Gospel Music: A Catalyst for Retention, Engagement, and Positive Health Outcomes for African Americans in a Cardiovascular Prevention and Treatment Program.

CONTEXT: Mortality associated with cardiovascular disease is significantly higher in African Americans compared with people of other ethnicities, with hypertension being the single most significant risk factor in this population. Underdiagnosis and undertreatment of hypertension is common. Although cardiovascular lifestyle education and self-management programs are available for the general public, many African Americans prefer to learn about health-promoting activities through interactive programs led by church ministries. OBJECTIVE: This study examined the influence of adding a faith-based protocol using creative musical expression as a catalyst for improving retention, engagement, and positive health outcomes for African Americans participating in a 1-y, lifestyle skills program for reducing cardiovascular risk factors. DESIGN: The study was a randomized, controlled trial. SETTING: The study occurred at Rodman Street Missionary Baptist Church (Pittsburgh, PA, USA). PARTICIPANTS: Participants were African Americans with at least 2 of the following medical conditions: high blood pressure, elevated cholesterol and/or triglycerides, heart attack, angina, stroke, irregular heartbeats, palpitations, shortness of breath, dizziness or fainting, diabetes, and tobacco use. INTERVENTION: Intervention and control groups both participated every other week in one 45-min structured cardiovascular risk reduction educational session over the course of 1 year. During alternative weeks, sessions comprised blood pressure checks, coupled with individualized support discussions focused on challenges and identified obstacles to adherence. In addition to the aforementioned sessions, the intervention group participated in a novel gospel music program with weekly, 45-minute vocal and instrumental sessions. OUTCOME MEASURES: Outcome measures include retention, attendance, systolic and diastolic blood pressures, weight, body mass index, hip measurement, and waist measurement as well as the Short Form-12 (SH-12) Health Survey. RESULTS: Subjects in the intervention group demonstrated a statistically significant 83.3% retention rate in the course of 1 year compared with only 54.3% for the control group (cardiovascular lifestyle education sessions alone). Six dropouts were noted in the intervention group in sharp contrast to 16 dropouts in the control group. Participants in the intervention group were 4.21 times more likely to complete the program than the control group. A significant difference was also noted for attendance, which was higher for the intervention group (21.33 sessions for the intervention group vs 17.95 sessions for the control group). Statistically significant systolic blood pressure reductions noted in both groups were sustained 6 mo postprogram conclusion. In addition, a statistically significant pre-between post-between group improvement in SF-12 Physical Component Scores was noted for intervention subjects in sharp contrast with controls who actually demonstrated worsening scores. CONCLUSIONS: The addition of a gospel music program as a catalyst for increase engagement in a sustainable, healthy lifestyle program warrants further consideration and additional study in African American churches.

Recreational Music-Making alters gene expression pathways in patients with coronary heart disease.

BACKGROUND: Psychosocial stress profoundly impacts long-term cardiovascular health through adverse effects on sympathetic nervous system activity, endothelial dysfunction, and atherosclerotic development. Recreational Music Making (RMM) is a unique stress amelioration strategy encompassing group music-based activities that has great therapeutic potential for treating patients with stress-related cardiovascular disease. MATERIAL/METHODS: Participants (n=34) with a history of ischemic heart disease were subjected to an acute time-limited stressor, then randomized to RMM or quiet reading for one hour. Peripheral blood gene expression using GeneChip® Human Genome U133A 2.0 arrays was assessed at baseline, following stress, and after the relaxation session. RESULTS: Full gene set enrichment analysis identified 16 molecular pathways differentially regulated (P<0.005) during stress that function in immune response, cell mobility, and transcription. During relaxation, two pathways showed a significant change in expression in the control group, while 12 pathways governing immune function and gene expression were modulated among RMM participants. Only 13% (2/16) of pathways showed differential expression during stress and relaxation. CONCLUSIONS: Human stress and relaxation responses may be controlled by different molecular pathways. Relaxation through active engagement in Recreational Music Making may be more effective than quiet reading at altering gene expression and thus more clinically useful for stress amelioration.

Impact of lifestyle factors on prognosis among breast cancer survivors in the USA.

Advances in diagnostic screening and adjuvant therapy have dramatically increased the number of breast cancer survivors in the USA, who may face changes in physical and mental health, social support, quality of life and economics. Women living with breast cancer are increasingly interested in lifestyle modification to decrease the risk of recurrence and mortality while increasing physical and emotional wellbeing. Although organizations such as the American Cancer Society support a healthy diet, frequent physical activity and stress reduction for decreasing breast cancer risk, studies examining the effects of lifestyle on clinical outcomes including survival and prognosis have been inconclusive. With the number of breast cancer survivors predicted to increase to 3.4 million by 2015, it is important to develop effective treatment paradigms that overcome barriers to behavioral modification to improve clinical outcomes and survivorship in breast cancer patients.

