THE ARTICLE by Mazor et al1 describes an intervention to improve the language and cultural competency skills of pediatric emergency department (ED) physicians. Like others, the authors have recognized the need to improve their efficiency and quality of care for Spanish-speaking patients. Across the country, the driving force behind the demand for improved services for Spanish-speaking patients is the rapidly growing Latino population. As of the 2000 census, Latinos are the largest ethnic minority group in the nation.2 This growth in the Latino population has been fueled by immigration and a high birth rate. Overall, 51% of all immigrants to the United States are from Mexico, Central and South America, and Spanish-speaking Caribbean countries.3 This does not include Puerto Ricans, who are US citizens and the second largest Latino subgroup in the country. Furthermore, the birth rates among Latina women are among the highest in the nation. For example, Mexican American women have a birth rate twice that of non-Hispanic white women (112 vs 58 births per 1000) and 50% higher than African Americans. The high birth rate among Latinos suggests that even with a decrease in immigration, the growth of the Latino population will continue into the future.4
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