The Effect of English Language Training on Health and Health Care Utilization

Last registered on November 19, 2024
View Trial History

Pre-Trial

Trial Information

General Information

Title
The Effect of English Language Training on Health and Health Care Utilization
RCT ID
AEARCTR-0014774
Initial registration date
November 12, 2024

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
November 19, 2024, 3:49 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information

Primary Investigator

Name
Sumit Agarwal
Affiliation
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Blake Heller
PI Affiliation
University of Houston
Contact Investigator
PI Name
Kirsten Slungaard Mumma
PI Affiliation
Teachers College, Columbia University
Contact Investigator

Additional Trial Information

Status
In development
Start date
2008-08-01
End date
2027-06-30
Keywords
Health
Additional Keywords
JEL code(s)
Secondary IDs
Prior work
This trial is based on or builds upon one or more prior RCTs.
Abstract
Adults with limited English proficiency may have difficulty navigating the complex bureaucracy of the U.S. health care system, leading to worse access and outcomes. We propose to examine the effect of English language training on health care utilization and health outcomes by linking administrative health care data to enrollment and lottery records from a public adult English for Speakers of Other Languages (ESOL) program. We hypothesize that participating in adult ESOL classes will increase use of outpatient care including primary care, subspecialty care, preventive care, and will decrease visits to the emergency department.
External Link(s)

Registration Citation

Citation
Agarwal, Sumit, Blake Heller and Kirsten Slungaard Mumma. 2024. "The Effect of English Language Training on Health and Health Care Utilization." AEA RCT Registry. November 19. https://doi.org/10.1257/rct.14774-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2008-08-01
Intervention End Date
2016-04-30

Primary Outcomes

Primary Outcomes (end points)
Utilization of outpatient care
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Preventive care utilization
Acute care utilization
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Applications for enrollment in adult ESOL courses regularly exceed the program’s capacity. Offers of admission to the adult ESOL program were determined by a random lottery conducted twice yearly. We will compare outcomes for applicants whose lottery number were drawn—and who were offered seats in oversubscribed ESOL classes as a result—to those whose lottery numbers were not drawn. Specifically, we will estimate the effect of winning a lottery to attend the adult ESOL program on outcomes of interest using an ordinary least squares regression of the form:

Y_(it) = α_(0) + α_(1)*WonLottery_(i) + α_(2)*X_(i) + ν_(clt) + e_(iclt)

where Y_(it) represents a health outcome of interest and α_(1) represents the estimated impact of winning the lottery to attend the adult ESOL program on that outcome, X_(i) is a vector of individual demographic controls, and ν_(clt) is a set of lottery fixed effects that interact the class difficulty level, time of day, and term at which an individual first applied to the lottery. If we replace Y_(it) with a measure of program enrollment or attendance, we can re-estimate the prior equation to measure the “first-stage” impact of winning one’s first lottery on ESOL participation:

Enrolled_(i) = β_(0) + β_(1)*WonLottery_(i) + β_(2)*X_(i) + ψ_(clt) + υ_(iclt)

where β_(1) represents the impact of an individual’s first lottery outcome on the ESOL enrollment or attendance outcome on the left-hand side of the equation. The predicted value of ESOL enrollment (or attendance) from this first-stage regression can be used as an instrument for ESOL enrollment (or attendance) in a second-stage of an instrumental variables regression of the form:

Y_(it) = δ_(0) + δ_(1)*Enrolled_(i) + δ_(2)*X_(i) + γ_(clt) + ϵ_(iclt)

where δ_(1) represents the estimated impact of ESOL enrollment on outcomes of interest for those who are induced to enroll by the outcome of their admissions lottery (i.e., the local average treatment effect for this group of applicants who “comply” with their lottery outcome).
Experimental Design Details
Not available
Randomization Method
Lottery determined random assignment. Offers of admission to the adult ESOL program were determined by a random lottery conducted twice yearly. Those applicants who won the lottery (i.e., whose lottery number were drawn) comprise the intervention or treatment group, and those applications who did win the lottery (i.e., who lottery number was not drawn) comprise the control group.
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
4,761 applicants
Sample size: planned number of observations
4,761 applicants
Sample size (or number of clusters) by treatment arms
1,248 were selected in the lottery and offered a chance to immediately enroll in the adult ESOL program and 3,513 did not
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Harvard University
IRB Approval Date
2024-06-24
IRB Approval Number
IRB24-0685
IRB Name
University of Houston
IRB Approval Date
2022-10-26
IRB Approval Number
STUDY00003821
Analysis Plan