Greater English Proficiency Research Articles

Health Literacy and Patient Compliance: Implications for Public Health Interventions from a COVID-19 Study

A wealth of research has documented the detrimental consequences of health illiteracy and its impact on a multitude of health-related issues. Scholars across various disciplines have consistently shown that individuals with higher educational attainment, those born in the United States, and those with greater English proficiency, are more likely to exhibit higher levels of health literacy. However, the extent to which these individuals adhere to established health guidelines remains an understudied area. Therefore, we analyzed data from one of the largest cities impacted by COVID-19 in the United States, to determine whether traditional predictors of high health literacy levels translated into higher levels of vaccination intentions and vaccination doses, to protect themselves and their communities from COVID-19 related illness and death. The results indicated that individuals with high health literacy levels do not necessarily exhibit higher levels of compliance, thus challenging conventional wisdom.

Correlates of HIV Testing Among Asian Immigrant Female Sex Workers in New York City and Los Angeles County.

This analysis examined correlates of HIV testing among Asian immigrant female sex workers in massage parlors. We interviewed 69 Chinese and Korean immigrant women who provided sexual services in massage parlors in New York City or Los Angeles County (2014-2016). Multivariable logistic regression results showed that participants who were younger, have lived in the U.S. for a longer period of time, had greater English proficiency, perceived higher HIV risk, or were living with an intimate partner were more likely to have had an HIV test. Disclosing sex work to a close friend was also positively associated with HIV testing at p < .1. These correlates may reflect differential access to information, systems, and social networks that would facilitate HIV testing, highlighting the importance of reducing social isolation and increasing HIV education, especially for older women who have come to the U.S. more recently. As the literature has indicated that Asian immigrant female sex workers experience high rates of intersectional stigma, efforts to mitigate these intersecting stigmas could further these objectives.

6 Code-switching, Language Attitudes, and Executive Function in Latinx Bilinguals

Objective:Code-switching is when bilingual individuals alternate between two languages in the same conversation. Some studies find that code-switching frequency is associated with executive functioning, while others do not. Individual attitudes towards bilingual language use and code-switching may explain the inconsistency in the literature. For instance, greater positive attitudes towards code-switching may be associated with more likelihood to engage in that practice and thus strengthen the cognitive benefit in executive function. Additionally, code-switching between English and Spanish has been stigmatized in the U.S., therefore it is unclear what sociocultural factors may predict positive attitudes. In this study, we assessed Latinx bilinguals’ attitudes on code-switching and investigated their relationship with code-switching frequency, sociodemographic and linguistic factors, and executive functioning.Participants and Methods:Participants were 525 community-dwelling English-Spanish bilingual Latinx adults from the Offspring study (Mage= 55.38 (10.42); Meducation= 12.62 (3.34); 71% women; 41% tested in English, 75% immigrant). A language history questionnaire assessed for bilingualism and code-switching frequency. Participants completed 7 questions on code-switching attitudes on a 7-point Likert scale ranging from Strongly Disagree to Strongly Agree (e.g., “switching between languages in a conversation is an important part of my identity”), that were summed for a total score with higher scores indicating more positive attitudes. Executive functioning was assessed with the NIH Toolbox Cognition battery, verbal fluencies, and the digit span test. Sociodemographic and linguistic factors included age, sex, education, immigrant status, parental years of education, English and Spanish proficiency (average score on self-reported ratings on speaking, reading, writing, and understanding), and testing language. General linear models evaluated the association of code-switching attitudes on executive function, after adjusting for relevant covariates.Results:Positive code-switching attitudes were correlated with greater code-switching, r(499)=.33, p&lt;.001. Younger age r(499)=-.11, being born in the US t(493)=-2.05, greater English proficiency r(497)=.15, and English dominance t(499)=2.22, were associated with more positive code-switching attitudes (all p’s &lt;.05). Sex, education, parental years of education, and Spanish proficiency were not associated with code-switching attitudes. Overall models of attitudes with executive function indicated that positive code-switching attitudes were associated with worse visual working memory (b = -0.08, t(169) = -2.75, 95% CI [0.14, -0.02]) after adjusting for age, sex, education, immigration status, parental years of education and testing language. Code-switching attitudes were not significantly associated with other executive function measures.Conclusions:Among a community-based sample of bilingual middle-aged Latinx adults, positive attitudes towards code-switching were associated with greater likelihood of code-switching in conversations, higher English proficiency, being US born, younger age, and English language dominance but negatively associated with visual working memory. These findings indicate that code-switching attitudes are influenced by sociodemographic and linguistic factors. Additionally, the negative association between code-switching attitudes and visual working memory provides support for previous studies showing code-switching as a disadvantage to cognition. Results of this study suggest that detailed characterization of sociocultural factors and aspects of bilingualism can provide further clarity in determining if there is a potential bilingual cognitive advantage. Future research should examine the relationship of code-switching with other aspects of bilingualism (e.g., age of acquisition).

