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Cognitive impairment is pronounced in forcibly displaced populations. This study examined how education and English proficiency are associated with cognitive difficulties between refugee and non-refugee older immigrants. Analyses assessed the moderating effect of refugee status on the association of education and English proficiency with cognitive difficulty. Results revealed that higher educational attainment and English proficiency were significantly associated with decreased odds of reporting cognitive difficulty. Further, refugees who had completed high school and were English proficient exhibited greater cognitive resilience. The implications emphasize the need for policies and focused interventions related to education and English language programs for resettled refugees. [ABSTRACT FROM AUTHOR]

After the onset of the COVID-19 pandemic in 2020, Asian Americans in the United States have experienced a surge in anti-Asian crimes, leading to heightened psychological distress among this community. Consequently, the mental well-being of Asian Americans demands greater attention than ever. Regrettably, Asians tend to underutilize or delayed mental health care treatments. This study examines the conventional and alternative mental health service utilization among Asians in the United States according to their English proficiency. From the 2015–2018 National Survey on Drug Use and Health, this study examined 3,424 self-identified non-Hispanic Asians aged 18–64 with Kessler score of at least 5. Stratified bivariate analysis and multivariable logistic regression analysis were conducted. Regardless of English proficiency, Asians did not utilize alternative mental health service more than conventional mental health service. However, those with limited English proficiency consistently utilize care less than those with English proficiency. Need factors, such as mental distress severity and self-rated health status, were significant factors associated with their mental health service utilization. English proficiency remains a structural factor in preventing Asians from utilizing mental health services regardless of the nature of services. Due to the COVID-19 pandemic, more Asians have been experiencing mental distress. This study demonstrates a particular need for mental health services that are culturally specific and Asian language friendly. [ABSTRACT FROM AUTHOR]

Objectives: Patients with limited English proficiency (LEP) have been shown to experience disparities in emergency department (ED) care. The objectives of this study were to examine the associations between LEP and irregular ED departures and return ED visits. Methods: We conducted a multicenter cross‐sectional analysis of 18 EDs within an integrated health system in the upper Midwest from January 1, 2018, to December 31, 2021. ED visits of pediatric and adult patients who were discharged on the index visit were included for analysis. We analyzed the association of LEP with irregular departures, 72‐h and 7‐day return visits, and ED disposition at the time of that return visit. Multivariable model associations were calculated using generalized estimating equations and reported as odds ratios (OR) with 95% confidence intervals (CIs). Results: A total of 745,464 total ED visits were analyzed, including 27,906 (3.7%) visits among patients with LEP. The most common preferred languages among patients with LEP were Spanish (12,759; 45.7%), Somali (4978; 17.8%), and Arabic (3185; 11.4%). After multivariable adjustment there were no differences in proportions of irregular departures (OR 1.09, 95% CI 0.99–1.21), 72‐h returns (OR 0.99, 95% CI 0.92–1.06), or 7‐day returns (OR 0.99, 95% CI 0.93–1.05) between patients with LEP or English proficiency. Patients with LEP returning within 72 h (OR 1.19, 95% CI 1.01–1.40) and 7 days (OR 1.15, 95% CI 1.01–1.33) were more likely to be admitted to the hospital. Conclusions: After multivariable adjustment, we did not find an increased frequency of irregular ED departures or 72‐h or 7‐day returns among patients with LEP compared with people proficient in English. However, we did find that higher proportions of patients with LEP were admitted to the hospital at the time of the return ED visit. [ABSTRACT FROM AUTHOR]

Objectives: To examine the cross-sectional association of linguistic adaptation with cognitive function, as well as its interactions with sociodemographic and health profiles in older Chinese and Korean immigrants in the U.S. Methods: Using harmonized data (N = 5063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we examined between- and within-group differences in the role of linguistic adaptation (English use in older Chinese Americans and English proficiency in older Korean Americans) in cognitive function. Results: The positive association between linguistic adaptation and cognitive function was common in both groups. We also found that the relationship was pronounced among subgroups with the underlying linguistic and cognitive vulnerabilities (i.e., the very old, women, those with low education, and newly immigrated individuals). Discussion: Findings show the importance of linguistic adaptation in older immigrants' cognitive health and suggest a need for targeted interventions for high-risk groups. [ABSTRACT FROM AUTHOR]

Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English proficiency influences access in US psoriasis patients. To compare biologic medication use for psoriasis patients with differing English proficiency levels. Population study of US psoriasis patients using the 2013–2017 Medical Expenditure Survey. Among a total of 4,470,820 US psoriasis patients (weighted), 4,028,119 (90.1%) had perfect English proficiency, and 442,700 (9.9%) had less than perfect English proficiency. Among the total population, 422,523 (9.5%) had access to biologics. Among those who received biologics, 411,411 (97.4%) of those had perfect English proficiency, and 11,112 (2.6%) of those had less than perfect English proficiency. Multivariate logistic regression found that patients with less than perfect English proficiency were significantly less likely to have access to biologics [OR 0.015 (95% CI: 0.001–0.179); p =.002], after adjusting for insurance status, income, education, healthcare utilization, and other sociodemographic and clinical factors. Psoriasis disease severity not specified. Psoriasis patients with low English proficiency are significantly less likely to receive biologics than those with high English proficiency. Those with higher English proficiency are 61 times more likely to access biologics. [ABSTRACT FROM AUTHOR]

This study examined factors in immigrant children's use of mental health services. Employed data described 4873 immigrant parents and children participating in the 2018 National Survey of Children's Health. Logistic regression results associated these children's likelihood of receipt of mental health services with, in positive direction, child mental health problems (ADD/ADHD; depression; anxiety; conduct/behavior problems), child age, parent education, and English proficiency. Associated in negative direction with likelihood of receipt of services were child physical health, Asian ethnicity, married parent, employed parent, and first-generation immigrant family. We found no association of services receipt with "other mental health problem", child gender, other minority races/ethnicities, parent gender, parent age, percentage of child's lifetime spent as U.S. resident, or health insurance status. Study implications include need to disseminate, in immigrants' native languages, information on mental health, available services, and Medicaid; and need to increase access to services by providing immigrant families with child care, interpreters, flexible scheduling, in-home therapy, bilingual therapists, and therapists sharing child's own race/ethnicity. Highlights: A study examined mental health services utilization in a national sample of immigrant children. Being from a first-generation immigrant family lowered a child's likelihood of using such services. Not speaking English at home decreased children's likelihood of using mental health services. Having relatively well-educated parents increased children's likelihood of using such services. Asian immigrant children were less likely to use mental health services than White immigrant children. [ABSTRACT FROM AUTHOR]

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Telemedicine provided older adults the ability to safely seek care during the coronavirus disease (COVID-19) pandemic. This study aimed to evaluate the potential impact of acculturation factors in telemedicine uptake between ethnic groups. As part of the National Health and Aging Trends Study 2018 survey, 303 participants (≥65 years) were interviewed. We assessed the impact of acculturation on telemedicine readiness by race and ethnicity. Compared to the white non-Hispanic immigrant population, Hispanic and Asian/Pacific Islander (API) populations had significantly lower telemedicine readiness and uptake. Limited English proficiency or older age at the time of migration was associated with telemedicine unreadiness and uptake in the Hispanic and API populations. Our findings suggested that acculturation factors play a substantial role in telemedicine uptake among older adult immigrants in the United States. Therefore, acculturation factors should be considered when promoting and adopting telemedicine technologies in older adults., Competing Interests: IRB ReviewSince all the analyses were performed on de-identified NHATS data which is publicly available for download, IRB review was not required. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study investigated the relation between Internet addiction and several associated factors (mental health, academic performance, socioeconomic status, self-esteem, demographic characteristics) for international students in the United States. One hundred and fifty-seven international students at a U.S. university completed five questionnaires: an Internet usage behavior questionnaire, an Internet addiction scale, a self-esteem inventory, a mental health inventory, and a demographic questionnaire. Data were analyzed using SPSS to examine the relation between Internet addiction and associated factors. The results indicated that male students who speak English as a second language and who are not religious are more likely to develop Internet addiction. Academic performance and socioeconomic status were found to be positive predictors of Internet addiction, and mental health and self-esteem were found to be negative predictors of Internet addiction. The relations between other associated factors were also examined. [ABSTRACT FROM AUTHOR]