Recreational music-making modulates immunological responses and mood states in older adults.

Given that previous studies have shown that recreational music-making has benefits for younger individuals, we explored two questions. (1) Could a recreational music-making protocol improve mood and modulate immunological responses in a direction opposite to that associated with chronic stress in older adults? (2) Would the protocol affect older and younger participants differently? Two groups of volunteers demarcated at age 65 years underwent identical one-hour recreational music-making interventions. Pre-and post-intervention data were collected using blood samples and mood state questionnaires. Data from 27 older and 27 younger volunteers were analyzed for cytokine production levels, natural killer cell activity, plasma catecholamines, and numbers of T cells, T cell subsets, B cells, and natural killer cells. Exercise expenditure was also recorded. In the older group, we found significant increases in the number of lymphocytes, T cells, CD4+ T cells, memory T cells, and production of interferon-gamma and interleukin-6. In the younger group, modulation was non-significant. Worthy of note was the specific immunological changes in the direction opposite to that expected with chronic stress in the older group. The increase in Th1 cytokine IFN-gamma and unchanged Th2 cytokine IL-4 and IL-10 levels in the older group suggests a shift to a Th1-dominant status, a shift opposite to that expected with stress. However, the immunological changes were not statistically different between the two groups. Mood states improved in both groups, but were also not statistically different between groups. Although no statistically significant difference was found between the two age groups, the improvement in immunological profile and mood states in the older group and the low level of energy required for participation suggest this music-making protocol has potential as a health improvement strategy for older individuals.

Creative musical expression as a catalyst for quality-of-life improvement in inner-city adolescents placed in a court-referred residential treatment program.

BACKGROUND: Obstacles to effectively rehabilitate inner-city adolescents in staff-secure residential treatment centers should not be underestimated. Effective evidence-based protocols are lacking to help juveniles who are often angry, detached, frustrated, and in direct conflict with their peers. Facing a myriad of issues ranging from youth delinquency offenses to trauma, abuse, drug/alcohol use, peer pressure/gang-related activities, lack of structure in home environments, mental health diagnoses, and cognitive functioning difficulties, these adolescents present extraordinary challenges to an over-stressed juvenile justice system. MATERIAL/METHODS: A randomized controlled crossover study is utilized to comprehensively evaluate the effectiveness of a novel creative musical expression protocol as a catalyst for nonverbal and verbal disclosure leading to improvements in quality of life for inner-city youth in a court-referred residential treatment program. A total of 52 (30 females and 22 males) African-American, Asian, Caucasian, and Puerto Rican subjects ranging in age from 12 to 18 (mean age 14.5) completed the study. RESULTS: Dependent variable measures included the Child and Adolescent Functional Assessment Scale (CAFAS), the Adolescent Psychopathology Scale (APS), the Adolescent Anger Rating Scale (AARS), the Reynolds Adolescent Depression Scale, 2nd edition (RADS 2), and the Adolescent Visual-Analog Recreational Music Making Assessment (A-VARMMA). Statistically significant (experimental vs control) improvements in multiple parameters include school/work role performance, total depression, anhedonia/negative affect, negative self-evaluation, and instrumental anger. In addition, extended impact (experimental vs control) is characterized by statistically significant improvements 6 weeks after completion of the protocol, for school/work role performance, behavior toward others, anhedonia/negative affect, total anger, instrumental anger, anger, and interpersonal problems. LIMITATIONS: The primary limitations of this study include an extended follow-up period of only 6 weeks post completion of the protocol, and the inability to blind the counselors performing standardized assessments. CONCLUSIONS: This study is the first of its kind to test a replicable creative musical expression protocol as a catalyst for nonverbal and verbal disclosure leading to improved quality of life for inner-city youth in a court-referred residential treatment program. With substantial potential for widespread dissemination, this innovative protocol for adolescents can be readily utilized by behavioral health professionals without prior musical experience.

Recreational music-making modulates natural killer cell activity, cytokines, and mood states in corporate employees.

