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Evaluation of a health careers program for Asian American and Pacific Islander high school students.

The authors evaluated a health careers program in a U.S. urban public high school. After small subgroups of the original sample were removed, participants included 162 Asian American and Pacific Islander students. Analyses of covariance indicated that, compared with the comparison group, the treatment group reported significantly higher levels of social support, school engagement, interest in learning, vocational expectations, and ethnic identity. Implications for multicultural counseling in schools are discussed.

Keywords: Asian American, Pacific Islander, high school

Los autores evaluaron un programa de carreras sanitarias en una escuela secundaria publica de Estados Unidos. Tras la eliminacion de pequenos subgrupos de la muestra original, los participantes incluyeron 162 estudiantes Asiatico-Americanos e Islenos del Pacifico. Los analisis de covarianza indicaron que, comparado con el grupo de comparacion, el grupo de tratamiento expreso unos niveles significativamente mayores de apoyo social, participacion escolar, interes en el aprendizaje, expectativas vocacionales e identidad etnica. Se discuten las implicaciones para la consejeria multicultural en escuelas.

Palabras clave: Asiatico-Americano, Isleno del Pacifico, escuela secundaria


For many ethnic minority adolescents, career decisions are not based on personal choice and interests but are instead bound to socioeconomic needs and cultural obligations (Luzzo & McWhirter, 2001). Specifically, many urban Asian American and Pacific Islander (AAPI) adolescents living in poverty work long hours to support their families at the expense of their academic citizenship (Ma & Yeh, 2010; Shea, Ma, & Yeh, 2007). For these youth, this focus on financial survival and family responsibilities often interferes with possible social relationships, career trajectories, and positive cultural identities (Kenny, Blustein, Chaves, Grossman, & Gallagher, 2003).

Urban public schools are social and political contexts in which adolescents quickly learn who has access to the educational pathways that lead to career success (Rosenbloom & Way, 2004). Students in urban versus suburban schools are less likely to receive a postsecondary degree (Hu, 2003), face high poverty rates (U.S. Census Bureau, 2007), and face more pressure to drop out of school (McIntyre, 2000). Urban youth also confronta variety of sociocultural barriers such as limited contact with career role models, scarcity of community resources, and racism that may circumscribe employment opportunities (Noonan, Hall, & Blustein, 2007). Because of these inequities, counselors must consider culturally relevant programs that provide youth with positive cultural identities, social and community connections, and future career options.

In the current study, we evaluate AAPI students' participation in the School Health Academy (SHA). This school-based program includes specific course work and activities that educate ethnic minority students about health careers in which they are underrepresented (e.g., paramedic, physician's assistant). Our research investigates the impact of this program on participants' social support, school engagement, interest in learning, vocational expectations, and ethnic identity as interrelated variables affecting youths' career beliefs and behaviors.

social support

Urban schools must recognize that ethnic minority youth have career aspirations and hopes that need to be nurtured (Perry, Przybysz, & Al-Sheikh, 2009). In particular, many AAPI youth come from interdependent cultures that prioritize group cohesion (Markus & Kitayama, 1991) and may benefit from peer support (Kenny et al., 2003). Feelings of being supported have been found to contribute positively to ethnic minority students' career development (Turner & Lapan, 2002). Social support specifically has been found to improve AAPI high school students' feelings of connection and support when discussing barriers to career choice (Shea et al., 2007).

Research on ethnic minority high school students indicates that social support significantly and positively predicts school performance (Levitt, Guacci-Franco, & Levitt, 1994), social skills, and career decision making (Ma & Yeh, 2010). Different types of social support have been associated with career exploration and development among ethnic minority urban youth (Diemer, 2007; Kenny et al., 2003). Feelings of social support may also contribute to urban students feeling more engaged in school and with their teachers (Libbey, 2004).

school engagement

The cultural relevance of facilitating peer social connections in schools cannot be separated from more general feelings of school engagement. Schools are critical ecological settings that serve as socializing agents for ethnic minority youth (Trickett & Formoso, 2008), and for AAPI youth in particular (Yeh, Kim, Pituc, & Atkins, 2008). School engagement refers to students' overall connectedness to school and is composed of the students' school interest as well as their bonding to teachers (Wehlage, Rutter, Smith, Lesko, & Fernandez, 1989). Previous research shows the positive association between student engagement in schools and career development (Kenny, Blustein, Haase, Jackson, & Perry, 2006) among ethnic minority high schoolers.