Technology Acceptance Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis.

Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States. This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use. This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ≥62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis. Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: β=-.202; P<.001; education: β=.210; P<.001; and English proficiency: β=.124; P=.048) and ICT use (age: β=-.157; P=.002; education: β=.215; P<.001; and English proficiency: β=.152; P=.01). Male gender was positively associated with PEOU (β=.111; P=.047) but not with PU (β=-.031; P=.59), smartphone use (β=.023; P=.67), or ICT use (β=.078; P=.16). Ethnicity was a significant predictor of PU (F4,333=5.046; P<.001), PEOU (F4,345=4.299; P=.002), and ICT use (F4,350=3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group (β=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: β=.158; P=.002 and PEOU: β=.166; P=.002) and ICT use (PU: β=.117; P=.02 and PEOU: β=0.22; P<.001), even when controlling for demographic variables. The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use.

Discourse of ‘early ELT for local development’

Economic globalization and the concomitant prominence of English as a global language (EGL) have had a considerable impact on educational policies and practices worldwide. The widespread belief in the economic benefits that individuals and societies can attain from greater English proficiency has created a global trend of early English language teaching (ELT) (Copland, Garton &amp; Burns, 2014; Enever, Moon &amp; Raman, 2009). In line with this global trend, Japan, as an economically advanced nation, has also gradually lowered the age at which English is introduced at school. Previous studies have explored the development of national ELT curricula, critically examining the discourses behind these official language-in-education policies (e.g., Kubota, 1998, 2002; Seargeant, 2009; Shiroza, 2020). However, obvious to the keen observer is that early ELT is often implemented more extensively and vigorously in Japan's rural communities than in urban areas, despite the latter's image of being only remotely affected by globalization.

Abstract PO-035: Knowledge, motivation, and mental health: Factors associated with adherence to Hepatitis B medication among underserved Asian Americans

Abstract Introduction: Chronic Hepatitis B (CHB) Virus disproportionately affects Asian Americans, where they represent 6% of the total United States (U.S.) population but make up 58% of Hepatitis B Virus (HBV)-linked hepatocellular carcinoma (HCC) cases. HBV is the leading risk factor for developing HCC. Vietnamese and Chinese Americans suffer from disproportionate amounts of HBV infections as they represent foreign born immigrants that have come from countries with endemic HBV levels. The consequences of non-adherence to medication among is increased virological failure and a higher risk of disease progression to CHB leading to conditions such as cirrhosis as well as HCC. Understanding what factors contribute to medication adherence can be crucial for providing appropriate support for maintaining long-term treatment adherence and sustaining a virological response through interventions and strategies for high-risk populations affected by HBV. This study aims to examine the sociodemographic and psychosocial predictors of low versus medium/high adherence to medication among a community-based sample of Chinese and Vietnamese HBV infected patients. Methods: Study participants were comprised of 382 Asian American CHB patients, including 298 (78.01%) Chinese Americans and 84 (21.99%) Vietnamese Americans. Study participants were recruited between March 2019 to March 2020 and were enrolled through multiple recruitment approaches in the Greater Philadelphia Area and New York City regions. This presentation reports data from the study baseline survey with measures that included medication adherence measured by the Morisksy Medication Adherence Scale, knowledge regarding HBV diagnosis, prevention and treatment, motivation of HBV medication treatment, self-efficacy about HBV medication treatment, depression, and socioeconomic status. Multivariable logistic regression model was used, controlling for recruitment source and clustering by site. Results: Multivariable logistic regression analysis revealed that with regards to sociodemographic predictors, living longer in the U.S. (OR=4.46; 95% CI: 1.23, 16.14; p=0.023), and greater English proficiency characterized as speaking English well or very well were associated with greater odds of medium/high medication adherence (OR=0.31; 95% CI: 0.10, 0.89; p=0.030). With regards to psychosocial predictors, greater knowledge about HBV diagnosis, prevention, and treatment was associated with greater odds of medication adherence (OR=1.46; 95% CI: 1.16, 1.83, p=0.025). Additionally, greater depression score was associated with lower odds of medium/high medication adherence (OR=0.88; 95% CI: 0.78, 0.98, p=0.025). Conclusion: The study findings suggested a need for intervention regarding medication treatment and tertiary prevention and management of CHB among underserved Asian Americans. Furthermore, the association between depression and medication adherence suggests the need for psychological interventions to enhance mental health outcomes and quality of life to potentially improve or maintain medication adherence. Citation Format: Aisha Bhimla, Lin Zhu, Wenyue Lu, Sarit Golub, Chibuzo Enemchukwu, Elizabeth Handorf, Yin Tan, Minhhuyen T. Nguyen, Min Qi Wang, Grace X Ma. Knowledge, motivation, and mental health: Factors associated with adherence to Hepatitis B medication among underserved Asian Americans [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-035.

