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Aim: We compared changes in tobacco consumption and diet in relation to changes in life expectancy in 1988-1998 in 22 OECD (Organisation for Economic Cooperation and Development) countries., Method: Between 1985 and 1995 using regression analysis we estimated differences in tobacco consumption per adult and the differences in the sum of atherogenic and thrombogenic indices against life expectancy. Each index was derived from the various fats per gram of food from standard texts, and from the annual measurements of fat in the food balance sheets of each country., Results: In 1985-1995, New Zealand showed the largest decrease in tobacco consumption per adult (41%) and the greatest decrease (except for Switzerland) in the sum of atherogenic and thrombogenic indices (17%) as a measure of diet. New Zealand ranked first for life expectancy increases from 1988-1998 for men (3.2 years), women (2.8 years) and both sexes combined. Regression analyses revealed that increases in life expectancy across the OECD for males, but not females, were strongly associated with decreases in tobacco consumption, with a weaker effect of diet improvement., Conclusion: These results suggest that reduced tobacco consumption in 1985-1995 likely contributed to New Zealand's gains in life expectancy from 1988-1998., Competing Interests: Nil.

Aims: To analyse electronic cigarette (EC) brands available in New Zealand for nicotine and toxicant yield ratings., Method: Fourteen EC brands were analysed before and after nicotine exhaustion for nicotine and nine for major toxicants. Concentration of nicotine and aldehydes in vapour was measured and compared with the nicotine and aldehydes in the smoke of a Marlboro cigarette., Results: ECs labelled as high strength (16-18+ mg nicotine) contained 5-46 mg nicotine. Nicotine EC brands yielded 19-93 mcg nicotine per puff compared to 147 mcg per puff for Marlboro cigarettes, and emitted 200 times less toxic aldehydes (acetaldehyde, formaldehyde and acrolein) than Marlboro cigarette smoke. Compared with the first generation EC, study ECs emitted 73% less aldehydes. Diethylene and monoethylene glycol were not detected in vapour., Conclusion: ECs available in New Zealand in 2013 exposed users to higher levels of nicotine than in older brands but lower than cigarettes, and to far lower levels of toxicants than cigarettes and earlier ECs, indicating potential as safer substitutes for tobacco.

Aim: To determine whether adding a low tax category for very-low nicotine content (denicotinised or Denic) cigarettes would facilitate higher excise and reduced consumption of addictive cigarettes (AddictiveCigs, defined as containing =2 mg nicotine per cigarette)., Method: Nicotine content was laboratory-tested to classify cigarettes into two tiers for excise. PubMed was searched for studies of low nicotine content cigarettes. Nicotine delivery studies and estimated current and future cigarette prices provided the basis for estimating the effect of smoking a mix of AddictiveCigs and Denics., Results: The test results indicated that mean nicotine content per cigarette for the 22 most popular New Zealand brands was 8.7 mg (range 5.6-12.4 mg); only AddictiveCigs were sold. Annual 10% excise increases now legislated are estimated to increase price to $17.60 per 20s packet by 2016. A minority of smokers will quit, by abstaining from AddictiveCigs. Continuing smokers if able to buy lower-priced Denics ($11 a packet), could partly switch to these, which although no less toxic would relieve cravings, reduce nicotine inhaled by 68-86%, and contain smoking costs, without reducing total cigarettes smoked per day., Conclusion: Introducing a lower excise rate for Denics would: (1) allow smokers to select their own mix of AddictiveCigs and Denics; (2) make Denics available to reduce cravings, reduce addiction, and reduce smoking costs of continuing smokers; (3) increase the political feasibility of increasing excise on AddictiveCigs sufficiently to greatly reduce addictive smoking; and (4) enable smokers to reduce their addiction before they quit, and therefore probably become more likely to succeed when they do so.