Focused on the health literacy of two subgroups of Asian immigrants, Korean (N = 118) and Vietnamese (N = 105), this study examines the interrelationships among demographics, health literacy, self-perceived health status, and quality of life using structural equation modeling. Findings suggest that, although often labeled as Asian immigrants as an aggregate in the health literature, immigrants from Korea and Vietnam report significant differences in areas of demographics (age, citizenship, time in the US, education, marital status, English proficiency, and health insurance), utilization of health services (mammogram screening, pap smear, colorectal screening, visit to doctors), health literacy, and self-perceived health status, representing their own unique ethnic and immigration status. As hypothesized, for both Korean and Vietnamese immigrants, demographics (especially English proficiency) influence health literacy, which in turn affects self-perceived health status and quality of life. Self-perceived health status also directly affects quality of life. Therefore, health communication and interventions should focus on improving health literacy and alleviating health literacy disparities, which could increase the well-being and QOL among subgroups of Asian immigrants. [ABSTRACT FROM AUTHOR]

Background: In the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes.Objective: To describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016.Design: We used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents.Participants: Respondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency.Main Measures: Insurance coverage was a binary variable indicating any health insurance coverage during the past 12 months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care.Key Results: Gains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency.Conclusions: Disparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA. [ABSTRACT FROM AUTHOR]

This study examined the effects of immigration and language factors on depressive symptoms and suicidal ideation among Asian American adolescents and young adults during three developmental periods. Using the National Longitudinal Study of Adolescent to Adult Health, linear regression and linear probability models were used for the data analyses. A significant group difference was observed in suicidal ideation between Asian American youth who were born in the U.S. and whose families spoke English at home and all other Asian American youth. Differences between ethnic groups were found in the mean scores of depressive symptoms and the probabilities of suicidal ideation between Asian American youth and non-Hispanic white (NHW) youth. The findings of this study reveal mental health disparities between Asian American youth and NHW youth in the U.S. These results emphasize the importance of implementing culturally sensitive mental health interventions for Asian American adolescents and young adults. [ABSTRACT FROM AUTHOR]

Objectives: Understanding the experience of foreigner objectification is relevant given the possibility of ethnocentrism, xenophobia, and mistrust of immigrants in the United States. The present study examines main and interactive effects of objectification and English proficiency on developmental outcomes among immigrant mothers and children.Method: Our study includes 173 youth from Latinx backgrounds (52% female, Mage = 12.86 years, SD = .68; 87% United States-born) and their mothers (Mage = 38.26 SD = 5.65; all foreign-born) from emerging immigrant contexts.Results: Bivariate and regression analyses suggest that lower English proficiency was associated with more objectification for youth; whereas higher English proficiency was associated with more objectification for mothers. For youth only, English proficiency was positively correlated with American identity. For both parents and youth, foreigner objectification was linked with negative psychological outcomes (e.g., mothers' depressive symptoms, youths' low self-esteem).Conclusions: Being subjected to assumptions that challenge individuals' social status can be psychologically harmful. Nuanced developmental variation, and implications regarding the dual role of objectification and English proficiency are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

This paper explores whether native-immigrant differences in mathematics test scores can be accounted for by a lack of English proficiency. To identify the causal effect of English proficiency on test scores, I use the fact that language proficiency is closely linked to age at arrival, and that migrant children arrive at different ages from different countries. Using US data from the New Immigrant Survey, I find that English proficiency has no effect on mathematics tests and therefore they can be used to assess students’ ability net of language effects. [ABSTRACT FROM AUTHOR]