Association of Hispanic ethnicity and linguistic acculturation with cardiovascular medication adherence in patients with suspected acute coronary syndrome.

Despite a higher prevalence of cardiovascular disease (CVD) risk factors, Hispanic-Americans have lower rates of CVD-related and all-cause mortality, as well as higher life expectancy than non-Hispanic whites – a phenomenon known as the Hispanic health paradox. However, this survival benefit attenuates with increased acculturation to Western lifestyles, potentially due to adoption of unhealthy behaviors. Accordingly, we assessed whether Hispanic ethnicity and linguistic acculturation, as measured by English proficiency, were associated with nonadherence to cardiovascular medications. We enrolled patients presenting to an academic medical center emergency department with suspected acute coronary syndrome between May 2014 and November 2017. Ethnicity, native language, and English proficiency were self-reported. Cardiovascular medication adherence was assessed using an electronic pill bottle that recorded the date and time of each bottle opening. Generalized linear models with a logit link were used to examine the association of Hispanic ethnicity and English proficiency with daily cardiovascular medication adherence, adjusting for demographics, comorbidities, and dosing frequency of the electronically-monitored medication. Among 332 included patients, mean age was 61.68 ± 12.05 years, 43.07% were women, and 62.95% were Hispanic, of whom 80.38% were native Spanish-speakers. Overall, Hispanics had higher odds of medication adherence than non-Hispanics (adjusted OR 1.31, 95% CI 1.16–1.49, p < 0.001). However, among native Spanish-speaking Hispanics, greater English proficiency was associated with lower odds of medication adherence (adjusted OR 0.80 per 1-point increase in English proficiency, 95% CI 0.75–0.86, p < 0.001). Although Hispanics had better medication adherence than non-Hispanics overall, increased linguistic acculturation among native Spanish-speakers was associated with worse adherence behaviors.

Using the CLB in WorkLINC

Striving for greater English proficiency and securing a job are common goals of newcomers to Canada. For newcomers in the Language Instruction for Newcomers to Canada (LINC) program, the Canadian Language Benchmarks (CLB)/Niveaux de competence linguistique canadiens (NCLC) provide an indicator of their abilities and progress in their language acquisition. The CLB have become the backbone of WorkLINC, an industry-specific work readiness program. They anchor curriculum, Portfolio-Based Language Assessment (PBLA) real-world tasks, and classroom activities. WorkLINC participants develop their vocabulary, soft skills, workplace safety knowledge, and get employment support. Instructors have shared the CLB with employers and community partners to increase comprehension of newcomers’ language levels. Though there are challenges meeting the diverse needs in multi-level cohorts, engaging learners about the purpose of classroom tasks and understanding the CLB competency areas in which they need development enables them to focus on achievable goals directly related to their employment aspirations.

Determinants of Depression Risk among Three Asian American Subgroups in New York City.

Although the fastest growing minority group, Asian Americans receive little attention in mental health research. Moreover, aggregated data mask further diversity within Asian Americans. This study aimed to examine depression risk by detailed Asian American subgroup, and further assess determinants within and between three Asian ethnic subgroups. Needs assessment surveys were collected in 16 Asian American subgroups (six Southeast Asian, six South Asian, and four East Asian) in New York City from 2013-2016 using community-based sampling strategies. A final sample of N=1,532 completed the PHQ-2. Bivariate comparisons and multivariable logistic models explored differences in depression risk by subgroup. Southeast Asians had the greatest depression risk (19%), followed by South Asians (11%) and East Asians (9%). Among Southeast Asians, depression risk was associated with lacking health insurance (OR=.2, 95% CI: 0-.6), not having a provider who speaks the same language (OR=3.2, 95% CI: 1.3-8.0), and lower neighborhood social cohesion (OR= .94, 95% CI: .71-.99). Among South Asians, depression risk was associated with greater English proficiency (OR=3.9, 95% CI: 1.6-9.2); and among East Asians, depression risk was associated with ≤ high school education (OR=4.2, 95% CI: 1.2-14.3). Additionally, among Southeast Asians and South Asians, the highest depression risk was associated with high levels of discrimination (Southeast Asian: OR=9.9, 95% CI: 1.8-56.2; South Asian: OR=7.3, 95% CI: 3.3-16.2). Depression risk and determinants differed by Asian American ethnic subgroup. Identifying factors associated with depression risk among these groups is key to targeting limited public health resources for these underserved communities.

