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and improvement in self-esteem among program completers (Kabat-Zinn 1994).

This article describes another inner-city program, The Stress Reduction and Relaxation Program, at the Community Health Center in Meriden, Connecticut. The city of Meriden, located in central Connecticut, has a population of 60,000. The Community Health Center of Meriden-CHC/Meriden, for short-opened in 1991. It is one of six primary care centers operated by the Community Health Center, Inc., a nonprofit health care agency established 25 years ago. CHC/Meriden serves approximately 6,500 clients, the majority of whom are Hispanic. Seventy-eight percent of CHC/Meriden's patients receive public assistance, including Medicaid (60 percent), City Welfare (12 percent), and Medicare (6 percent). An additional 18 percent have no health insurance, and 4 percent have private insurance.

The Stress Reduction and Relaxation Program has been offered in either English or Spanish at CHC/Meriden since the fall of 1993. Patients completing the program demonstrate significant reductions in physical and psychologic symptoms and improvement in self-esteem (Creaser 1995, Roth & Creaser 1997). Among patients who complete the Spanish courses, there is a statistically significant decrease in the number of health center visits in the year following completion, compared to the year prior to entering the program (Stanley 1997).

Mindfulness Practice and Personal Change

Patients who complete the Stress Reduction and Relaxation Program at CHC/Meriden often experience dramatic personal changes in a relatively short period of time. Patients report a variety of changes that include: greater peace of mind; more patience; less anger and fewer temper outbursts; better interpersonal communication; more harmonious relations with family members; improved parenting skills; more restful sleep; decreased use of medications for pain, sleep, and anxiety; decrease or cessation of cigarette smoking; weight loss; greater acceptance of aspects of life over which they have no control; greater self-knowledge; and a marked improvement in overall sense of well-being. Similar findings have been reported by patients completing mindfulness-based stress reduction programs at other sites (Kabat-Zinn 1990, Kabat-Zinn 1994, Tate 1994, De Torrijos 1997, Bonus 1997).

In an effort to better understand how mindfulness practice effects health, research on mindfulness-based stress reduction is beginning to move beyond studies of symptom reduction. Studies

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