Students who feel connected to counselors, academic mentors, and teachers have demonstrated increased comfort in the school environment (Clauss-Ehlers & Wibrowski, 2007; Kimbrough, Molock, & Walton, 1996). For AAPI adolescents, feeling part of a larger community (in this case, the school) may help to facilitate indigenous assets emphasizing group cohesion (Shed et el., 2007). Hence, a school-based program that encourages school engagement and bonding to teachers may increase students' interest in learning and overall performance in school.

interest in learning

In order for ethnic minority students to be engaged in the curriculum, schools must offer a developmental learning environment emphasizing real-life career options (Mau, 2001). Adolescents are more likely to be engaged in learning when they find relevance in course work pertaining to career work (Lapan, Gysbers, & Petroski, 2001). For adolescents, school and leisure activities provide essential learning experiences that shape self-perception and understanding of the world (Niles & Harris-Bowlsbey, 2005). Programs offering real-life job experiences may motivate students and give them a better understanding of their potential capabilities in future occupations. Real-life learning strategies and school achievement are also associated with students' interest in learning (Ainley, 1993). For counselors, it is important to remember that interest in learning in school contributes to positive vocational expectations.

vocational expectations

Educational strategies that allow students to experience various work settings may promote positive expectations about future careers (Isaacson & Brown, 2000). Often, ethnic minority youth are socialized to believe that their options for academic citizenship and meaningful employment are impossible because of their marginal status in society (Kenny et al., 2003). Having positive vocational expectations involves imagining oneself in multiple occupational roles. This option is frequently silenced among urban youth who must attend to family responsibilities and financial obligations (Luzzo & McWhirter, 2001).

ethnic identity

Ethnic identity is a multidimensional, fluid, and dynamic construct (Phinney & Kohatsu, 1997) that attempts to explain one's sense of connection to, and feelings associated with, an ethnic group. For many years, counselors have been concerned with providing programs that harness positive ethnic identities at school (Casey-Cannon, 2008). The urban school context in particular is where cultural identities are created, validated, ignored, and silenced (Rosenbloom & Way, 2004).

Counseling programs in schools have the potential to reciprocally engage students in a way that encourages positive shifts in their cultural identity (Borrero, 2006). For career development programs, it is important to consider how ethnic and academic identities are not always mutually supported in the classroom (Nasir & Saxe, 2003). Because research has found that racial and critical consciousness contribute positively to career development and vocational expectations (Diemer & Blustein, 2006; Diemer & Hsieh, 2008), programs such as the SHA must find ways to strengthen ethnic identity along with different vocational possibilities.

research question and hypothesis

For the current study, we asked the following research question: Do participants in the SHA have significantly higher levels of social support, school engagement, interest in learning, vocational expectations, and ethnic identity at the end of the program compared with students in a comparison group? Our hypothesis is that SHA students versus comparison group students will have significantly different levels of social support, school engagement, interest in learning, vocational expectations, and ethnic identity at posttest in the expected directions.

description of program

SHA is a school-based program for underrepresented, low-income ethnic minority students who may not typically consider or pursue health careers and provides knowledge and information about potential health occupations, educational paths and degrees, and health issues and topics that affect local communities. This program responds to research demonstrating that many racial groups experience structural social barriers to career aspirations and perceive blocked opportunities (Gibson & Ogbu, 1991). Other researchers have found that for low-income, urban AAPIs, career aspirations come secondary to family obligation (Ma & Yeh, 2010; Shea et al., 2007). These students discussed career options in terms of work obtained during or immediately after high school that could support the family (e.g., waiting tables) and did not consider long-term or "prestigious" careers (e.g., doctor, lawyer; Ma & Yeh, 2010; Shea, Ma, Yeh, Lee, & Pituc, 2009). These findings contrast with previous research on middle-class, suburban Asian American students that found an association between higher socioeconomic status and reported career prestige of the selected professions such as doctor, nurse, or health professional (see Tang, Fouad, & Smith, 1999).

The main objectives of SHA are to (a) to prepare and educate low-income ethnic minority adolescents about various health careers in which they are underrepresented, (b) build their sense of a positive ethnic identity, and (c) promote confidence in pursuing health careers they may not have considered before. SHA is a 2-year program for juniors and seniors, and the main activities include health-related course work; field trips to different health careers; an internship program at a local hospital; social events with community members, teachers, and participants; and group and individual advisement. The specific goals and activities in the program are directly linked with all of our variables of interest. For example, we believe that health-related activities and course work will contribute to students' interest in learning and school engagement. We also contend that field trips and internships will help to promote positive vocational expectations in students. The focus on social activities, group advisement, and interaction with role models demonstrates a priority on social support and ethnic identity.