Aim: To phase out sales of cigarettes and of smoking tobacco products in New Zealand by the year 2020., Current Situation: 99% of tobacco is smoked as cigarettes. Cigarettes are highly addictive, lethal, and cannot be made safer. Since 1950 commercial cigarettes have prematurely killed over 160,000 New Zealanders. Despite causes-disease warnings on tobacco packaging (from 1987) and graphic warnings (2007), bans on tobacco advertising and promotions (1990), bans on indoor workplace smoking (1990, 2004), subsidies on medicinal nicotine (2000), and despite one-third of smokers annually making serious attempts to quit, 1 in 5 New Zealand adults smoke, 2 in 5 Māori adults smoke, and cigarette consumption per adult remains virtually unchanged since 2003. Four in 5 smokers regret they ever started., Proposed Policies: Four policies combined could make cigarette smoking less attractive and the use of nicotine-only products more attractive, with respect to relative price, availability and addictiveness. These mean increasing tax on all cigarettes equally; and a bill to strengthen the Smoke-free Environments (SFE) Act: to allot cigarette sales quotas and then gradually lower them; reduce the nicotine content of cigarettes gradually by a sinking lid or by nicotine tax; and permit the sale of satisfying non-combustible nicotine-only products for smokers. As supply reduces, prices rise, and nicotine satisfaction decreases, smokers will quit; and black market risk will be minimised. Commercial cigarettes will no longer be obtainable, and even if some smoke tobacco grown legally for their own use, or even if some is obtainable illegally, tobacco consumption will greatly reduce., Conclusion: The smoking of tobacco sold legally kills 5000 New Zealanders annually. The SFE Act can be amended to phase out legal sales within this decade. Intensive policy research is needed now as public interest increases. Support from the public and from legislators to promote a suitable amendment bill is now needed.

Aims: To assess whether smoking declined markedly since 2003, as reported by the New Zealand Health Survey (NZHS) of 2007., Method: Comparison of daily smoking prevalence from the NZHS, Census, and annual ACNielsen Ltd smoking prevalence survey against tobacco and cigarette volumes released to the domestic market, 1996-2007., Results: From 2003 to 2007, NZHS-reported daily cigarette smoking prevalence decreased from 22.8% to 18.1%, implying 125,000 (-17%) fewer smokers, whereas cigarettes annually released for sale increased 7.5% from 3957 to 4253 million sticks. In contrast, the Census and the ACNielsen commercial survey estimated 1.0 and 1.5 percentage point decreases respectively in numbers smoking. Identifiable factors explained up to 34% of the decrease in numbers smoking. Anti-smoking sentiment was greater in 2007., Conclusion: It is highly doubtful if adult daily smoking prevalence has yet decreased below 20%. Smokers responding to the 2007 NZHS, more than in previous health surveys, tended to underreport their smoking. They may have opted out of responding altogether, or otherwise not reported they smoked. Future health surveys should include biochemical validation of smoking status.

Smokers need new products and policies to escape smoking's risks. And the next generation needs policies that will better protect them from becoming smokers. Low-nitrosamine tobacco snuff (hereafter termed 'snuff') is 20 times less dangerous than cigarette smoking. Its sale as nasal snuff raises the question as to how long cigarettes, including cigars and pipe tobacco, should continue to be sold and allowed to hasten the deaths of 4000 New Zealanders annually. Oral snuff has helped to reduce smoking to unusually low levels in Swedish men, is much less dangerous than smoking, and does not cause lung or mouth cancer. Moreover, smokeless tobacco (which includes snuff) could reduce smoking-caused health inequity for Maori. Snuff can improve population health, and more so if more smokers switch to it. Continued bans on snuff are now regarded by some experts as unsound public policy. Added to the mountain of evidence against cigarettes, sufficient evidence now exists for Government to use snuff to create safer tobacco choices for smokers, end cigarette sales altogether, and thus end the cigarette smoking deaths epidemic--in which 200,000 New Zealanders have died so far. The New Zealand Government can: Fund media campaigns to inform smokers of their new choices, and to urge them to quit smoking. (The 2007 Budget commits an extra $11 million per year for 4 years, an excellent start.) Regulate for warnings on snuff cans stating that snuff is "addictive but much safer than smoking", and regulate imports to only permit reduced-risk low-nitrosamine products. Tax each class of tobacco products proportionate to the respective risks of each. (Tax cigarettes at 20 times the snuff rate, instead of at the same rate.) Legislate, to expand the Smoke-free Environments Act's aims to include ending the sale of cigarettes and ending smoking deaths--i.e: Allow oral snuff to compete with cigarettes for market share (and for the smoker's nicotine receptors). Reduce addiction to smoking, by decreasing the nicotine content of cigarettes by 5% every 6 months. (Below 20% of current levels, most smokers will quit or switch to snuff.), Allot cigarette supply quotas to manufacturers and importers, decreasing by 5% every 6 months, on the grounds that cigarette smoke is irremediably toxic. The summed effects of these changes could end cigarette sales within 10 years, and prevent 90% of cigarette deaths within 22 years thereafter.