Limited English proficiency is associated with disparities across diverse health outcomes. However, evidence regarding adverse birth outcomes across languages is limited, particularly among U.S. Asian and Pacific Islander populations. The study goal was to consider the relationship of maternal language to birth outcomes using statewide hospitalization data. Detailed discharge data from Hawaii childbirth hospitalizations from 2012 (n = 11,419) were compared by maternal language (English language or not) for adverse outcomes using descriptive and multivariable log-binomial regression models, controlling for race/ethnicity, age group, and payer. Ten percent of mothers spoke a language other than English; 93% of these spoke an Asian or Pacific Islander language. In multivariable models, compared to English speakers, non-English speakers had significantly higher risk (adjusted relative risk [ARR]: 2.02; 95% confidence interval [CI]: 1.34–3.04) of obstetric trauma in vaginal deliveries without instrumentation. Some significant variation was seen by language for other birth outcomes, including an increased rate of primary Caesarean sections and vaginal births after Caesarean, among non-English speakers. Non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries. [ABSTRACT FROM PUBLISHER]

The authors examined the help‐seeking attitudes of 109 Chinese international students studying in the United States. Results revealed that significant relationships exist among acculturation, ethnic identity, English proficiency, and attitudes toward seeking professional counseling services. Limitations and recommendations for future research are discussed. Los autores examinaron las actitudes hacia la búsqueda de ayuda de 109 estudiantes internacionales chinos cursando estudios en Estados Unidos. Los resultados revelaron que existen relaciones significativas entre la aculturación, la indentidad étnica, el dominio del idioma y las actitudes hacia la búsqueda de servicios profesionales de consejería. Se discuten las limitaciones y recomendaciones para investigaciones futuras. [ABSTRACT FROM AUTHOR]

The authors' objective was to investigate the association between Chinese immigrant mothers' authoritative parenting and their children's socioemotional and behavioral difficulties. Participants were 136 first-generation Chinese immigrant mothers with 3–5-year-old children residing in the United States. Authoritative parenting was associated with lower socioemotional and behavioral difficulties in children as reported by preschool teachers. Further moderation analyses revealed that immigrant mothers' English proficiency moderated the association between authoritative parenting and children's difficulties. Specifically, authoritative parenting was significantly associated with fewer total difficulties only for children with mothers who reported higher English proficiency. [ABSTRACT FROM PUBLISHER]

We examined how social factors (i.e., social connection, social self-efficacy, and comfort with disclosing distress) and English proficiency predicted two subjective well-being trajectories (i.e., negative affect and satisfaction with life). The sample of this four-wave longitudinal study (across pre-arrival and first three semesters) included 411 Chinese international students studying in the United States. Four distinct trajectory classes were identified for negative affect and satisfaction with life. The classes generally included individuals who had (a) consistently high well-being, (b) experienced some degree of culture shock, (c) enhanced well-being, and (d) low well-being. Social connection with mainstream society was a better predictor of satisfaction with life trajectories than social connection with one’s ethnic community. Comfort with disclosing distress and self-perceived English proficiency were significant predictors only for the satisfaction with life trajectories. The important role of social factors and English proficiency in international students’ adjustment and practical implications are also discussed. [ABSTRACT FROM PUBLISHER]