The original sample included 197 students from a large urban public school in San Francisco. In total, 121 of the students were students enrolled in the SHA group (also known as the treatment group) and 76 were in the comparison (or nonexperimental) group. The comparison group included students from a required career development class at the same school. Because of the small sample sizes of Latino/a and African American students, only AAPI students were included in the data analysis.

The total sample of AAPI students included 162 participants. The final treatment sample used in the analysis (N = 99 students) comprised 42 (42.4%) male and 57 (57.6%) female students, with 44 (44.4%) seniors and 55 (55.6%) juniors. They had a mean age of 17 years (SD = 0.71, range = 16-18 years). The ethnicities of the SHA group included 77 (77.8%) Chinese, nine (9.1%) Chinese/Vietnamese, three (3%) multiracial, five (5.1%) Filipino/a, three (3%) South Asian, and two (2 %) Southeast Asian. There were 17 first-generation students, and the rest (n = 82) were second generation or higher.

All of the students in the treatment group were identified as low income and qualified for free lunch at the school (a requirement of participation). The final comparison sample included 63 total participants. There were 34 (54%) male students and 29 (46%) female students, with 43 (68.3%) seniors and 20 (31.7%) juniors. They had a mean age of 18.8 years (SD = 0.56, range = 18-20 years). The ethnicities of the comparison group included 56 (88.9 %) Chinese, four (6.3%) multiracial, one (1.6%) Filipino/a, one (1.6%) South Asian, and one (1.6%) Southeast Asian. There were 30 first-generation students and 33 were second generation or higher.


Prior to the recruitment of participants, we received full institutional review board approval for the study. The students in both groups and their parents were given flyers about the study along with a consent form indicating their willingness to participate in the study. All students were sent a link via e-mail to a 30-survey website that included all of the research questions.


Demographic information. Students completed information about their age, gender, grade level, generation level, language use, and ethnic and racial background.

Social support. Social support was measured using the Multidimensional Scale of Perceived Social Support-Friends subscale (MSPSS-FR; Zimet, Dahlem, Zimet, & Farley, 1988). Items are scored using a 6-point scale ranging from 1 (strongly disagree) to 6 (strongly agree). A sample item is "I feel a strong sense of connection with other students in nay classes." The scale has been used extensively with diverse urban youth (e.g., Canty-Mitchell & Zimet, 2000; Edwards & Lopez, 2006). The coefficient alpha was .89 for the MSPSS-FR.

School engagement. School engagement was measured using the Bonding to School questionnaire (BTS; Wehlage et al., 1989). The BTS is an 11-item scale with two subscales: Bonding to Teacher and School Interest. An item from the BTS includes "Success in life does not have much to do with the things studied in school" (reverse scored). Participants respond using a 6-point Likert-type scale (1 = strongly disagree to 6 = strongly agree). This scale has been used with large samples of ethnically and economically diverse youth with strong validity and reliability (Annunziata, Hogue, Faw, & Liddle, 2006). The alpha for the current study was .78.

Interest in learning. Interest in learning was measured using the Student Interest in Learning Scale (Borrero & Yeh, 2011), which was developed to assess a student's level of interest in learning in his or her classes. The six-item scale inquires about students' feeling challenged ("I feel challenged in my classes"), engaged ("I feel engaged in my learning"), bored, confident, and satisfied with their classes. The items are scored on a 6-point Likert-type scale (1 = strongly disagree to 6 = strongly agree). Initial findings reveal strong reliability coefficients with a diverse student sample. The alpha coefficient for the overall scale was .78.

Vocational expectations. Vocational expectations were measured using the six-item Vocational Outcome Expectation scale (VOE; McWhirter, Crothers, & Rasheed, 2000), which measures outcome expectation related to career. Sample items include "My career planning will lead to a satisfying career for me" and "I can make my future a happy one." Responses on the items are rated on a 6-point scale (1 = strongly disagree to 6 = strongly agree). The total score ranges from 6 to 36, with higher scores representing more positive outcome expectations. The VOE was normed on urban high school students. It has also been used in prior research with high school students from diverse racial backgrounds, and strong validity and reliability have been established (e.g., McWhirter et al., 2000). In the current study, the alpha was .93.

