Language Disparities Research Articles

Association Between Limited English Proficiency and Hearing Healthcare Use in the United States.

To determine whether limited English proficiency (LEP) is associated with likelihood of prior audiogram and hearing aid use among US adults with hearing loss. This cross-sectional study of four merged National Health and Nutrition Examination Survey (NHANES) cycles included 12,636 adults with subjective (self-reported) or objective (audiometric) hearing loss. Subjects were classified as LEP if they completed the NHANES survey in a language other than English, or with the help of an interpreter. Likelihood of audiogram among participants with subjective and objective hearing loss, and likelihood of hearing aid use among participants with objective hearing loss were assessed using unadjusted and adjusted logistic regression. Individuals with LEP were less likely to have undergone audiogram among subjects with subjective (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.67-0.77), and objective (OR 0.70, 95% CI 0.65-0.74) hearing loss. The association persisted for those with subjective hearing loss (OR 0.79, 95% CI 0.72-0.86), and objective hearing loss (OR 0.81, 95% CI 0.73-0.89) after adjusting for relevant covariates. Individuals with LEP were less likely to use hearing aids (OR 0.88, 95% CI 0.84-0.93). This association disappeared (OR 0.99, 95% CI 0.95-1.04) after adjustment. LEP is associated with lower utilization of hearing healthcare services. This may be due to the complex interplay of socioeconomic and language disparities, which may act as barriers to hearing healthcare utilization. Individuals with LEP should be prioritized when designing interventions to improve accessibility to hearing healthcare. 3 Laryngoscope, 134:5122-5130, 2024.

Tracking a Decade of Development of Early Childhood Care and Education in Kazakhstan, 2006–2015

The study employed data from the 2006, 2010–2011 and 2015 Multiple Indicator Cluster Surveys to assess the decade of early childhood care and education (ECCE) development in Kazakhstan. Enrollment grew from 15% to 60% but remained lower than the targeted rate of 75%. The effects of the wealth gradient and language disparities on enrollment were reduced significantly. Concurrently, regional disparities in enrollment increased during the reform period and the child’s age became a significant precursor of enrollment over time. Parents opted to enroll relatively older children to ECCE and this trend has been shown to become more prominent over time.

Geometric Morphometric and Pattern Discrimination of Handwritten Numeral Characters Based on Local Ethnicities and Native Linguistic Disparities in Malaysia for Forensic Applications

Handwriting can be influenced by factors like culture and native language disparities; however, the specific research to discriminate handwritten numeral characters for forensic questioned document investigation involving the diverse ethnicities (Malay, Chinese and Indian) in Malaysian population remains unreported. Despite its application in forensic anthropology, utilization of the landmark based analysis using the Geometric Morphometric (GMM) technique for examining handwritten numeral character specimens appears sparse. Therefore, this present research that attempted to discriminate ethnicities background of 390 consenting adult participants in Malaysia based on the handwritten numeral characters (0-9) using GMM technique, merits forensic and scientific considerations. Results revealed that while there were universal ones, ethnic-specific handwritten numeral characters that may possibly be influenced by culture and native language (Malay, Chinese and Tamil languages) also prevailed. Significant differences (p < 0.0001) in ethnic-specific characters for the Malay, Chinese and Indian participants who attended the different national primary school settings in Malaysia were also observed. In conclusion, the discrimination of handwritten numeral characters for forensic examination of questioned documents among Malay, Chinese and Indian authors for the development of forensic intelligence is empirically supported.