Cervical cancer is one of the most important disease burdens experienced by Vietnamese-American women. Human papillomavirus (HPV) is the etiological agent in almost all cases of cervical cancer. We surveyed Vietnamese-American women to determine receipt of HPV vaccine and assessed if limited English proficiency and knowledge related to HPV vaccine were associated with HPV vaccine uptake. Of the 113 Vietnamese-American women who participated in the study, 58 % (n = 68) was born in Vietnam. The mean years of residency in the United States was 12.75 years. Only 16 (14 %) reported receiving HPV vaccine and 11 (9 %) reported receiving all three shots. Thirteen women responded that they are not at all likely to receive HPV vaccine. Of the whole sample, 47 % (n = 53) reported proficiency in spoken and written English. English proficiency was significantly associated with receipt of HPV vaccine (OR = 4.4; confidence interval (95 % CI) = 1.2; 16.50; p = 0.03). Of the knowledge items, 70 % (n = 79) responded correctly that HPV increases the risk for cervical cancer. However, as many as 60 % responded incorrectly, that HPV infection can be cured with medication. The item, 'People infected with HPV can be cured with medication,' was the most important variable associated with receipt of HPV vaccine. Specifically, those with correct response were 3.8 times more likely to report receiving the HPV vaccine (OR = 3.8; 95 % CI = 1.1; 13.5; p = 0.04). Important public health needs are the development and evaluation of educational programs on HPV and cervical cancer that are designed for Vietnamese-American women. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that children’s approaches to learning (ATL) at kindergarten entry predict their academic achievement years later. However, the gains associated with ATL may be diminished for Hispanic immigrant children, many of whom are English language learners (ELLs). We tested whether ATL predicted math scores in a sample of first- and second-generation Hispanic immigrants drawn from the Early Childhood Longitudinal Study—Kindergarten cohort. We further tested whether English proficiency moderated this association. Separate models by study wave (kindergarten, first grade, and third grade) were run to examine whether associations among English proficiency, ATL, and math changed over time. Results indicated that ATL, measured at the previous wave, predicted math scores in first and third grade, but not kindergarten. Moreover, in third grade, ATL predicted math only for children who were proficient in English. The implications for Hispanic immigrant children are discussed. [ABSTRACT FROM PUBLISHER]

Abstract: Studies show math achievement to be the best predictor of entering post-secondary education. However, less is known about the predictors of math achievement, particularly among immigrant youth. This study examined English proficiency and peer interethnic relations as predictors of mathematics achievement among Latino and Asian high school students, postulating an interaction between the predictors and mediation by academic motivation. A multilevel moderated-mediation model was used to analyze data from a national sample of 2113 non-native English speaking Latino and Asian students attending high school in the U.S. We found that higher academic motivation mediated the relationship between English proficiency during their sophomore year and gains in senior math achievement scores for both Asian and Latino students. For Latino students however, this indirect path was only significant for students whose perceptions of positive peer interethnic relations at school were average or above average. [Copyright &y& Elsevier]

This study examined the relationship between scores on the TOEFL Internet-Based Test (TOEFL iBT®) and academic performance in higher education, defined here in terms of grade point average (GPA). The academic records for 2594 undergraduate and graduate students were collected from 10 universities in the United States. The data consisted of students’ GPA, detailed course information, and admissions-related test scores including TOEFL iBT, GRE, GMAT, and SAT scores. Correlation-based analyses were conducted for subgroups by academic status and disciplines. Expectancy graphs were also used to complement the correlation-based analyses by presenting the predictive validity in terms of individuals in one of the TOEFL iBT score subgroups belonging to one of the GPA subgroups. The predictive validity expressed in terms of correlation did not appear to be strong. Nevertheless, the general pattern shown in the expectancy graphs indicated that students with higher TOEFL iBT scores tended to earn higher GPAs and that the TOEFL iBT provided information about the future academic performance of non-native English speaking students beyond that provided by other admissions tests. These observations led us to conclude that even a small correlation might indicate a meaningful relationship between TOEFL iBT scores and GPA. Limitations and implications are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Using the Early Childhood Longitudinal Study-Birth Cohort (n≈6800), we examined the factors explaining variation in school readiness in a large and nationally representative sample of children in immigrant and non-immigrant families. In OLS regression models with rich controls to account for selection, we found that language background was a key factor in explaining children of immigrants'' expressive language and early reading at kindergarten, whereas both socioeconomic status and language background helped explain their performance in math. [Copyright &y& Elsevier]

