This chapter, in three parts, explores the influence of culture on health beliefs, behaviors, and outcomes in frail elders who are part of an immigrant population. The first part presents the concept of culture and acculturation. It explores the models used to explain the health and social outcomes of immigrant groups, and it describes the demographics of immigrant groups with an emphasis on several multicultural countries. The second part examines the health, particularly oral health, of ethnocultural minority groups and explains how oral health can relate to cultural background. These include oral health status, beliefs, attitudes, and knowledge, as well as oral health-related practices, use of general healthcare services, and barriers to care. The last section identifies the gaps in our current knowledge about the systemic and oral health of older immigrants and discusses future challenges to health promotion and clinical practice.

This paper provides a profile of clients seen by male sex workers (MSWs) in Córdoba, Argentina. Thirty-two MSWs completed a diary after each paid sexual encounter with a client over a two-week period. The results show that 254 commercial sex encounters were reported. More than half of these encounters were with first time clients. The most common source of recruiting clients was advertisements followed by street contact. The majority of the clients were aged in their 30s or 20s, and identified as 'middle class' and 'bisexual' or 'gay'. In the majority of the encounters, alcohol or drugs were not used by clients, and in about less than half of the cases, the MSWs had some personal tracing information about the client. Most of the clients indicated to the MSW what sexual activity they wanted and unsafe anal sex was requested in a minority (6%) of the encounters. While most workers reported having no or little attraction to the client, most indicated that they would serve the client again. The implications of the results for public health education and further research are discussed.

A total of 31 male sex workers recruited in Cordoba, Argentina, completed a questionnaire about the use and barriers to the use of health services, contact with the police and perception about the need of sex workers organizations. The results reveal that the majority preferred to use public services for general and sexual health concerns. The most frequently identified barriers to use of health services were waiting time before consultation and opening hours. The majority agreed for the need of a sex workers organization to advocate on their behalf, particularly achieving decriminalization of sex work and providing sexual health information to sex workers. Many reported contact with police that was generally positive, although some concerns were raised. The paper discusses implications for public health measures aimed at promoting greater sexual safety in the male sex industry.

A study was designed to assess the oral health of older Greek and Italian adults attending community clubs and living in Melbourne, Australia. The study also aimed to evaluate a community-based health promotion intervention on the oral health knowledge, attitude and practices of older Greeks/Italians. This paper discusses the design of an oral health promotion program and presents its qualitative and quantitative evaluation. Methods: The study included some 800 older adults who completed an oral health interview in their native language and underwent a detailed dental examination. The oral health promotion intervention consisted of three components: i) a series of oral health seminars held at the clubs in the participants' native languages, ii) the provision of oral care products relevant to each oral health seminar and iii) the production of oral health information sheets. The intervention program was known as the ORHIS (Oral Health Information Seminars/Sheets). Results: A total of 520 older adults participated in the evaluation. At post-test, the experimental groups were significantly more likely than the control groups to have improved oral health attitudes, oral health knowledge, self-assessed physical health status, and dentures hygiene. Positive outcomes were also achieved for self-reported oral hygiene practices and use of oral health services, but not for any of the clinical variables. Conclusion: The qualitative evaluation indicated that the oral health promotion program was effectively delivered in ethnic social clubs, highly acceptable to these communities and valued by participants in the study.Implications of this evaluation for the design and implementation of oral health interventions in migrant older adults groups and clubs are discussed and a number of recommendations made.

Introduction: The oral health of older Australians is a major public health challenge in the twenty-first century. However, little is known about the oral health status and needs of older migrants. Aims: This paper uses a qualitative methodology to obtain a better understanding of the oral health meanings and experiences of Greek and Italian older migrants. Methods: Seventeen focus group discussions were conducted, made up of 172 participants, recruited from eight Italian and nine Greek elderly clubs in Melbourne. Results: Participants were aware of the major oral diseases and treatments available. The data suggests that, although they knew of the need for periodic dental check-ups, there were barrier, which interfered with seeking check-ups. Participants also held a number of false beliefs, and strong negative attitudes towards dentistry. Conclusion: If programs are to increase the use of oral health services, specific barriers, myths, false beliefs and negative attitudes must be addressed.