Language-Based Disparities in Route of Hysterectomy for Benign Disease

Study ObjectiveTo assess the association between patient primary language and route of hysterectomy. DesignA retrospective cohort study was conducted using the Healthcare Cost and Utilization Project's State Inpatient Database (SID) and State Ambulatory Surgery and Services Database (SASD). SettingAll inpatient and outpatient hysterectomies from the most recent year of available data (2020–2021) from the six states that record patient primary language in the SID and SASD (Indiana, Iowa, Maryland, Michigan, Minnesota, and New Jersey) were queried. Patients or ParticipantsPatients aged 18 and over undergoing an inpatient or ambulatory hysterectomy for benign indication. InterventionsMinimally invasive hysterectomy compared to abdominal hysterectomy. Measurement and Main ResultsThe association between patient primary language (English vs. non-English) and route of hysterectomy (abdominal vs minimally invasive) was evaluated. The cohort included 52,226 patients who met inclusion criteria. The majority of patients were non-Hispanic White (71%), with a median age of 46 years (IQR 40.0–53.0). 91.4% of patients spoke English as their primary language, 3.6% spoke Spanish, and 5.0% spoke another non-English language. Patients with a non-English primary language were significantly less likely to undergo minimally invasive hysterectomy compared to patients who spoke English (OR 0.60, 95% CI 0.56–0.64, p <.001). This association remained significant following adjustments for age, race, insurance, median income, state, and fibroid, abnormal uterine bleeding, prolapse or endometriosis diagnosis (aOR 0.77, 95% CI 0.71–0.84). In a sensitivity analysis of English vs Spanish vs other non-English language, the association remained significant for other non-English languages (aOR 0.67, 95% CI 0.60–0.75) but not for Spanish (aOR 0.95, 95% CI 0.83–1.09). ConclusionPatients who are non-English speaking are significantly less likely to receive a minimally invasive hysterectomy. Addressing language disparities may improve access to a minimally invasive route of surgery, a possible surrogate for improved surgical outcomes, for our gynecologic patients.

Teletherapy to address language disparities in deaf and hard-of-hearing children: study protocol for an inclusive multicentre clinical trial

IntroductionChildren who are deaf or hard-of-hearing (DHH) are at risk for speech and language delay. Language outcomes are worse in DHH children from lower socioeconomic backgrounds, due in part to...

Socioeconomic Status and Its Impact on Language Development in Preschool Children in South Sudan

Purpose: The aim of the study was to analyze the socioeconomic status and its impact on language development in preschool children. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Socioeconomic status significantly influences language development in preschool children, with higher SES linked to better language skills. Disadvantaged backgrounds often correlate with delayed language acquisition and poorer linguistic abilities. Factors like access to resources and parental education impact language outcomes. Unique Contribution to Theory, Practice and Policy: Social interactionist theory, the theory of cultural capital &amp; the ecological systems theory may be used to anchor future studies on socioeconomic status and its impact on language development in preschool children. Provide professional development opportunities for educators and caregivers to enhance their understanding of the impact of socioeconomic factors on language development and equip them with effective strategies for addressing language disparities in diverse preschool settings. Advocate for policies that prioritize equitable access to high-quality early childhood education and childcare services, including targeted funding initiatives aimed at improving resources and staffing ratios in preschools serving low-income communities.

Bridging large language model disparities: Skill tagging of multilingual educational content

AbstractThe adoption of large language models (LLMs) in education holds much promise. However, like many technological innovations before them, adoption and access can often be inequitable from the outset, creating more divides than they bridge. In this paper, we explore the magnitude of the country and language divide in the leading open‐source and proprietary LLMs with respect to knowledge of K‐12 taxonomies in a variety of countries and their performance on tagging problem content with the appropriate skill from a taxonomy, an important task for aligning open educational resources and tutoring content with state curricula. We also experiment with approaches to narrowing the performance divide by enhancing LLM skill tagging performance across four countries (the USA, Ireland, South Korea and India–Maharashtra) for more equitable outcomes. We observe considerable performance disparities not only with non‐English languages but with English and non‐US taxonomies. Our findings demonstrate that fine‐tuning GPT‐3.5 with a few labelled examples can improve its proficiency in tagging problems with relevant skills or standards, even for countries and languages that are underrepresented during training. Furthermore, the fine‐tuning results show the potential viability of GPT as a multilingual skill classifier. Using both an open‐source model, Llama2‐13B, and a closed‐source model, GPT‐3.5, we also observe large disparities in tagging performance between the two and find that fine‐tuning and skill information in the prompt improve both, but the closed‐source model improves to a much greater extent. Our study contributes to the first empirical results on mitigating disparities across countries and languages with LLMs in an educational context. Practitioner notesWhat is already known about this topic Recent advances in generative AI have led to increased applications of LLMs in education, offering diverse opportunities. LLMs excel predominantly in English and exhibit a bias towards the US context. Automated content tagging has been studied using English‐language content and taxonomies. What this paper adds Investigates the country and language disparities in LLMs concerning knowledge of educational taxonomies and their performance in tagging content. Presents the first empirical findings on addressing disparities in LLM performance across countries and languages within an educational context. Improves GPT‐3.5's tagging accuracy through fine‐tuning, even for non‐US countries, starting from zero accuracy. Extends automated content tagging to non‐English languages using both open‐source and closed‐source LLMs. Implications for practice and/or policy Underscores the importance of considering the performance generalizability of LLMs to languages other than English. Highlights the potential viability of ChatGPT as a skill tagging classifier across countries.

