Shonali Saha

Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis

IMPORTANCE Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. OBJECTIVE To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. EVIDENCE REVIEW We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. FINDINGS After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). CONCLUSIONS AND RELEVANCE Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.

Synthetic and Other Drug Use among High School Students: The Role of Perceived Prevalence, Access, and Harms

ABSTRACT Background: Synthetic and other drugs have become available to teens, yet little is known about risk factors of use. Objective: To examine adolescent use of one class of synthetic drugs and its association with perceptions about its prevalence, access, and risk of substance use. Methods: Adolescents from a convenience sample of 104 middle and high schools (N = 59,218) participated in an anonymous survey to assess school climate and substance use in 2013–2014. Multilevel logistic regression examined the association between risk for synthetic and other drug use, perceptions of substance use, and school-level characteristics. Results: Results indicated that 2,407 (4.3%) students reported synthetic and other drug use in the past 30 days. A large proportion of youth perceived drugs to be problematic at school but underestimated the harms associated with drug use. Participants also perceived tobacco, alcohol, marijuana, and prescription drugs are easy to obtain. Risk factors for synthetic and other drug use included the perception that substance use was a large problem at school, ease of access to drugs, and limited harm associated with drug use. School enrollment and socio-economic status of students reduced odds of drug use. Similar trends were found regarding marijuana use. Conclusion/Importance: Synthetic and other drug use is an emerging public health concern. Many youth identified substances as problematic and easily accessible in their schools but underestimated their potential harms. Health and education professionals need to increase effective education around substance use, including common risk factors for synthetic drug use.