Aim: To review New Zealand red meat and meat fat supply trends before and after the introduction of the Quality Mark standard., Methods: Review of trends in: per capita meat fat supply estimates from the Food and Agriculture Organization (FAO); carcase and meat cut composition reports of knife dissection and chemical analyses; the fate of fat trim; and a Lincoln College study of home-cooked and trimmed beef. Intervention From September 1997, the red meat industry's Quality Mark required trimming of beef and lamb cuts to no more than 5 mm external fat., Results: (1) Trimming of fat from red meat before sale (supported by virtually all butchers) decreased the fat and saturated fat content of a red meat carcase by 30% (beef, -27%; lamb, -30%; tallow unchanged); by -8% in the total food supply; and by -17% across all meat. In 2002, fat comprised 7.4% of trimmed beef cuts, and 11.2% of all beef sold: cuts, mince, or sausages. In 2002, fat comprised 15.3% of lamb cuts; and 15.5% with mince included. (2) From 1995 to 2002, total saturated fat availability per capita in the food supply decreased by 19% (from 65 g to 53 g per day), mostly due to 7 g less saturated fat daily from red meat. (3) When combining effects (1) and (2), saturated fat per capita decreased: -27% in total food supply; -65% in red meat excluding tallow; -48% in red meat including tallow. In 1995 (without trimming), red meat contributed 25% of saturated fat in the total food supply whereas in 2002, red meat contributed 19% before (and 13% after) trimming. (4) Home trimming may remove an additional 27% of fat from beef steaks., Conclusion: Centralised meat processing, and Quality Mark labelling since 1997, ensured fat was trimmed from beef and lamb cuts, and reduced saturated fat in red meats by 30%. In 2002, mince and sausages accounted for nearly half of beef fat sold as red meat.

Aim: To compare the emissions toxicity of two manufactured cigarette brands, one with and one without a charcoal filter, in the light of manufacturers' laboratory research findings on the properties of charcoal filters., Method: Emissions of Mild Seven charcoal filter brands, regular (labelled '12 mg tar') and Light (labelled '9 mg tar') purchased in 2004, were compared with those of Holiday Extra-mild brand (9 mg tar, acetate filter), purchased in 2002. All emissions were tested under intensive machine smoking conditions by Labstat International Inc., Kitchener, Ontario., Results: The Mild Seven brands contained a small amount of charcoal, its black granules visible against the white acetate filter. The charcoal filter in the brands tested did not reduce toxicity to the extent expected, though they gave significantly lower emissions for the respiratory-toxicants acrolein (14%-17% lower, p 'less than and equal to' 0.01) and formaldehyde (26-37% lower, p 'less than and equal to' 0.01). Reductions were not significant for acetaldehyde, and actually higher for hydrogen cyanide. Overall, estimated cardiovascular-respiratory toxicity was not reduced, whether based on toxicant emissions or the toxicant to nicotine ratios. Of the packet labels, neither tar yield (mg) nor the descriptors 'mild', 'light', or 'extra-mild', or 'charcoal filter' for these three brands was associated with any reduction of the combined respiratory--and cardiovascular toxicity of mainstream smoke, as measured by leading toxicants tested by the intensive method. Previously secret documents from cigarette companies, including British American Tobacco, reported reductions of 75%-80% in hydrogen cyanide, acetaldehyde, acrolein, and formaldehyde in mainstream smoke from addition of charcoal to the filter. We estimated that an effective charcoal filter could reduce a brand's overall relative toxicity score for identifiable toxicant by over 40%., Conclusion: Since 1965, major cigarette firms have known from their chemists that many smoke toxicants, including hydrogen cyanide and acrolein, were removable by manufacturing the cigarette with a charcoal filter. To this day, few brands have charcoal filters. The best known, Mild Seven, contained a token charcoal filter only. In neither Japan nor New Zealand did this brand lower cardiovascular toxicant emissions in smoke. In the Smoke-free Environments Act, Government has the power to lower smoke emissions by regulation, but no regulations are in place. The Act does not give power to add filters to cigarettes, but does give power to lower smoke emissions to the level attainable by using a charcoal filter, which could reduce smoke emission toxicity to a large extent. Regulation to require effective charcoal filters is now long overdue.