BACKGROUND: With growing evidence linking job stress to illness, finding an effective means of stress management has become a challenging international endeavor. Although music therapy has attracted the attention of various fields as a promising method for alleviating stress, lack of standardization and paucity of data have served as impediments to widespread utilization. MATERIAL/METHODS: The effects of a Recreational Music-Making (RMM) group drumming protocol was evaluated on Japanese male corporate employees. A total of 20 volunteers participated in a one-hour RMM session while 20 volunteers engaged in leisurely reading for one hour (controls). After a six-month interval, the groups switched activities and underwent one session each. Pre- and post-intervention data were collected using mood state questionnaires and blood samples. Individual and group mean values for natural killer (NK) cell activity, NK cell percentage, and cytokine gene expression were analyzed. RESULTS: NK cell activity in the RMM group increased among individuals with low pre-intervention levels, and decreased among those with high pre-intervention levels. A significant correlation was established between changes in NK cell activity and the changes in the level of gene expressions for interferon-gamma and interleukin-10. The RMM group demonstrated enhanced mood, lower gene expression levels of the stress-induced cytokine interleukin-10, and higher NK cell activity when compared to the control. CONCLUSIONS: Based upon documented changes in NK cell activity, coupled with gene expression changes for interferon-gamma, interleukin-10, and improved mood, this RMM protocol has significant potential for utilization in the corporate wellness environment.

Recreational music-making modulates the human stress response: a preliminary individualized gene expression strategy.

BACKGROUND: A central component of the complex human biological stress response is the modulation of the neuro-endocrine-immune system with its intricate feedback loops that support homeostatic regulation. Well-documented marked gene expression variability among human and animal subjects coupled with sample collection timing and delayed effects, as well as a host of molecular detection challenges renders the quest for deciphering the human biological stress response challenging from many perspectives. MATERIAL/METHODS: A novel Recreational Music-Making (RMM) program was used in combination with a new strategy for peripheral blood gene expression analysis to assess individualized genomic stress induction signatures. The expression of 45 immune response-related genes was determined using a multiplex preamplification step prior to conventional quantitative Real Time Polymerase Chain Reaction (qRT-PCR) mRNA analysis to characterize the multidimensional biological impact of a 2-phase controlled stress induction/amelioration experimental protocol in 32 randomly assigned individuals. RESULTS: In subjects performing the RMM activity following a 1-hour stress induction protocol, 19 out of 45 markers demonstrated reversal with significant (P = 0.05) Pearson correlations in contrast to 6 out of 45 markers in the resting control group and 0 out of 45 in the ongoing stressor group. CONCLUSIONS: The resultant amelioration of stress-induced genomic expression supports the underlying premise that RMM warrants additional consideration as a rational choice within our armamentarium of stress reduction strategies. Modulation of individualized genomic stress induction signatures in peripheral blood presents a new opportunity for elucidating the dynamics of the human stress response.

Recreational music-making: an integrative group intervention for reducing burnout and improving mood states in first year associate degree nursing students: insights and economic impact.

The challenges of providing exemplary undergraduate nursing education cannot be underestimated in an era when burnout and negative mood states predictably lead to alarming rates of academic as well as career attrition. While the multi-dimensional nature of this complex issue has been extensively elucidated, few rational strategies exist to reverse a disheartening trend recognizable early in the educational process that subsequently threatens to undermine the future viability of quality healthcare. This controlled prospective crossover study examined the impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions as well as Total Mood Disturbance (TMD) in first year associate level nursing students. A total of 75 first year associate degree nursing students from Allegany College of Maryland (ACM) participated in a 6-session RMM protocol focusing on group support and stress reduction utilizing a specific group drumming protocol. Burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Statistically significant reductions of multiple burnout and mood dimensions as well as TMD scores were noted. Potential annual cost savings for the typical associate degree nursing program (16,800 dollars) and acute care hospital (322,000 dollars) were projected by an independent economic analysis firm. A cost-effective 6-session RMM protocol reduces burnout and mood dimensions as well as TMD in associate degree nursing students.

Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers.

OBJECTIVES: This controlled, prospective, randomized study examined the clinical and potential economic impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions, as well as on Total Mood Disturbance (TMD) in an interdisciplinary group of long-term care workers. METHODS: A total of 112 employees participated in a 6-session RMM protocol focusing on building support, communication, and interdisciplinary respect utilizing group drumming and keyboard accompaniment. Changes in burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Cost savings were projected by an independent consulting firm, which developed an economic impact model. RESULTS: Statistically-significant reductions of multiple burnout and mood dimensions, as well as TMD scores, were noted. Economic-impact analysis projected cost savings of $89,100 for a single typical 100-bed facility, with total annual potential savings to the long-term care industry of $1.46 billion. CONCLUSIONS: A cost-effective, 6-session RMM protocol reduces burnout and mood dimensions, as well as TMD, in long-term care workers.