Mindfulness teaching is a potentially powerful tool that can potentially benefit a broad range of adolescents and their families and should be further explored in at-risk populations. 
This study adds to existing mindfulness literature by highlighting the adolescent voice regarding participation in mindfulness research. At-risk adolescents are an underrepresented, unheard and often an absent population in research. Interviews of twenty-three female, middle-school students residing in poor, high-risk communities were conducted before and after an intervention focused on mindfulness (MC) along with an attentional comparison intervention (AC) to reduce stress. Before interventions, mindfulness students were “happy,” “mad” and “angry.” Post-test they were “happy,” “excited,” and “relaxed.” Post-intervention, the attentional group was “mad,” “irked” and “annoyed.” Auditory interruptions affected concentration for all participants. Participants learned to control stress and enjoyed support from the instructors. Unique to mindfulness participants was the use of specific strategies. Clinical decision making can incorporate mindfulness techniques for best outcomes in adolescents.

Adolescents; Happy; Mad; Mindfulness; Awareness

Rawlett K (2017) Adolescent Experience with Mindfulness. JSM Health Educ Prim Health Care 2(3): 1032.

At-risk behaviors are correlated with poor outcomes among teenagers. Adolescence, particularly the middle school years, is a pivotal time for stress reduction to reduce risk and improve mental and psychological health. Risk factors in adolescence include low socio-economic status, being raised by a single parent or non-parent, being born to a teenage mother, being raised in a ‘foster’ household, parental alcoholism and being abused mentally or physically [1]. The previously mentioned risk factors are associated with lower academic achievement, incarceration, teen and unwanted pregnancy, increased mental illness and violence even after controlling for sex, race/ethnicity and grade level [2]. The relationship between risk factors and poor outcomes highlights the need to investigate the specific relationships between at-risk behaviors and adverse outcomes [1,2]. Emotional distress and substance use are known risk factors for teens to experience violence and peer delinquency [3]. Neighborhood income inequality is related to increased risk of perpetrating a violent act and being a victim of aggression. Adolescents living in areas of high poverty were more likely to observe an individual suffer from a violent death in the previous twelve months as compared to youth in slightly more affluent communities [4].

Teaching adolescent’s mindfulness may be useful for adolescents because it has the potential to improve coping and reduce stress. Mindfulness-Based Stress Reduction (MBSR) was formulated by Jon Kabat-Zinn [5,6] to teach clients an ancient and transforming practice as an adjunct to their medical treatments. MBSR programs are successful in decreasing stress and increasing coping in adults. Mindfulness programs can be tailored for youth [7]. Specific program changes for your include less time spent in meditation, meditation, weekly practice with mindful eating and de- weekly practice with mindful eating and de weekly practice with mindful eating and delivering course content over 6 weeks instead of the standard 8 week programming [8].Individuals included in mindfulness programs geared toward adolescents show increased self-regulation [9], awareness [10], psychological and social functioning [11,12] and general health [12,13].

The purpose of this brief report is to describe responses to interviews of participants regarding their thoughts, self-assessments and experiences before and after a mindfulness intervention (MC) as compared to attentional comparison (AC) inter- AC) inter- interventions. In addition, this study highlights the adolescent voice regarding participation in mindfulness research. At-risk adolescents are underrepresented in health care research and an often unheard and absent population in research studies. The aim of the study is to provide a window into the experience of at-risk adolescents participating in mindfulness versus attentional interventions. Clinical decision-making strategies and program evaluation will be presented from the information provided by participants.

Participant answers to interview questions were independently coded by the study lead, a Family Nurse Practitioner (FNP), together with a qualitative research expert. After initial coding, the FNP interviewer and the researcher met to compare analyses for consensus.

The boarding school educates at-risk youth living throughout Maryland with a high-quality academic program with a nurturing boarding program during the week. Eligibility for the school involves one or more of the following criteria: a household income at 100% or below the poverty level, a primary caregiver that is not a biological parent, a single parent household, a history of being abused and/or a history of being expelled from a previous school. The students live in campus dormitories Monday through Friday during the academic year.

The target population and focus of the intervention was approximately 30 of the 40 sixth grade girls. Adolescents were eligible for inclusion if they were: girls attending the boarding school and 11-13 years old with their responsible parent/caregiver at least 18 years old during initial. The adolescents were not eligible for inclusion if the parent/caregiver was not fluent in English, could not understand or complete the interview questions, unable to attend sessions, failing 2 or more subjects or currently pregnant.

Twenty-three female adolescents were included in the study. Sixteen out of 22 participants were African American. One student dropped out of the study before the first class session due to self-reported stigma of attending mindfulness classes. Per interviews with school staff, female sixth graders have the largest challenges adjusting to residential life in a new school. Focusing solely on female students highlights the unique developmental process of preteen girls.

Students who fulfilled the inclusion criteria were contacted by the investigator via word of mouth and by providing an information table between classes and during special school events such as a school art event, parent/teacher meetings and dorm so- event, parent/teacher meetings and dorm so- event, parent/teacher meetings and dorm socials. The researcher distributed an information flyer with written information for students and parents. Administrative personnel and teachers were informed of the study through email and individual meetings.

he purpose and details of the study were discussed with students and parents before enrollment in the research study. University IRB approved consent forms were signed by at least one parent or guardian and approved assent forms were signed by all participants prior to the beginning of the research.