Aims: To explore the scope for regulating to reduce the toxicity of manufactured cigarettes sold in New Zealand (NZ), based on published toxicant emissions by brand., Methods: Internet searches of published cigarette smoke emissions of 13 toxicants chosen on risk assessment principles, for 20 British Columbian, 15 Australian brands, and one NZ brand, Holiday Extra-mild (HEM), tested by Health Canada intensive smoke machine method at Labstat Inc, Kitchener, Ontario, as a ratio of toxicant to nicotine yield. We estimated relative overall smoke toxicity per disease group and per brand, after adjusting for the published cigarette-attributed mortality fractions for cancer, cardiovascular, and respiratory disease., Results: After allowing for nicotine yield, filter ventilation, and compensatory over-smoking, there were significant differences between brands, with the NZ brand estimated to be the most toxic. Low-yield cigarettes (<0.9 mg nicotine ISO) were estimated to be on average 19% more potent overall than medium-yield cigarettes (p<0.01). Of toxicants identified and measurable in smoke; 1,3-butadiene accounted for 45% of cancer potency; hydrogen cyanide for 89% of cardiovascular; and acrolein for 97% of respiratory potency--these three toxicants accounting for 65% of identified brand potency. Individual toxicant emissions varied across brands by a factor of 1.5 for carbon monoxide, to 32 for lead. Compared with HEM, one Canadian brand, 'Export A full flavor', carried a 37% lower cancer risk. This lower risk was largely due to differences in nicotine yield, lowering the toxicant/nicotine ratio., Conclusions: Cigarettes, unregulated, are unduly dangerous. Though many smoke toxicants cannot yet be quantified, risk assessment based on current data suggests that regulation could partly reduce identifiable cancer risk, and possibly eliminate the excess cardiovascular and respiratory toxicity of HEM, when compared with regular Canadian brands. The first goal should be to reduce emissions of the leading three toxicants, in addition to more effective charcoal filters. Tobacco smoke, unlike unburnt or non-smoking tobacco, contains toxic gases and trillions of reactive oxygen species molecules per puff, and will remain inherently harmful. Regulation could usefully part-reduce smoke toxicity exposure for continuing smokers, while not relenting on efforts to assist smokers and society to be quit of smoking.

Aims: To investigate whether parental smoking and other parental behaviours are risk factors for smoking in 14- and 15-year-old children., Methods: National cross-sectional survey of 14 930 female and 14 341 male 4th form students who answered an anonymous, self-administered questionnaire in November 2001., Results: The effect of both parents smoking on the risk of daily smoking by students varied significantly (p <0.0001) between ethnic groups, being strongest for Asian students (adjusted relative risk (RR) = 6.64 compared with students of non-smoking parents), intermediate for European (RR = 3.11) and Pacific (RR = 3.05) students, and weakest for Maori (RR = 1.74). Adolescent smoking was also positively associated with pocket money amount and living in a home where people smoked. Two thirds of daily smoking could be explained by the combined exposure to one or more of the following factors: parental smoking, pocket money >5 dollars per week, and smoking in the house., Conclusions: Parental behaviour is a key determinant of smoking by New Zealand adolescents. Efforts that target the role of parents should be pursued, such as health promotion strategies that advise parents about the possible benefits of banning smoking in the home, limiting pocket money, and not providing cigarettes to their children.

Aim: To test the correlation of per capita A1 beta-casein (A1/capita) and milk protein with: 1) ischaemic heart disease (IHD) mortality; 2) Type 1 (insulin-dependent) diabetes mellitus (DM-1) incidence., Methods: A1/capita was estimated as the product of per capita cow milk and cream supply and its A1 beta-casein content (A1/beta) (calculated from herd tests and breed distribution, or from tests of commercial milk), then tested for correlation with: 1) IHD five years later in 1980, 1985, 1990 and 1995, in 20 countries which spent at least US $1000 (purchasing power parities) per capita in 1995 on healthcare; 2) DM-1 at age 0-14 years in 1990-4 (51 were surveyed by WHO DiaMond Project; 19 had A1 data). For comparison, we also correlated 77 food, and 110 nutritive supply FAO (Food and Agriculture Organization)-based measures, against IHD and DM-1., Results: For IHD, cow milk proteins (A1/capita, r = 0.76, p <0.001; A1/capita including cheese, r = 0.66; milk protein r = 0.60, p = 0.005) had stronger positive correlations with IHD five years later, than fat supply variables, such as the atherogenic index (r = 0.50), and myristic, the 14-carbon saturated fat (r = 0.48, p <0.05). The Hegsted scores for estimating serum cholesterol (r = 0.42); saturated fat (r = 0.37); and total dairy fat (r = 0.31) were not significant for IHD in 1995. Across the 20 countries, a 1% change in A1/capita in 1990 was associated with a 0.57% change in IHD in 1995. A1/capita correlations were stronger for male than female mortality. On multiple regression of A1/capita and other food supply variables in 1990, only A1/capita was significantly correlated with IHD in 1995. DM-1 was correlated with supply of: A1/capita in milk and cream (r = 0.92, p <0.00001); milk and cream protein excluding cheese (r = 0.68, p <0.0001); and with A1/beta in milk and cream (r = 0.47, p <0.05). Correlations were not significant for A2, B or C variants of milk beta-casein. DM-1 incidence at 0-4, 5-9 and 10-14 years was equally correlated (r = 0.80, 0.81, 0.81 respectively) with milk protein supply. A 1% change in A1/capita was associated with a 1.3% change in DM-1 in the same direction., Conclusions: Cow A1 beta-casein per capita supply in milk and cream (A1/capita) was significantly and positively correlated with IHD in 20 affluent countries five years later over a 20-year period--providing an alternative hypothesis to explain the high IHD mortality rates in northern compared to southern Europe. For DM-1, this study confirms Elliott's 1999 correlation on 10 countries for A1/capita,1 but not for B beta-casein/capita. Surveys of A1 beta-casein consumption in two-year-old Nordic children, and some casein animal feeding experiments, confirm the A1/capita and milk protein/capita correlations. They raise the possibility that intensive dairy cattle breeding may have emphasised a genetic variant in milk with adverse effects in humans. Further animal research and clinical trials would be needed to compare disease risks of A1-free versus 'ordinary' milk.

