Friday, November 29, 2013

Help-Seeking in the School Context: Understanding Chinese American Adolescents’ Underutilization of School Health Services

In contrast to the “model minority” stereotype, many Chinese American youth exhibit considerable need for both preventative and intervention services.1,2 Data specific to Chinese American adolescents is limited, but studies with samples of Asian American adolescents have indicated greater need for mental health services and higher risk for depression, anxiety, self-injury, and suicide than White or Black youth even when controlling for demographics and caregiver characteristics.2-9 School health programs (SHPs) have been identified as one strategy to overcome barriers like cost and transportation faced by underserved adolescents. In San Francisco, SHPs have been implemented in 15 schools, where Chinese American adolescents make up 45% of students, but only 25% of SHP users.10 In the present study, authors Anyon, Whitaker, Shield, and Franks address this issue by examining the influence of contextual factors (e.g., referrals, peer dynamics) on Chinese American students’ underutilization of SHPs.

Methods and Sample

Researchers conducted data analysis on the 2007 Youth Risk Behavior Survey (YRBS) administered in San Francisco to identify unique factors influencing the help-seeking behavior of Chinese American students. Subsequently, focus groups and interviews were held in Spring 2008 to a) assist in interpreting YRBS findings and b) explore how school contexts influence help-seeking pathways. Students for the focus groups and interviews were recruited from physical education classes in three schools. Students who had previously used SHP services participated in individual interviews instead of focus groups out of concern for privacy and confidentiality.

The survey sample was limited to include 1,700 students who attended schools with a SHP. Grade level (9th-12th) and gender (male, female) were both equally distributed. Racial and ethnic identities are as follows:
  • Chinese American: 42%
  • Latino: 20%
  • Other Asian ethnic groups: 15%
  • White: 9%
  • Black: 7%
  • Multiracial: 4%

While the majority of the sample completed the YRBS in English, five percent of participants completed the survey in another language. Sixty percent of the sample reported at least one risky health behavior and 40% of the sample reported accessing SHP at least one time.

Five focus groups (N=39) were conducted with 44 Chinese American students who reported not accessing their SHP. Participants were in 9th (N=29) and 10th (N=15) grades. Most participants (N=39) were born in the U.S. with their parents having been born outside of the U.S. At home, participants reported speaking primarily Cantonese (N=16), primarily English (N=13), or both Cantonese and English (N=13). Gender was equally distributed between male and female participants.

Seven interviews (three males, four females) were conducted with Chinese American students who reported accessing their SHP. All grade levels were represented. All participants reported being born in the U.S. with their parents having been born outside of the U.S. At home, participants reported speaking primarily Cantonese (N=2), primarily English (N=1), or both Cantonese and English (N=4).


Data analysis resulted in several themes emerging from the YRBS, focus group, and interview data in three areas: 1) recognition of service need, 2) the decision to seek help, and 3) service selection. Here are several highlights of the findings:
  • Chinese American students, compared to peers of other racial and ethnic identities, were significantly less aware of SHP services. Moreover, among participants who had never used SHP services, Chinese American students more often cited not needing services as the reason for non-use.
  • After controlling for various factors (language, sex, grade, risk behaviors), Chinese American students (compared to Black, White, and other Asian peers) were significantly more likely to believe SHP is for troublemakers. Focus group and interview data corroborate these findings, with a common perception among Chinese American students being that the “bad kids” are those who need services. Focus group data also indicated that Chinese American students related regular SHP access to “different” students or students with “problems,” a label they did not want for themselves or their friends.
  • Interview participants indicated that teacher referrals were helpful in easing resistance to services, particularly in regards to behavioral healthcare. Many of the interviewees reported basing service use on others’ assessment of their needs (i.e., referrals).


To address the help-seeking barriers identified in the study, Anyon and colleagues make several suggestions for improving SHP use:
  • Implement support and empowerment groups for Chinese American youth and SHP staff to build relationships that support voluntary help-seeking from SHPs
  • Emphasize universal services (e.g., primary care, recreational activities) to alter student perceptions of SHP use
  • Train teachers in somatic and internalizing symptoms that warrant referrals to SHPs

For More Information

The full article is located in the Journal of School Health, Vol. 83. You can learn more about Dr. Anyon and her work on her faculty page and her DU portfolio.


Anyon, Y., Whitaker, K., Shields, J.P., & Franks, H. (2013). Help-seeking in the school context: Understanding Chinese American adolescents’ underutilization of school health services. Journal of School Health, 83(8), 562-572. doi: 10.1111/josh.12066


1 Choi, Y., & Lahey, B.B. (2006). Testing the model minority stereotype: Youth behaviors across racial and ethnic groups. Social Service Review, 80(3), 419-452. doi: 10.1086/505288

2 Lee, S.J., & Rotheram-Borus, M.J. (2009). Beyond the “model minority” stereotype: Trends in health risk behaviors among Asian/Pacific Islander high school students. Journal of School Health, 79(8), 347-354. doi: 10.1111/j.1746-1561.2009.00420.x

3 Bui, K., & Takeuchi, D. (1992). Ethnic minority adolescents and the use of community mental health care services. American Journal of Community Psychology, 20(4), 403-417. doi: 10.1007/BF00937752

4 Ho, J., Yeh, M., McCabe, K., & Hough, R.L. (2007). Parental cultural affiliation and youth mental health service use. Journal of Youth and Adolescents, 36(4), 529-542. doi: 10.1007/s10964-006-9114-x

5 Garland, A.F., Lau, A.S., Yeh, M., McCabe, K.M., Hough, R.L., & Landsverk, J.A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162(7), 1336-1336. doi: 10.1176/appi.ajp.162.7.1336

6 Goldston, D.B., Molock, S.D., Whitbeck, L.B., Murakami, J.L., Zayas, L.H., Hall, G.C.N. (2008). Cultural considerations in adolescent suicide prevention and psychosocial treatment. American Psychologist, 63(1), 14-31. doi: 10.1037/0003-066X.63.1.14

7 McCabe, K., Yeh, M., Hough, R.L., Landsverk, J., Hurlburt, M.S., Culver, S.W., & Reynolds, B. (1999). Racial/ethnic variation across five public sectors of care for youth. Journal of Emotional and Behavioral Disorders, 7(2), 72-82. doi: 10.1177/106342669900700202

8 Sen, B. (2004). Adolescent propensity for depressed mood and help seeking: Race and gender differences. The Journal of Mental Health Policy and Economics, 7(3), 133-145.

9 Yeh, M., McCabe, K., Hough, R.L., Lau, A., Fakhry, F., & Garland, A. (2005). Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use. Journal of Consulting and Clinical Psychology, 73(5), 800-807. doi: 10.1037/0022-006X.73.5.800

10 Simmons, M., David, R., Larsen-Fleming, M., & Combs, N. (2010). A snapshot of youth health and wellness, San Francisco 2009. San Francisco, CA: Adolescent Health Working Group.

No comments:

Post a Comment