Ethnic identity. Ethnic identity was assessed using the Ethnic Identity Scale (EIS; Umana-Taylor, Yazedjian, & Bamaca-Gomez, 2004). The 17-item EIS includes subscales that assess individuals' exploration (seven items; e.g., "I have attended events that have helped me learn more about my ethnicity"), resolution (four items; e.g., "I have a clear sense of what my ethnicity means to me"), and affirmation (six items; e.g., "I wish I were of a different ethnicity") regarding their ethnicity. Items are scored using a 4-point Likert scale. The scale helps to provide a better understanding of how adolescents identify with their own ethnicity and how they are affected by that particular identity. In the current study, the alpha coefficient was .88.


Members of both the treatment and the comparison groups completed all of the surveys at the beginning and end of SHA. Preliminary descriptive analyses were performed to ensure that the data had a normal distribution. We conducted a multiivariate analysis of variance (MANOVA) to assess any differences based on the main demographic variables. No differences were found, so we did not control for any of the demographic variables. To assess the effects of the SHA on student outcomes, we performed five analyses of covariance (ANCOVAs), one for each of the dependent variables. ANCOVA is able to partial out the effects of the pretest scores to assess whether the pretest measures differences across treatment and comparison conditions. Pretest scores served as the covariates in the ANCOVAs that were conducted in the current study.


As shown in Table 1, results indicate that, compared with a matched comparison group, students who participated in the SHA had significantly higher levels of social support, school engagement, interest in learning, vocational expectations, and ethnic identity. Specifically, students' social support, F(1, 160) = 10.74, p < .001, partial [[eta].sup.2] = .06; school engagement, F(1, 160) = 15.66, p < .001, partial [[eta].sup.2] = .09; interest in learning, F(1, 160) = 7.90, p < .01, partial [[eta].sup.2] = .05; vocational expectations, F(1, 160) = 9.44, p < .001, partial [[eta].sup.2] = .06; and ethnic identity, F(1, 160) = 4.24, p < .05, partial [[eta].sup.2] = .03, differed at posttest across conditions after the effects of pretest scores were partialed out. For social support, school engagement, interest in learning, vocational expectations, and ethnic identity, the estimated mean scores were higher in the treatment versus comparison groups, suggesting that students in the SHA had higher levels of all of these variables as a result of being in the program.


The results of our study indicate that AAPI students who participated in a SHA tended to have significantly higher levels of social support, school engagement, interest in learning, vocational expectations, and ethnic identity after the program. These results speak to the importance of exposure to multiple career options, relationship building, and the need for such programs for AAPI youth in urban schools.


Consistent with our hypotheses, students in the SHA reported increased levels of social support at the time of the posttest compared with those in the comparison group. Increased use of social support is especially important for youth from interdependent cultures who tend to rely on peer relationships when coping with stressors such as racism and negative stereotypes at school (Borrero, Yeh, Tito, & Luavasa, 2010). Ethnic minority students often value support from friends from the same cultural background because other more Westernized forms of seeking help are culturally stigmatized and the students may feel misunderstood (Shea et al., 2007).


As predicted, SHA students showed increased school engagement compared with their peers who were not in the SHA. The authentic application of learning and connection to career trajectories is what can make school, and therefore academic achievement, a priority for youth (Lapan et al., 2001) and something they want to be part of. Again, especially for AAPI youth who are so often alienated from the structures and systems of school that make achievement attainable (Borrero, Yeh, Cruz, & Suda, 2010; Borrero, Yeh, Tito, & Luavasa, 2010), this program proved worthy for students from many different cultural backgrounds. Furthermore, their increased scores in school engagement show that adolescents in the program were more invested in their academics (Ainley, 1993) and also in the relationships they were forming with students and teachers alike. These aspects of school belonging and connection in the SHA further promote the cultural assets of AAPI youth and help them to navigate their cultural and academic identities at school.


SHA students' increased interest in learning provides evidence that the real-life, career-oriented attributes of learning that occurred in the program had an effect on participants. This finding suggests that these ethnic minority adolescents are more likely to connect their classroom learning with the career options they were exposed to during the program. Ethnic minority adolescents in this sample were able to make connections between the learning that they were doing in school and the realities of life in their communities (Shea et al., 2009). This connection between school and home made learning more authentic for the students and increased their desire to apply learning in meaningful ways.