Developing Early Reading Profiles for Latinx Kindergarten Students Using Typical Universal Screeners

The purpose of the current study was to determine students’ early reading profiles at the beginning and end of kindergarten using existing school-based measures with a sample of Spanish speaking, Latinx students. Using latent profile analysis, a multivariate analytic technique that empirically identifies profiles based on student responses to multiple measures, students’ performance was compiled using typical universal screening measures of reading, a formal measure of English language development, and information regarding referral for special education evaluation and grade retention. At the beginning of the year, students demonstrating greater English proficiency also had increased ability on initial sound fluency and letter naming fluency tasks in English. By the end of the year, students demonstrating continued deficits in early literacy skills (phoneme segmentation fluency, letter naming, and nonsense word fluency) included students referred for special education or grade level retention than students who demonstrated greater proficiency in these skill areas. Recommendations for research and school-based practices are provided.

The Effects of Language Skills on the Economic Assimilation of Female Immigrants in the United States

AbstractThis paper uses recent data from the American Community Survey between 2010 and 2015 to investigate the effect of language skills on women’s economic assimilation who immigrated to the United States as children. The problem of endogenous language acquisition and measurement error in the language variable is addressed utilizing the phenomenon that younger children learn languages more easily than older children to construct an identifying instrument. Two‐stage‐least‐squares estimates suggest that greater English proficiency has a positive effect on a number of indicators of economic assimilation of adult women including several measures of labor supply and earnings. A range of sensitivity tests are undertaken to check the validity of these results.

New York City Taxi Drivers' Knowledge and Perceptions of the Affordable Care Act.

This study was conducted to assess New York City taxi drivers' knowledge and perceptions of the Affordable Care Act (ACA). A cross-sectional street-intercept study design was used to assess drivers' knowledge about the ACA. A 146-item questionnaire was administered from September 12 to December 6, 2013 to 175 yellow taxi and for-hire vehicle drivers. 91 % of drivers were foreign-born; 50 % were uninsured. Mean knowledge about the ACA was quite low; 78 % of the sample either knew nothing or only a little bit about the ACA. 77 % wanted more information about the ACA. Greater English proficiency, more years driving a taxi, and knowledge of having or not having a pre-existing health condition (vs. not knowing) were related to higher ACA knowledge levels. Knowledge of a pre-existing condition (whether they had one or not) compared to those who lacked such knowledge was also an important predictor of the perception of whether the ACA would have a positive impact. To facilitate enrollment, efforts should focus on occupationally-focused initiatives that educate drivers at their places of work and leisure, to raise the overall knowledge levels and enrollment of the community.

