Objectives: The objectives of this study were to assess the general acceptability and to assess domains of potential effect of a mindfulness-based stress reduction (MBSR) program for human immunodeficiency virus (HIV)-infected and at-risk urban youth. Methods: Thirteen-to twenty-one-year-old youth were recruited from the pediatric primary care clinic of an urban tertiary care hospital to participate in 4 MBSR groups. Each MBSR group consisted of nine weekly sessions of MBSR instruction. This mixed-methods evaluation consisted of quantitative data-attendance, psychologic symptoms (Symptom Checklist 90-Revised), and quality of life (Child Health and Illness Profile-Adolescent Edition)-and qualitative data-in-depth individual interviews conducted in a convenience sample of participants until interview themes were saturated. Analysis involved comparison of pre-and postintervention surveys and content analysis of interviews. Results: Thirty-three (33) youth attended at least one MBSR session. Of the 33 who attended any sessions, 26 youth (79%) attended the majority of the MBSR sessions and were considered ''program completers.'' Among program completers, 11 were HIV-infected, 77% were female, all were African American, and the average age was 16.8 years. Quantitative data show that following the MBSR program, participants had a significant reduction in hostility ( p ¼ 0.02), general discomfort ( p ¼ 0.01), and emotional discomfort ( p ¼ 0.02). Qualitative data (n ¼ 10) show perceived improvements in interpersonal relationships (including less conflict), school achievement, physical health, and reduced stress. Conclusions: The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health. However, because of the small sample size and lack of control group, it cannot be distinguished whether the changes observed are due to MBSR or to nonspecific group effects. Further controlled trials should include assessment of the MBSR program's efficacy in these domains.

Evaluated distress during invasive procedures in childhood leukemia. Child and parent distress, assessed by questionnaires and ratings, were compared in two arms of a randomized, controlled prospective study, one a pharmacologic only (PO) (n = 45) and the other a combined pharmacologic and psychological intervention (Cl) (n = 47), at 1, 2, and 6 months after diagnosis. The cross-sectional control group (CC) consisted of parents of 70 patients in first remission prior to the prospective study. Mothers' and nurses' ratings of child distress indicated less child distress in the Cl group than the PO. When contrasted with the CC group, the Cl group showed lower levels of child distress. Data showed decreases over time in distress and concurrent improvements in quality of life and parenting stress and supported an inverse association between distress and child age.

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Child and parental distress related to lumbar punctures and bone marrow aspirates and general family adaptation are evaluated in a cross-sectional study of children currently in treatment with leukemia in first remission (N = 70). A parental self-report measure developed for this study--the Perception of Procedures Questionnaire (PPQ)--yielded three factors: (a) parental satisfaction, (b) parental distress or involvement, and (c) child distress. Data from the PPQ showed high levels of both satisfaction and distress in the context of invasive procedures. Data from standardized measures of family adaptation demonstrated a range of functioning. Analyses by length of time since diagnosis indicated that parental distress remains stable over the course of treatment. The data are discussed with respect to the newly developed measure of parental procedures (the PPQ) and the need for research in this field that provides an integration of procedural distress with parent and family perceptions and adjustment.