Aims: To investigate whether pocket money amount and socio-economic status are risk factors for smoking in 14 and 15 year old children., Methods: This was a national cross-sectional survey of 4th form students who answered an anonymous self-administered questionnaire in November 2000. Socio-economic status was determined from the Ministry of Education school socio-economic deciles., Results: Questionnaires from 14793 girls and 14577 boys were analysed. Socioeconomic status (SES) was inversely associated with smoking prevalence in girls only (p<0.0001). Students in low SES decile schools received greater amounts of pocket money than those in high SES decile schools (p<0.0001). Compared with students who received $1-10 in the last 30 days, for students receiving pocket money >$30, $21-30, or $11-20, the adjusted relative risks for smoking > or = monthly were 1.73 (95% CI 1.61, 1.85), 1.48 (1.35, 1.62), and 1.15 (1.03, 1.28) in girls, and 1.57 (1.46, 1.70), 1.32 (1.19, 1.46), and 1.11 (1.00, 1.23) in boys, respectively. The proportion of smokers purchasing cigarettes increased with amount of pocket money received in the last 30 days (p<0.0001)., Conclusions: Cigarette smoking is positively related to pocket money amount in adolescents. This finding has important public health significance, but further research is required to determine if the association is causal.

Aims: To compare the New Zealand food supply and trends from 1961 to 1995 with other Organisation for Economic Co-operation and Development (OECD) countries, with an emphasis on foods linked with coronary heart disease (CHD)., Method: Food and Agricultural Organization per capita food supply statistics for 24 OECD countries were converted to nutritional supply values and adjusted for edible portion., Results: In 1995, New Zealand had the highest supply per capita of butter and meat fats among OECD countries, ranking its food supply highest for thrombogenicity and third for atherogenicity. Seafood and alcohol supply were average and vitamin E supply was high compared with other OECD countries. Beneficial trends have occurred with increases in fruit consumption, vegetable consumption and fibre intake between 1961 and 1995. While total fat intake has not changed appreciably, the fatty acid profile has shifted and is now less likely to promote CHD., Conclusions: The New Zealand diet's tendency to promote CHD has decreased, particularly since 1985. The diet's fatty acid profile, however, remains highly atherogenic and thrombogenic, predisposing to CHD, and the fat content of the food supply remains high, predisposing to obesity. Continued efforts are needed to improve the diet of New Zealanders and to maintain food supply data collection for long term monitoring of these changes.