Treating Culturally and Linguistically Isolated Koreans via Telepsychiatry

The Center for Pan Asian Community Services (CPACS), a community organization that provides culturally competent social and health services to immigrant, refugee, and racial-ethnic minority populations, identified a treatment gap within the population they serve. Korean clients with limited English proficiency experienced significant difficulty in accessing appropriate mental health services in the Atlanta area. CPACS approached the National Center for Primary Care at Morehouse School of Medicine to address this health care access problem. Barriers to providing treatment included a lack of Korean-speaking providers in the Atlanta area, which led to out-of-state collaborations using telepsychiatry services. Financial instability was another major barrier to the success of the program. We secured a grant from the Atlanta Clinical and Translational Science Institute (ACTSI) to test the feasibility of this project. Sixteen participants were recruited by CPACS in 2010 and 2011 to participate in this pilot program. The success of the program depended on strong collaborations with CPACS, which provided a culturally and linguistically competent facilitator trained to interact with program participants, and with the Asian Community Mental Health Services (ACMHS) in Oakland, California, which provides multicultural and multilingual behavioral health services to vulnerable community members in California. ACMHS offered a culturally and linguistically competent psychiatrist, who provided treatment via teleconferencing equipment. All participants received an initial telepsychiatry diagnostic assessment, followed by treatment recommendations that were given to the patient and the facilitator by the telepsychiatrist. Ongoing follow-up sessions were recommended by the telepsychiatrist at her clinical discretion. The number and frequency of the additional sessions were determined on the basis of individual needs of the participants, and the overall pilot program lasted for 20 weeks. The facilitator was available by telephone to any participants who needed assistance outside of the established telepsychiatry clinic hours. A majority of patients were female, married, and college educated. Most participants had lived in the United States for over ten years and described their physical health status as poor to fair. Patients showed improved outcomes in depression and anxiety. For example, a 43-year-old Korean female presented to the program with an eight-year history of anxiety complicated by complex psychosocial stressors related to her marriage and emigration to the United States. After engaging in treatment via telepsychiatry and receiving psycho-education regarding mental health treatment options, she responded well to antidepressant medication and supportive therapy provided in the telepsychiatry sessions and reported a dramatic decrease in overall anxiety symptoms. Similarly, there was a significant reduction in psychological distress, anxiety, and depression for the majority of patients who participated in the program. This project was designed to provide mental health services to a population that underutilizes and often avoids seeking such treatment. The preliminary findings are promising, despite the small sample. The significant improvement in symptoms of depression, anxiety, and psychological distress suggests that culturally informed telepsychiatry may be an effective method to increase utilization of mental health services in traditionally underserved minority populations. Although the findings are encouraging, there were some challenges in the implementation of this project. For assessment of language proficiency, many patients appeared to have greater English proficiency than they reported on initial assessment. These individuals with greater English proficiency may have continued in the program because they valued culturally competent providers in addition to language-proficient providers. Participants expressed greater comfort talking to an ethnically matched provider, even if they themselves spoke in English fluently. Furthermore, all screening tools used to evaluate treatment responses were self-report measures. It is possible that social desirability bias and other cultural factors influenced the patients, causing them to report greater symptom improvement than they actually experienced. Nevertheless, our findings show that there may be efficacy in treatment when issues of cultural competence and accessibility are appropriately addressed in mental health service provision to an underserved, minority population. In the future, we hope to expand these findings to larger populations and evaluate this model among other populations with unique cultural and linguistic needs.

Pathway to Health Literacy in Korean American Immigrants: The Mediating Role of English Proficiency

This study investigated predictors of and pathways to health literacy among Korean American immigrants residing in New York City (n = 407). Social Cognitive Theory guided the study and the Chew et al. 16-item health literacy screening scale was employed. Structural equation modeling using Mplus 4.21 tested the proposed conceptual model. Findings revealed that education and English proficiency were the most influential predictors of health literacy; education was directly associated with health literacy and indirectly through language proficiency. Predictors of greater English proficiency included higher levels of education, younger age, and unmarried status. The findings suggest that immigrants with minimal English abilities, little education, and no health insurance have particular intervention needs, perhaps best met by a patient-centered approach focusing on individual language needs and cultural health beliefs.

The Language Learning Benefits of Extensive Reading: Teachers Should Be Good Role Models

Visioning a world class university is certainly an appropriate target for a university. Realizing this vision would need an expansion of knowledge and greater English proficiency as in this period of history, English is the language of IT which is an important key to acquiring knowledge. Using a sample of 40 level one students from UiTM Dungun this study found that in tandem with studies done elsewhere, extensive reading does seem to make a difference in the proficiency level of the students. Further the study also found that students who have a positive predisposition towards English read more and achieved better grades. However the study found no difference in the amount of reading done by boys and girls. The study discussed qualitatively the ability of teachers to inculcate the reading interest in the students, thus it is a triangular study which employs quantitative and qualitative means.

Language usage and fertility in the Mexican-origin population of the United States

This article examines the effects of English proficiency and female education on cumulative and recent fertility within the Mexican-origin population in the U.S. To ascertain whether the cultural or the human capital aspects of linguistic variables have the greater salience for fertility behavior, fertility patterns of bilingual women are compared with those of monolingual women speaking English or Spanish. Using the 1980 U.S. Census 5 percent Public Use Microdata Sample for ever-married Mexican-origin women aged 15-44, we find that for almost all age cohorts, the effects of English proficiency are negative and increase with rising education. The strength of the interaction is greater in younger age groups. Greater English proficiency is also associated with a more negative impact of education for native- than foreign-born women. Overall, the influence of "opportunity cost," as opposed to cultural factors, is more important in shaping the fertility behavior of these women.

THE STUDY OF LANGUAGE ATTITUDES

THE STUDY OF LANGUAGE ATTITUDES