English skills of Puerto Rican students: the effect of gender, SES and school socioeconomic composition

Abstract This study evaluates the effects of gender, socioeconomic status (SES), and school of origin on students’ language performance. We used data from the test Measurement and Evaluation for Educational Transformation (META, for its acronym in Spanish). We analyzed the results of 21,425 eleventh-grade students from 194 public schools in Puerto Rico. The results suggest that there is a significant relationship between students’ gender and their English skills. Female students achieved higher levels of language performance than male students. There was also a significant relationship between SES and language performance. Students with a more advantaged socioeconomic status showed better language outcomes than students from disadvantaged socioeconomic backgrounds. The socioeconomic composition of the school was found to play an important factor in the linguistic performance of students: a diverse socioeconomic composition is related to better school performance and the narrowing of language disparities. We propose that the composition of schools’ student bodies is a factor that educational linguistic policy makers in Puerto Rico should give more consideration to, as it could have a key role in ameliorating English language attainment and education in general in Puerto Rico’s public schools.

Abstract 823: Parent-endorsed potential interventions to improve language disparities in pediatric cancer

Abstract Introduction: Children with cancer whose parents speak languages other than English (LOE) experience disparities including underrepresentation on clinical trials, decreased access to resources and inadequate interpretative services. Few studies in pediatric oncology have investigated the communication experiences of families who speak LOE, and rarely have studies sought parental recommendations for improvement. In this study, we aimed to characterize the experiences of parents of children with cancer who speak LOE and identify stakeholder-driven interventions to improve deficiencies. Methods: We enrolled parents of children with cancer who spoke any LOE and conducted semi-structured interviews about perceptions of medical care, communication and support from the medical team within 3 months of a new cancer diagnosis and 6-12 months post-diagnosis. Inductive content analysis was performed, with iterative transcript review and memo-writing informing the development of codes. Code frequency, temporal duration and distribution across language subtype were calculated and reported as descriptive statistics. Analysis was organized in MAXQDA, a mixed-methods data analysis software. Results: Twenty-eight parents, representing 7 different languages, were enrolled. All parents completed first interviews and 14 have completed second interviews to date. Parents described frequent problems with interpretation and felt their child’s care would be improved if they spoke English. Parents made suggestions on how to improve their experience and understanding of their child’s medical care (Table 1). Conclusion: Challenges related to language interpretation are pervasive and parents who speak LOE believe their child’s cancer care would be improved if they spoke English. Parents identified preferred communication practices and specific interventions that may be useful in promoting understanding of their child’s medical care and overall enhance supportive resources. Parent-endorsed communication practices and potential interventions to improve language disparities Preferred communication practices Use simple terms Limit conversations between providers when no interpreter present Speak to English and non-English speakers equally Always automatically use professional interpreters Take your time Repeat Demonstrate Rephrase Use drawings Point Ask for preferred language Be specific and detailed Speak slowly Use short phrases Allow time for interpretation Requested resources in preferred language Educational videos Written educational materials Translated hospital documents List of supportive resources List of financial resources List of reliable websites Language matched parent buddy support system Side by side instructions in English and preferred language System-level changes Increased in-person interpreter staffing Staff education on approach to LOE encounters Patient advocate to review medications and check labels Interpreter use at all points of contact Provision of language concordant providers Citation Format: Melanie Stall, Naomi Winick, Erica Kaye. Parent-endorsed potential interventions to improve language disparities in pediatric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 823.

