Even to a greater degree than the Reformed, the Evangelicals became most noted among American Protestants for their establishment and staunch support of hospitals, orphanages, and homes for the elderly. Probably most similar in ethos (among English-speaking Protestant groups) to the Methodists, pastors emphasized pietist preaching and catechizing young people for the rite of confirmation, a rite still cherished highly to this day by congregations deriving from ESNA roots. Reflecting a later generation of immigration, the German language persisted for several generations in most congregations before such services were gradually phased out in the era between the World Wars, due in part to anti-German sentiment among some Americans. In 1919, they began missionary efforts in Honduras, establishing what is now called the Evangelical and Reformed Church in Honduras .