Sleep Medicine, Brigham and Women’s Hospital, Boston, MA 3 Institute for Extraordinary Living, Kripalu Center for Yoga and Health, Stockbridge, MA 4 Olin Business School, Washington University, St Louis, MO # Corresponding Author. Address: Research Department, The New England School of Acupuncture, 150 California Street, Newton, MA 02458. e-mail: lisa_conboy@hms.harvard.edu 171 © 2013 Elsevier Inc. All rights reserved EXPLORE May/June 2013, Vol. 9, No. 3 ISSN 1550-8307/$36.00 http://dx.doi.org/10.1016/j.explore.2013.02.001 ORIGINAL RESEARCH