ASMALL MIXED-METHOD RCT OF MINDFULNESS INSTRUCTION FOR URBAN YOUTH Erica M.S. Sibinga, MD, MHS, 1# Carisa Perry-Parrish, PhD, 2 Katherine Thorpe, MA, 3 Marissa Mika, MHS, 4 and Jonathan M. Ellen, MD 5 Objective: We aimed to explore the specific effects of mindfulness-based stress reduction (MBSR) for urban youth by comparing it with an active control program, designed to control for time, positive peer-group experience, and positive adult instructor. Methods: Patients between the ages of 13–21 years who received primary pediatric care at our urban outpatient clinic were eligible for study participation. Those who were inter- ested were consented and randomly assigned to an eight-week program of MBSR or Healthy Topics (HT), a health educa- tion curriculum. To increase sensitivity to outcomes of interest, mixed methods were used to assess psychological symptoms, coping, and program experience. Analysis of variance and regression modeling were used; interviews were audio-taped, transcribed, and coded for key themes. Results: A total of 43 (26 MBSR, 17 HT) youths attended one or more sessions, of whom 35 [20 MBSR (77%), 15 HT (88%)] attended the majority of the sessions and were considered completers. Program completers were African American, 80% female, with average age of 15.0 years. Statistical analysis of survey data did not identify significant post-program differences between groups. Qualitative data show comparable positive experiences in both programs, but specific differences related to MBSR participants' use of mindfulness techniques to calm down and avoid conflicts, as well as descriptions of internal processes and self- regulation. Conclusions: Compared with an active control program, MBSR did not result in statistically significant differences in self-reported survey outcomes of interest but was associated with qualitative outcomes of increased calm, conflict avoid- ance, self-awareness, and self-regulation for urban youths. Importantly, based on qualitative results, the HT program functioned as an effective active control for MBSR in this sample, facilitating a more rigorous methodological approach to MBSR research in this population. We believe the promising effects elucidated in the qualitative data have the potential for positive affective and behavioral outcomes. Key words: Mindfulness, meditation, urban youth, stress, mindfulness-based stress reduction, adolescents (Explore 2014; 10:180-186 & 2014 Elsevier Inc. All rights reserved.) INTRODUCTION Recurrent and chronic stresses have been implicated in many negative outcomes, including hypertension, obesity, anxiety, aggression, and depression. 1–6 Often, urban youth in the United States are exposed to significant on-going stresses, including poverty, failing educational systems, and exposure to community and interpersonal violence. We are interested in identifying approaches to reduce stress and/or mitigate the negative effects of stress for urban youths. Mindfulness-based stress reduction (MBSR) is a structured eight-week program of mindfulness instruction, designed and shown to enhance participants' mindfulness, or non- judgmental awareness of present-moment experience. 7,8 Over the past few decades, MBSR has been studied in a broad spectrum of clinical and non-clinical adult populations. Meta-analyses have concluded that the MBSR program likely results in beneficial outcomes, such as reduced stress, anxiety, and depression, but these reviews consistently cite the need for increased scientific rigor, particularly related to control conditions. 9 –12 Recently, some studies in adults have included active control arms, gradually improving the meth- odology used for MBSR research. 13–16 Research of MBSR for children and youths has begun to emerge over the past decade. Initial small and multi-modal studies suggest feasi- bility, acceptability, and the potential for beneficial effects of MBSR for children and youths. 17,18 Our own uncontrolled study shows that the MBSR program is associated with improvements including reductions in hostility, emotional e-mail: esibinga@jhmi.edu 1 Division of General Pediatrics and Adolescent Medicine, Depart- ment of Pediatrics, Center for Child and Community Health Research, Johns Hopkins School of Medicine, Baltimore, MD 2 Department of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD 3 Department of Psychology, St. John's University, Queens, NY 4 Department of History and Sociology of Science, University of Pennsylvania, Philadelphia, PA 5 Johns Hopkins University School of Medicine, All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL # Correspondence to: Suite 4200, Mason F Lord Building, Center Tower, 5200 Eastern Ave, Baltimore, MD 21224. 180 & 2014 Elsevier Inc. All rights reserved. EXPLORE May/June 2014, Vol. 10, No. 3 ISSN 1550-8307/$36.00 http://dx.doi.org/10.1016/j.explore.2014.02.006 ORIGINAL RESEARCH