Language Disparities in Caregiver Satisfaction with Physician Communication at Well Visits from 0-2 Years

ObjectiveThis study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity. MethodsLongitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity. ResultsOf 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)]. ConclusionCaregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.

Exploring the Social and Cognitive Factors Shaping the Acquisition of Science Concepts among Primary School Students in first and second languages

This study investigates the intricate interplay of social and cognitive factors influencing the acquisition of science concepts among primary school pupils, with a focus on their first and second language. A survey research design was carried out across different primary schools in Ijebu Ode Government Area of Ogun State, during the third term of the 2022/2023 academic year. A sample size of 268 primary four pupils, 196 from eight private and seventy-two (72) from three public primary schools, were randomly selected through simple random sampling technique. A pilot survey was conducted by administering the research instruments to 46 male and 72 female randomly selected primary 4 pupils after which the instruments were subjected to analysis. The data collected were analyzed using a t-test and hierarchical regression analysis. Regression analysis showed that pupil motivation, teacher support, parent support, and school environment have a significant contribution to pupils’ science performance test (SPT). The results revealed a significant correlation between pupil motivation, teacher support, parental involvement, and the school environment, collectively influencing pupils' science performance. The study emphasizes addressing language disparities, enhancing student motivation, fostering collaborative support from parents and teachers, and creating a conducive learning environment in primary schools to improve overall science education performance.

Estimation of racial and language disparities in pediatric emergency department triage using statistical modeling and natural language processing.

The study aims to assess racial and language disparities in pediatric emergency department (ED) triage using analytical techniques and provide insights into the extent and nature of the disparities in the ED setting. The study analyzed a cross-sectional dataset encompassing ED visits from January 2019 to April 2021. The study utilized analytical techniques, including K-mean clustering (KNN), multivariate adaptive regression splines (MARS), and natural language processing (NLP) embedding. NLP embedding and KNN were employed to handle the chief complaints and categorize them into clusters, while the MARS was used to identify significant interactions among the clinical features. The study also explored important variables, including age-adjusted vital signs. Multiple logistic regression models with varying specifications were developed to assess the robustness of analysis results. The study consistently found that non-White children, especially African American (AA) and Hispanic, were often under-triaged, with AA children having >2 times higher odds of receiving lower acuity scores compared to White children. While the results are generally consistent, incorporating relevant variables modified the results for specific patient groups (eg, Asians). By employing a comprehensive analysis methodology, the study checked the robustness of the analysis results on racial and language disparities in pediatric ED triage. The study also recognized the significance of analytical techniques in assessing pediatric health conditions and analyzing disparities. The study's findings highlight the significant need for equal and fair assessment and treatment in the pediatric ED, regardless of their patients' race and language.

A Prospective Observational Cohort Study of Language Preference and Preoperative Cognitive Screening in Older Adults: Do Language Disparities Exist in Cognitive Screening and Does the Association Between Test Results and Postoperative Delirium Differ Based on Language Preference?