Objectives: This study evaluated the impact of a community-based oral health promotion programme on the use of oral health services, oral health knowledge, attitudes, and practices of older Greek and Italian adults attending community clubs and living in Melbourne, Australia. Methods: The oral health promotion intervention consisted of three components: a series of oral health seminars, held at the clubs in the participants’ native languages, the provision of oral health care products, and the production of oral health information sheets. The intervention programme was known as the Oral Health Information Seminars/Sheets (ORHIS). The content of each session was determined following suggestions and findings from the data collected. A pre-test–post-test non-equivalent control group quasi-experimental design was chosen to evaluate the intervention. A total of 520 independent-living older adults, members of Greek or Italian social clubs participated in this evaluation. Results: Participants who took part in the intervention responded with higher levels of achievement than those in the control groups. After controlling for baseline variables, experimental groups were significantly more likely than the control groups at post-test to have improved oral health attitudes, oral health knowledge, and self-assessed physical health status, as well as, self-reported oral hygiene practices and use of oral health services. Discussion: The ORHIS approach was successful within the setting of social clubs, and highly acceptable to these communities. As such, it represents a helpful approach for the design of (oral) health interventions in older adults. Further research is required to test the long-term impact including the economic evaluation of the ORHIS approach.

A total of 31 male sex workers recruited in Cordoba, Argentina, completed a questionnaire about the use and barriers to the use of health services, contact with the police and perception about the need of sex workers organizations. The results reveal that the majority preferred to use public services for general and sexual health concerns. The most frequently identified harriers to use of health services were waiting time before consultation and opening hours. The majority agreed for the need of a sex workers organization to advocate on their behalf, particularly achieving decriminalization of sex work and providing sexual health information to sex workers. Many reported contact with police that was generally positive, although some concerns were raised. The paper discusses implications for public health measures aimed at promoting greater sexual safety in the male sex industry.

This article describes the socio-demographic and sex work characteristics of sex workers in Sydney, Melbourne, and Brisbane. A total of 185 male sex workers completed the questionnaire component of the study. The results of this study serve to debunk many of the myths surrounding the popular view of the male sex worker (MS W). The respondents in this study were on average 27 years old, and the majority had completed secondary education, with 30% having gained some form of tertiary qualification. Interestingly, those MSWs who had not completed secondary education were mostly street workers and were generally aged under 25 years. The majority of sex workers lived in rented accommodation, with only 6% reporting to be homeless. Half of all respondents identified as being "gay," 31% as "bisexual" and 5.5% as "straight." More than half of the respondents were in a permanent relationship. Only 7.3% of this group reported using heroin daily, although the majority consumed alcohol, tobacco, marijuana, and ecstasy. The majority of sex workers had been in the profession for less than six months, although some had been working in the industry for more than ten years. Most of the sex workers reported having taken an HIV test and a preference to offer safer sex. The article highlights ways in which the work context of MSW can be better understood and supported by education and public policy programs.

As discussed in chapters 14 and 16, questionnaires and in-depth interviews are the most commonly used methods for data collection in quantitative and qualitative research. Researchers use these methods because, generally speaking, retrospective self-reports of events provide accurate and valid data (O'Hare 1991; O'Callaghan & Callan 1992). However, to adapt an example from Reis and Wheeler (1991), let us suppose that we want to study the level of job satisfaction of intensive care nurses, how they spend their time during a working day, and their reaction to each of these activities. Traditionally, researchers would use self-report methods in which participants would be asked to retrospectively count and recall events and tasks, reflect on the various work situations and then report on their reactions, feelings or actions (Csikszentmihalyi & Larson 1987). However, data gathered using retrospective recall methods can suffer from a number of problems, such as underreporting of events, memory distortion, selective memory or reinterpretation of past experience, and recall biases (Csikszentmihalyi & Larson 1987; Tidwell, et al. 1996). Furthermore, such data will represent self-reported and not observed behaviour (Konings et al. 1995). There may be no way for the researcher to determine, for example, the circumstances that led to a specific event (e.g. the interaction between the persons involved), contextual to the event recorded (i.e. the perceived challenge of the task performed or the characteristics of the patients in terms of age or medical diagnosis), or the exact time when such events took place.

Background: Over the last 50 years an increasing number of migrants have settled in Australia. These immigrants now constitute a large proportion of the Australian population, and some research suggests that they may be at high-risk for oral diseases. Methods: This paper presents data on the oral health status of a convenience sample of 721 ambulant Greek- (n=367) and Italian-born (n=354) adults aged 55 years or older. The volunteer participants were recruited through ethnic social clubs located in Melbourne, Australia. Results: The sample was largely a dentate one (83.6 per cent); with a mean DMFS score of 67.5 (s.d. 37.4). Dentate participants had 13 per cent of their restorative care unmet, and 57.3 per cent needed oral hygiene instruction plus removal of stain and hard deposits on their teeth. Almost 8 per cent required complex periodontal therapy and 30 per cent of those fully edentulous were in need of full dentures. Conclusions: Comparing these findings with existing data on oral health of older adults in Australia, the participants in this study appear to have lower DMFS scores and a higher prevalence of gingivitis, but less need for complex periodontal treatment. Inequalities were apparent in the proportion of unmet restorative and prosthetics needs.