Aim: To determine recent changes in cigarette purchasing behaviour of 14- and 15-year-old students in New Zealand., Method: Nationwide cross-sectional surveys of fourth form students in 85 schools in New Zealand by means of an anonymous self-administered questionnaire collected in November 1992 and in November 1997., Results: Analyses were restricted to 4198 out of 11 824 total students in 1992, and 4526 out of a total of 11 350 in 1997, who were current smokers aged 14 and 15 years. Self-purchasing of cigarettes decreased by 37% (95% CI: -40, -34) from 1992 to 1997, adjusting for age, sex and ethnicity, while acquiring cigarettes from other people increased. There was decreased purchasing from dairies (-6%; 95% CI: -8, -4) and supermarkets (-9%; 95% CI: -16, -1) but increases from other sources such as take-away shops, tobacconists and vending machines. From 1992 to 1997, weekly buying increased by 23% (95% CI 16, 32), students who were refused a sale increased by 153% (95% CI 139, 169) and students who had difficulty in buying increased by 324% (95% CI 276, 379). The latter were less likely to buy weekly than students who did not have difficulty (31.1% vs 41.4%). Students who smoked < or =5 cigarettes per week were 32% (95% CI 13, 53) more likely to have difficulty in buying than students smoking >20 per week., Conclusion: These results indicate major changes in cigarette purchasing behaviour between 1992 and 1997, when there was increased enforcement against underage sales of tobacco.

Aims: To determine trends in the cigarette smoking behaviour of 14- and 15-year-old students in New Zealand., Methods: Nationwide cross-sectional surveys of fourth-form students in New Zealand in 85 schools by anonymous self-administered questionnaire in 1992 and 1997. In 1992, 79% of schools and 70% of students responded; in 1997, 88% and 72%, respectively., Results: Responses were analysed from 11,824 14- and 15 year-old fourth formers in 1992 and from 11,350 in 1997. Daily, weekly or monthly combined smoking prevalence increased by 27% (95% confidence interval (CI) 21-32), adjusting for age, sex and ethnicity, from 23.4% in 1992 to 28.5% in 1997. Daily smoking increased from 11.6% in 1992 to 15.5% in 1997 - an adjusted 37% (95% CI = 24-47) increase. The increase in daily smoking was: greater in girls (44%, 95% CI = 33-57) than boys (28%, 95% CI = 16-42), adjusting for age and ethnicity; unrelated to the socioeconomic decile of schools; and greatest in Auckland and Northland., Conclusion: This increase in smoking is large, 27-37% over five years, of uncertain cause, affects both sexes, all regions, ethnic and socio-economic groups, and certain cigarette brands. Regular school smoking surveys and more smokefree youth venues are recommended. Addiction and nicotine absorption merit monitoring. Legislation can require disclosure of manufacturing recipes used for youth-popular cigarette brands. On 1960-97 trends it would take 100 years to reduce fourth-form smoking to 5% prevalence. The proposed gradual denicotinisation of all cigarettes would allow smoking but prevent addiction, within ten years.

Results from a dynamic computer model of rubella vaccination programmes indicate that consideration should be given to vaccinating all one-year-old girls and boys and revaccinating all girls at about 11 years of age, as well as continuing with the programme for susceptible women in the childbearing age group. With vaccine-induced immunity decaying at about 1% annually, the vaccination of 80 to 95% of all one-year-olds, 95% of 11 year old girls, and 5% of women aged 15 to 33 annually is expected to reduce congenital rubella syndrome deformities to less than 5% of the 1980 incidence by 1994, and to negligible levels thereafter. In comparison, continuation of the present scheme may reduce deformities to only 69% of 1980 levels by 1994 with a slow decline to 25% in 2010. (The 1980 levels used were computer generated to eliminate short-term fluctuations, and do not apply to actual figures from that year.) For convenience and better compliance, measles vaccine and the initial rubella vaccine may be given in combined form at 15 months without altering the effect of either. The rate of decay of immunity after vaccination is critically important in congenital rubella syndrome prediction, so that further accurate monitoring of immune status and congenital rubella incidence is essential.

A cohort of approximately 500 boys was screened for retained testes at ages five and seven years and when the boys were aged three, five, seven and nine years, their parents were questioned about hospitalisation for surgery. Orchidopexy for retained testes had been performed on 15 of the 536 boys (2.8%) while one other had orchidopexy for high retractile testes (0.2%). Eighty-one percent of this surgery was performed between the seventh and ninth years of age.

Attributable risks of mortality and morbidity occasioned by current or past cigarette smoking are applied to recent mortality and hospital morbidity data. The 1981 census data on smoking, the hospital discharge data from 1984 and mortality since 1980 are analysed showing that 1 in 5 deaths of men aged 15 to 60 can be attributed to smoking, as can 1 in 9 deaths of women 15 to 60. In all 4137 deaths per year are attributable to smoking. Each year 4815 years of working life (15 to 60) are lost due to cigarette smoking induced premature mortality. Excess hospital use caused by cigarette smoking is estimated to cost more than $81 million (in 1986 dollars).