A greater percentage of surgical procedures are being performed each year on patients 65 years of age or older. Concurrently, a growing proportion of patients in English-speaking countries such as the United States, United Kingdom, Australia, and Canada have a language other than English (LOE) preference. We aimed to measure whether patients with LOE underwent cognitive screening at the same rates as their English-speaking counterparts when routine screening was instituted. We also aimed to measure the association between preoperative Mini-Cog and postoperative delirium (POD) in both English-speaking and LOE patients. We conducted a single-center, observational cohort study in patients 65 years old or older, scheduled for surgery and evaluated in the preoperative clinic. Cognitive screening of older adults was recommended as an institutional program for all patients 65 and older presenting to the preoperative clinic. We measured program adherence for cognitive screening. We also assessed the association of preoperative impairment on Mini-Cog and POD in both English-speaking and LOE patients, and whether the association differed for the 2 groups. A Mini-Cog score ≤2 was considered impaired. Postoperatively, patients were assessed for POD using the Confusion Assessment Method (CAM) and by systematic chart review. Over a 3-year period (February 2019-January 2022), 2446 patients 65 years old or older were assessed in the preoperative clinic prior. Of those 1956 patients underwent cognitive screening. Eighty-nine percent of English-speaking patients underwent preoperative cognitive screening, compared to 58% of LOE patients. The odds of having a Mini-Cog assessment were 5.6 times higher (95% confidence interval [CI], 4.6-7.0) P < .001 for English-speaking patients compared to LOE patients. In English-speaking patients with a positive Mini-Cog screen, the odds of having postop delirium were 3.5 times higher (95% CI, 2.6-4.8) P < .001 when compared to negative Mini-Cog. In LOE patients, the odds of having postop delirium were 3.9 times higher (95% CI, 2.1-7.3) P < .001 for those with a positive Mini-Cog compared to a negative Mini-Cog. The difference between these 2 odds ratios was not significant ( P = .753). We observed a disparity in the rates LOE patients were cognitively screened before surgery, despite the Mini-Cog being associated with POD in both English-speaking and LOE patients. Efforts should be made to identify barriers to cognitive screening in limited English-proficient older adults.

Uncovering Language Disparity of ChatGPT on Retinal Vascular Disease Classification: Cross-Sectional Study.

Benefiting from rich knowledge and the exceptional ability to understand text, large language models like ChatGPT have shown great potential in English clinical environments. However, the performance of ChatGPT in non-English clinical settings, as well as its reasoning, have not been explored in depth. This study aimed to evaluate ChatGPT's diagnostic performance and inference abilities for retinal vascular diseases in a non-English clinical environment. In this cross-sectional study, we collected 1226 fundus fluorescein angiography reports and corresponding diagnoses written in Chinese and tested ChatGPT with 4 prompting strategies (direct diagnosis or diagnosis with a step-by-step reasoning process and in Chinese or English). Compared with ChatGPT using Chinese prompts for direct diagnosis that achieved an F1-score of 70.47%, ChatGPT using English prompts for direct diagnosis achieved the best diagnostic performance (80.05%), which was inferior to ophthalmologists (89.35%) but close to ophthalmologist interns (82.69%). As for its inference abilities, although ChatGPT can derive a reasoning process with a low error rate (0.4 per report) for both Chinese and English prompts, ophthalmologists identified that the latter brought more reasoning steps with less incompleteness (44.31%), misinformation (1.96%), and hallucinations (0.59%) (all P<.001). Also, analysis of the robustness of ChatGPT with different language prompts indicated significant differences in the recall (P=.03) and F1-score (P=.04) between Chinese and English prompts. In short, when prompted in English, ChatGPT exhibited enhanced diagnostic and inference capabilities for retinal vascular disease classification based on Chinese fundus fluorescein angiography reports. ChatGPT can serve as a helpful medical assistant to provide diagnosis in non-English clinical environments, but there are still performance gaps, language disparities, and errors compared to professionals, which demonstrate the potential limitations and the need to continually explore more robust large language models in ophthalmology practice.

Access to Financial Assistance Programs and Their Impact on Overall Spending on Oral Anticancer Medications at an Integrated Specialty Pharmacy.