As predicted, SHA participants' vocational expectations increased over time as compared with their peers in the comparison group. This finding emphasizes the importance of these adolescents being able to see and interact with culturally similar professionals who are successful in real-world careers. In addition, it is clear that these contacts and experiences had an effect on participants' ideas for future career identities. Because students learned about the roles and realities of different careers in the health professions, they were able to reflect on their own abilities to engage in such work. Especially for ethnic minority youth, having positive vocational expectations is pivotal in bolstering the self-confidence and resilience needed to overcome the socioeconomic needs and cultural obligations they face (Diemer & Hsieh, 2008).


AAPI students' heightened sense of ethnic identity at posttest reveals that the SHA not only provided a space for participants to bond with students from many different cultural groups (Ensher & Murphy, 1997) but also offered these adolescents the chance to think about their own career trajectories as members of their cultural group, as well as what it would be like to work as a health professional. Specifically, participants were actively engaged in meaningful experiences with members of their own cultural groups who have demonstrated successful pathways in a multitude of careers. These interactions offered opportunities for students to see ethnically similar role models who encouraged cultural belonging and affirmation (Gonzales-Figueroa & Young, 2005). The increase in the SHA students' positive ethnic identities underscores the ways in which counseling programs can create, promote, and validate cultural assets and identities.


Because of different student cultural backgrounds as well as geographic location and school setting, we caution against generalizability. In addition, the number of students in the comparison group was smaller than the number of students in the treatment group, thus posing a potential methodological limitation. Despite the different sample sizes, the ANCOVA controlled for any differences based on pretest scores. Furthermore, tests of statistical power revealed strong power for the sample size used. Another limitation was that we did not have specific income information about the sample. A requirement for participation in the program was that students must qualify for the district's free-lunch program, which is based on family income level. However, we did not have this information for the comparison group. Moreover, there were more first-generation students in the comparison group versus the treatment group. It is possible that the differences in our findings may have been somehow related to differences in our two groups.

implications for counseling and research

The results of this study underscore the importance of developing counseling services for AAPI adolescents to help them develop positive, strong, and integrated cultural, social, academic, and career identities. Although our findings certainly provide strong justification for replication and future adaptation of this specific type of career-focused program, there are two main strengths of the program that we believe have long-standing advantages for programs in urban schools. First, SHA exemplifies the powerful impact of ecologically based counseling programs for AAPI adolescents' development. Students in the SHA reported positive outcomes associated with their relationships with their peers, teachers, community, school, and cultural group. These are critical social settings for adolescents and speak to the potential role that counselors can have in shaping relational, academic, and cultural experiences for AAPIs. Future counseling interventions for AAPI students may consider ways to incorporate culturally relevant best practices that promote students' assets and holistic development.

A second interrelated strength that emerged is the role of collaboration and community in counseling programs. Specifically, the SHA was designed to include multiple partnerships with individuals in different health settings. For example, students visited local community agencies and health clinics. These visits provided opportunities for personal interactions with visible role models and mentors. Because many of these adolescents have never met someone from their cultural group who represented a future profession, the impact of having a role model or mentor is especially meaningful to their personal, professional, and reference-group identity making.

Received 04/05/11

Revised 11/03/11

Accepted 01/13/12


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Christine J. Yeh, Department of Counseling Psychology, and Noah E. Borrero, Teacher Education Department, University of San Francisco. Correspondence concerning this article should be addressed to Christine J. Yeh, Department of Counseling Psychology, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117 (e-mail:
Mean Score Changes of Variables From Pretest to Posttest

                              Pretest Means        Posttest Means

Measure                   Control   Treatment   Control   Treatment

Social support             20.25      22.80      21.23      23.18
School engagement          19.48      19.20      18.55      20.80
Interest in learning       23.65      24.33      24.31      26.15
Vocational expectations    27.32      28.20      26.82      28.83
Ethnic identity            69.24      69.57      65.97      69.01


Measure                      F         ES

Social support            10.74     .06 ***
School engagement         15.66     .09 ***
Interest in learning      7.90      .05 **
Vocational expectations   9.44      .06 ***
Ethnic identity           4.24      .03 *

Note. N = 162. ES = effect size.

* p < .05. ** p < .01. *** p < .001.
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Author:Yeh, Christine J.; Borrero, Noah E.
Publication:Journal of Multicultural Counseling and Development
Article Type:Report
Geographic Code:1USA
Date:Oct 1, 2012
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