Students were randomized by dorm to meet with the MC group or the AC group. Both intervention groups met for 1-1.5 hours weekly for six weeks in separate but congruent meeting spaces. Intervention groups started at 6 pm. The MC group received a structured mindfulness-based intervention. The AC group consisted of structured discussion in a seminar-like setting. For example, when the MC group was learning about mindful eating the AC group was learning about general nutrition guidelines and healthy food choices. An attentional comparison group was chosen over an attention-only group to provide the most comparable and similar intervention without overlapping mindfulness content and concepts.

Learning to Breathe (L2B) mindfulness curriculum group

The MC Sessions were by led by the PI (K.R.), who previous ly completed a course in mindfulness techniques and was also trained by the author of the  L2B curriculum ? menting the course [8]. The MC intervention involved gathering with participants as a group and guiding the girls in techniques for knowing the context of one’s body in time and space, reflection,acknowledging emotions and regulations,attentional  awareness practicing loving kindness and noting personal habits. The MC incorporated particular activities around mindful eating, concentrating, motion along with small group discussion about feelings and emotions including pleasant and unpleasant events with mindfulness focus [1,6].

Attentional Comparison Group

A Certified Psych/Mental Health Nurse Practitioner led the weekly AC classes. The AC sessions involved meeting as a group, guiding participants in learning about assertiveness,healthy nutrition, setting appropriate goals, exploring barriers that may arise when implementing goals and how achieve with long-term aspirations.

Prior to the beginning of the intervention, baseline demo? graphic data and history were obtained from the student and parent or guardian. Students filled out self-reported question? naires and wrote answers to interview questions before the first session. Self-reported measures were open-ended questions presented before and after finishing the six-week study interven? tions. Interview questions were: What two words or phrases best describe you? What distracts you? How do you manage stress?

Before study interventions, MC students are “happy,” “mad” and “angry.” One student writes, “I am Mad (note the capital M) and not in the mood to be here.” Another, “I am sad & grumpy” before the MC. Post-test MC students are positive: “happy,” “excited,” and “relaxed.” In the questionnaire after MC intervention, a student writes, “I feel Smart, caring, and thoughtful”. Another student, “The words that describe me today are Happy, Hopeful, loving and fun!” AC group has mixed emotions. Negative emotions, “mad,” “ irked "and "annoyed" remain unchanged from before to after interventions.

Intervention groups indicate auditory interruptions affecting concentration. Distractions are consistent for all participants: laughing heard outside the room, disruptive sounds and voices that were not teaching. When asked about classroom distractions or difficulty concentrating, students write, ”I am distracted by too much talking, too much noise,””Distracted by funny comments (made by others during class) and I laugh,” and ”When people are banging on the tables.”

MC group incorporates mindfulness techniques to manage stress. Post-test techniques include listening (to music), body scans, breathing and meditating. Individual students wrote, ”I manage stress by inhaling and exhaling,””I like to do Meditating and Body Scans,””I do the Body Screen (body scan) to help manage my stress” and ”I manage my stress by listening to music and just breathing in and out.” AC class does not show a change in dealing with stress. Students manage stress ‘”screaming, yelling, hitting and taking it out on inanimate objects.”

In program evaluation, MC students like learning techniques of breathing, paying attention, using silence and listening to music for peace. AC participants enjoy talking, expressing true self and getting stress out. Groups enjoy guidance of instructors and 100% of participants indicate interest in future mindfulness classes at school. Girls indicate getting outside and providing larger space would improve overall program.

Stress rises in the teen years and often follows tensions with in the teen's life. Interventions with mindfulness focus aiming to decrease stress and can be useful with adolescents [2]. Youth mental health disorders are increasing attributed to growing stress [1]. High-risk, middle school students who live in urban areas participating in mindfulness-based programs have lower physical bodily complaints in the absence of a known medical condition. Students participating in mindfulness programs also have lower negative affect and coping, depression, self-harm, rumination and post-traumatic stress disorder when side by side with students receiving sole health education [14].

Limitations and risk for cross-contamination exists. Students’ desires to please the session instructors, teachers and parents may represent coercion at a subconscious level. Interventions were implemented late in the school year. Sixth graders, at school for months, may have acclimated to school life. Changes within and between groups might be evident if instruction ex tended past six weeks. Student behavior was poor at times and adversely affected intervention implementation. Missing family structure and home discipline present challenges for concentration and paying attention. Behavior improved during a visit from the headmaster. Authority figure involvement in weekly sessions may be a helpful strategy in future studies.

Adolescent girls, considered at-risk for various reasons, can benefit from unstructured interactions. MC participants learned mindfulness strategies to reduce stress, providing clinically significant implications. Unique populations are accessible in communities if interventions involve minimal inconvenience for participants.

Clinically relevant is the MC using specific techniques: breathing, listening and meditating to reduce stress. Practitioners should emphasize specific techniques for adolescent self- regulation. Direct clinical applications, well established in adolescent psychiatry, can be expanded. School-based Wellness centers can offer advanced health electives for middle and high school students and mirror undergraduate programs [15]. Preliminary studies incorporate clinical mindfulness programs with successful treatment and preventing relapse in adolescent substance abuse disorder [16]. Cutting edge research demonstrates successful treatment of pediatric chronic pain through structured mindfulness interventions and reduces narcotic prescriptions [17].

Implementation barriers include noise distractions and space limitations. Knowledge from this study can strengthen clinical decision making. Creating quiet time and listening to music may improve patient experience and health outcomes. Teaching mindfulness in middle adolescence may be a powerful strategy that can help adolescents and warrants further exploration in adolescent care.

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