Financial assistance (FA) programs are increasingly used to help patients afford oral anticancer medications (OAMs), but access to such programs and their impact on out-of-pocket (OOP) spending has not been well explored. This study aimed to (1) characterize the impact of receipt of FA on both OOP spending and likelihood of catastrophic spending on OAMs and (2) evaluate racial/ethnic disparities in access to FA programs. Patients with a cancer diagnosis prescribed an OAM anytime between January 1, 2021, and December 31, 2021 were included in this retrospective, single-center study at an integrated specialty pharmacy affiliated with a tertiary academic cancer center. Fixed-effect regression models were used to characterize the impact of receipt of FA on overall spending and likelihood of catastrophic spending on OAMs, as well as explore the association of race/ethnicity with receipt of FA. Across 1,186 patients prescribed an OAM, 37% received FA. Receipt of FA was associated with lower annual spending on OAMs (β = -$1,236 US dollars [USD; 95% CI, -$1,841 to -$658], P < .001) but not reduced risk of catastrophic spending (odds ratio [OR], 0.442 [95% CI, 0.755 to 3.199], P = .23). Non-White patients (OR, 0.60 [95% CI, 0.43 to 0.85], P = .004) and patients who spoke English as a second language (OR, 0.46 [95% CI, 0.23 to 0.90], P = .02) were less likely to receive FA compared with White and English-speaking patients, respectively. FA programs can mitigate high OOP spending but not for patients who spend at catastrophic levels. There are racial/ethnic and language disparities in access to such programs. Future studies should evaluate access to FA programs across diverse delivery settings.

Pre-pandemic preventable hospitalization is associated with increased telemedicine use in safety-net settings.

The COVID-19 pandemic necessitated a major expansion in telemedicine use. The continued use of telemedicine post-pandemic has the potential to enhance healthcare use for people at risk for sub-optimal healthcare access and utilization, such as patients with previous preventable hospitalization. This study analyzed the association between pre-pandemic preventable hospitalizations (PPHs) and telemedicine use during the pandemic. This retrospective cohort study uses Medicaid administrative claims data (01/2018-06/2022) for patients of a large Federally Qualified Health Center in Arizona that implemented telemedicine in March 2020. Bivariate and multivariable generalized estimating equations were used to analyze the relationship between the outcome and predictor variables. We also analyze racial/ethnic and primary language disparities in telemedicine use among those with PPH and report the average predicted probability. There was a statistically significant relationship between telemedicine use and PPH even after adjusting for comorbidity severity (OR:1.85; CI: 1.74, 1.96). Analyses restricted to those who had PPHs showed an seven-percentage point difference in the predicted probability of telemedicine use between non-Hispanic White individuals and Asian/Pacific Islanders, the group with the lowest probability of telemedicine use among our study sample. Telemedicine is a unique tool that can be leveraged by interventions that aim to optimize healthcare use among those with a history of preventable hospitalizations. However, the lack of targeted interventions to identify and address barriers to telemedicine use among minoritized groups could limit the impact of such interventions and widen disparities.

Racial, ethnic and language disparities in healthcare utilization in pediatric patients following tonsillectomy

ImportanceTonsillectomy is one of the most common surgical procedures performed in the United States. However, there is little known about the intersectionality of race, ethnicity, and language and how these factors influence post-tonsillectomy outcomes such as ED utilization and hospital readmission rates. ObjectiveTo examine disparities in emergency department (ED) utilization and hospital readmissions for post-tonsillectomy complications based on insurance status, patient race, ethnicity and language spoken. DesignThis was retrospective cohort over four years. SettingTertiary Care Children's Hospital. ParticipantsAll children (n = 10,215) who underwent tonsillectomy or adenotonsillectomy at a tertiary children's hospital from January 2015 to December 2018 were identified and included. There were no exclusion criteria. ExposureThe exposure of interest was tonsillectomy. Main outcomes and measuresOutcomes and variables of interest were defined prior to data collection. The primary outcome of this study was emergency department (ED) utilization defined as any ED or urgent care visit within 21 days of the tonsillectomy for surgery-related concerns. The secondary outcome of this study was readmissions following tonsillectomy. ResultsA total of 10215 pediatric patients (median age, 6 years; 5096 [50 %] male) who underwent tonsillectomy were included in the analysis. 13 % of patients presented to the ED with surgery-related complaints. Among English proficient patients, multi-racial patients were the only group with an elevated odds of ED utilization (OR:1.5, 95 % CI: 1.2, 1.9). Non-English language preference (NELP) patients of Black, Hispanic, Asian, and American Indian/Alaskan Native race/ethnicity also had elevated odds of ED use post-tonsillectomy compared to non-Hispanic White English proficient patients. Six percent of all patients had an unplanned hospital readmission. Asian patients with non-English language preference had 2.1 times the odds of readmission (95 % CI: 1.2, 3.6); and were disproportionately admitted for post-tonsillectomy hemorrhage. Conclusionsand Relevance: Language disparities in ED use and readmission persist after adjusting for risk factors. Non-English language preference populations have a higher rate of ED utilization, especially for minor complications. Disparities may result from differential health literacy or predispositions to complications. Future directions include additional research on mechanisms and targeted interventions to increase education and access to language-appropriate resources.