Using the 2000 US census data for immigrants of twenty language groups resided in metropolitan areas, we test the hypothesis that the rate of returns (in earnings) to English proficiency is not constant but varies with the language environment (as defined by group size, segregation, linguistic heterogeneity and inequality) in which immigrants are embedded. Results from our hierarchical model indicate that while an increase in the size and segregation of the language group diminishes returns to English proficiency, a rise in linguistic heterogeneity and inequality in the metropolitan area has the opposite effects. This study expands the scope of the previous studies by identifying conditions under which returns to English proficiency among immigrants are modified by a set of contextual factors often overlooked. [ABSTRACT FROM AUTHOR]

When nurses who are educated internationally immigrate to the United States, they are expected to have English language proficiency in order to function as a competent nurse. The purpose of this research was to provide sufficient information to the National Council of State Boards of Nursing (NCSBN) to make a defensible recommended passing standard for English proficiency. This standard was based upon the Test of English as a Foreign Language (TOEFLTM). A large panel of nurses and nurse regulators (N = 25) was convened to determine how much English proficiency is required to be minimally competent as an entry-level nurse. Two standard setting procedures, the Simulated Minimally Competent Candidate (SMCC) procedure and the Examinee Paper Selection Method, were combined to produce recommendations for each panelist. In conjunction with collateral information, these recommendations were reviewed by the NCSBN Examination Committee, which decided upon an NCSBN recommended standard, a TOEFL score of 220. Because the adoption of this standard rests entirely with the individual state, NCSBN has little more to do with implementing the standard, other than answering questions and providing documentation about the standard. [ABSTRACT FROM AUTHOR]

The increasing linguistic diversity of the United States student population has brought to the forefront problems in the interpretation of test scores for non-native speakers of English in graduate admissions. The degree to which test scores reflect English proficiency was studied using data on N = 451 students whose native language was Spanish. They had taken the GRE, English proficiency tests, and the PAEG, a test in Spanish used for admission to graduate schools in Puerto Rico. Regression analyses revealed that the proportion of variance explained by the English proficiency terms (independent of developed skills measured in Spanish) was highest for the GRE verbal test (34%), lowest for the quantitative test (8%) and intermediate for the analytical test (16%), the Psychology (18%) and Biology (17%) Subject tests. These findings are discussed in light of efforts to increase access to higher education for Hispanic students. [ABSTRACT FROM AUTHOR]

Objective: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and associated with over 90% of cervical cancer cases.  The present study aimed to examine levels of HPV and HPV vaccine awareness and associated factors, particularly English proficiency, across various racial/ethnic groups., Methods: Two cross-sectional datasets, 2017 and 2018 Health Information National Trends Survey (HINTs), were analyzed for the current study. Binary logistic regression analyses were conducted., Findings: Non-Hispanic Whites had the highest levels while non-Hispanic Asians had the lowest levels of awareness regarding HPV and the HPV vaccine. English proficiency was significantly associated with increased HPV awareness among all groups except non-Hispanic Asian, and was significantly associated with greater HPV vaccine awareness in all groups., Discussion: In order to promote health equity across race/ethnicity, language barriers among minorities should be addressed when implementing health education on HPV and the HPV vaccine.

This study examines whether English proficiency and geographic context explain health insurance status among older Latino and Asian immigrants in the U.S. Drawn from the 2010-2012 ACS PUMS, 57,936 Latino and 47,742 Asian immigrants aged 65 and older were selected. Logistic regression analysis was conducted for the U.S. as a whole and separately by geographic region. In the entire U.S., having limited English proficiency (LEP) and being proficient in English (EP) increased odds of being uninsured among Latino immigrants, whereas LEP and EP decreased odds of being uninsured among Asian immigrants. In the stratified analyses for geographic regions, there were significant ethnic differences in the directionality of the relation between English proficiency and uninsured status. Regional institutions should take care to expand access to information on health care and insurance coverage to racial/ethnic minorities, taking into account the characteristics of these groups at the local level.

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.