Does linguistic diversity make destinations more sophisticated? Exploring the effects on destination personality

Today's destinations are gradually moving toward linguistic diversity to help tourists obtain a better experience. Accordingly, using diverse languages is developing as a noteworthy destination marketing and management measure. Applying destination personality theory, this research examines the impact of linguistic diversity on destination personality, as well as tourists' attitudes and behavior across five studies. With different populations, Studies 1, 2, and 3 found that linguistic diversity enhances sophisticated destination personality, tourists' attitudes and visit intentions, exploring the role of the number of languages and language disparity in constructing linguistic diversity while ruling out the alternative explanation of other destination personalities. Study 4 and Study 5 revealed the moderating roles of destination type and travel goal. This research contributes to theory and practice in language and destination personality and enriches the growing literature on tourists' attitudes toward destination marketing and management.

The Dynamics of Evangelism in a Multicultural Context: Challenges and Opportunities for Contextualization

Evangelism in a multicultural context has become a primary concern in the mission of the modern church. In an effort to comprehend the dynamics involved in evangelism within multicultural environments, this research aims to identify the primary challenges faced by evangelists while also detailing the emerging opportunities in the endeavor to contextualize the message of the Gospel. Through an in-depth literature review in qualitative research, this study reveals the complexity of the multicultural context within the scope of evangelism. The main challenges encompass differences in religious beliefs, language disparities, and cultural tensions, all of which necessitate a prudent and adaptable approach. However, within these challenges, significant opportunities also arise. These opportunities include the formation of intercultural bridges, an improved understanding of religious pluralism, and the potential for collaboration among people of different faiths. The research findings emphasize the importance of contextualizing the Gospel message to establish an effective and meaningful approach within a multicultural context. This study provides valuable insights for churches and evangelists operating in multicultural environments, stimulating discussions about the role of contextualization in disseminating the message of the Gospel in an increasingly diverse society.&#x0D;

Heritage Language Fluency: Effects on Second Generation, Asian American Youth's Bicultural Identity

This paper studies the bicultural experiences of second generation, Asian American high schoolers, specifically regarding heritage language. As this population is constantly in different environments where they have to adhere to different cultural contexts, many disconnects have continuously arised due to cultural gaps or clashes. Among these cultural disconnects is language disparities between that of the host and heritage country. Thus, the objective of this paper was to examine the relationship between fluency of heritage language and this demographic’s bicultural identity through a mixed-method survey. After conducting correlational and thematic analysis of the results, it was found that while significant commonalities are present in perspectives toward heritage language, there were unique intricacies within each data set that were molded by participants’ personal experiences and situations. Thus, from the data collected, heritage language fluency does play a part in shaping bicultural identity, but there is a lack of direct correlation. Asian American youth’s bicultural experiences and other fundamental aspects like assimilation pressures and surrounding communities work in conjunction with language to impact the bicultural experience. Therefore, considering the diverse sources of assimilation pressures, a cross-context collaboration is needed, where heritage language learning is supported and valued.