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The prevalence of kava (Piper methysticum), alcohol and tobacco consumption in Nuku'alofa (urban) and Foa (rural) are described. Current kava consumption was males 48% and females 1%. Prevalence was significantly higher among rural males. Current alcohol consumption was almost exclusive to the urban population and predominantly male, but only 2 (1%) rural males were current alcohol consumers. 169 (84.0%) of the rural males were irregularly or had ceased consuming alcohol. Tobacco consumption also showed a significant male predominance. There was a significantly higher total tobacco consumption in the urban population. Concordance of the three habits was evident among males with 27 concordant positive (expected = 5.98) and 46 concordant negative (expected = 6.60). It appears that kava, a traditional Pacific beverage may have lost ground to alcohol as urban Tongans adopt a more cosmopolitan life style. Kava, if proved relatively harmless, may be promoted as a less unhealthy alternative to tobacco and alcohol.

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Follow-up of 427 cases initially diagnosed in Wairoa county during 1962-76 as rheumatic fever and/or rheumatic heart disease showed that 40 had neither condition and 51 had chronic rheumatic heart disease only. Sources of misdiagnosis were cardiac (e.g. congenital heart disease, onset of atrial fibrillation), joint (e.g. rheumatoid arthritis, gout), streptococcal infections not proceeding to rheumatic activity and febrile conditions of childhood. Awareness of the problems, some strengthening of the diagnostic criteria, and the evolution of the illness with time would serve to correct misdiagnosis.

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PIP: Atoll dwelling people of Tokelau in the central Pacific have been studied in their home environment and after migration to the industrial culture of New Zealand. The migrants reflect the predominantly male and young composition of their group. Recent migration has eased the lot of the surplus young women from Tokelau, resulting in earlier marriage and less long term spinsterhood. The apparently higher fertility of women residing in New Zealand is largely explained by selection of female migrants who already have 2 or more children. Earlier menarche and earlier marriage in New Zealand probably contribute little. Future trends will be monitored, and a decline in migrant fertility is expected, if Tokelauans follow the pattern of other Polynesian migrants to urban environments.^ieng

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The diagnostic criteria of acute rheumatic fever are reviewed from experience in a New Zealand community. Two-hundred-and-sixty-one first attacks labelled rheumatic fever and 209 other episodes occurred in a defined geographic population during 1962--76. The major importance of heart, joint and brain manifestations is confirmed. Criterior levels for fever, P-R interval prolongation, erythrocyte sedimentation rate, white cell count and antistreptolysin-O titre are suggested. Nodules and evidence of established rheumatic heart disease were not found to be of diagnostic significance because they tended to be equally common among patients with rheumatic fever and patients considered to have another disease. Separate criteria for cases with and without pre-existent rheumatic heart disease are given, to enable assignment of episodes to probable rheumatic fever status.

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Tokelauans show an increased prevalence and incidence of diabetes mellitus after migration to the modern industrial society of New Zealand (NZ). In females the prevalence rose from 6.1 percent before migration to 10.8 percent afterwards, while in males a nonsignificant rise from 2.3 percent to 4.4 percent was observed. Migrants who had been in New Zealand for longer periods had higher incidence than other migrants. Time since arrival in New Zealand was a significant predictor of diabetes, but time spent in an intermediate environment, Samona, on the way to New Zealand was not. Increase in body weight and adiposity occurred in the migrants. Adiposity was associated with an increased risk of diabetes, but nonspecific weight increase was not. Diabetic females had experienced 15 percent more births than nondiabetic females. Changed energy balance related to diet and work patterns may be related to the increased incidence of diabetes in migrants, in a population predisposed by high serum uric acid concentrations, obesity and high fertility.

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Rheumatic fever remains important in New Zealand, and rheumatic heart disease is common. In a high risk area, a study of primary preventive strategies was undertaken among primary school children. The principal aim was to reduce beta-haemolytic streptococcal throat carriage. Subordinate aims were to reduce sickness-related absenteeism and the clinical incidence of streptococcal disease. The strategies compared included (1) identification and treatment of asymptomatic carriers at three-monthly surveys; (2) between-survey home visits of a nurse to identify infections and encourage prompt referral to the family doctor; (3) an exercise programme intended to increase general and respiratory fitness. Some benefit resulted from each strategy but the exercise programme was the least costly. The benefits of treatment of carriers and home visiting are probably insufficient to make them worthwhile.

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The clinical features of acute rheumatic fever as seen in Wairoa County 1962--76 are described. The types of cases seen comprised 107 definite first attacks, 78 definite recurrences, and 117 first attacks and 34 recurrences which did not satisfy strict diagnostic criteria. The incidence of the major manifestations, carditis, polyarthritis and chorea were 53 percent, 56 percent and 11 percent in definite first attacks, and 81 percent, 26 percent and 8 percent in definite recurrences, respectively. The ratio of recurrences to first attacks was high (58 percent). The Wairoa population exhibits factors thought to contribute to a high risk of recurrence--young age distribution, non-Caucasian ethnicity, avoidance of parenteral prophylaxis and frequent carditis in the first attack.

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The prevalence of alcohol consumption, the choice of beverages and the quantity of drinks used by a Polynesian society are described, both in the Tokelau atolls and among Tokelauan migrants in New Zealand. Current drinking was uncommon but increasing among women. Among men, it was more common, but both prevalence and quantity were modest compared with national alcohol consumption in New Zealand. Description of alcohol consumption in such migrant populations may provide a basis for encouraging continuing prudence regarding alcohol and ready acceptance and provision for the non-drinker of alcohol.

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Two epidemiological surveys of New Zealand adolescents are reported. The prevalence of asthma was 7.5 percent in Rotorua and 7.9 percent in Wairoa. Additional questions asked in Wairoa identified 18.2 percent of subjects who had experienced wheeze but had not been labelled "asthma". The association of active asthma with nasal obstruction was confirmed. Wheeze which had not been labelled asthma was associated with the combination of subject's own and maternal cigarette smoking. The use of asthma medication was associated with easier geographic and socio-economic access to medical care, as well as with asthma activity.

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Surveys of children aged 5--17 in a predominantly rural area showed a high prevalence of inflamed ears and perforated drums in younger subjects and of perforated and scarred drums in older subjects. Abnormal drums were associated wtih lower socioeconomic status, ethnicity and low altitude and low rainfall. Maori children had both higher incidence and lower recovery rates than non-Maori children. The wider use of trained nurses for case detection and follow up is advocated, at an estimated cost of 53 cents per child examination. Further parent education and co-ordination of nurse/audiometrist surveys are necessary.

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A survey of a secondary school serving a small town and rural district in New Zealand revealed that 46 percent of the students, aged 12 to 18, were current cigarette smokers. The smoking habits of elder siblings and peers were closely related to subjects' smoking. Parental opposition to smoking, beliefs that smoking was bad for health and a degree of self-esteem appeared to have protective value. The key to prevention of cigarette smoking may lie in parent and early childhood education aimed at increasing awareness of the dangers of smoking, fostering a soical climate of opposition to smoking, and increasing the child's self-confidence.

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The decline in incidence of rheumatic fever seen in many countries is not evident in New Zealand. Wairoa county has the highest hospital admission rate within New Zealand, 232 per 100 000 per year, five times the national average, 43 per 100 000. Studies in Wairoa included a cross-sectional survey of the local secondary school. Throat swabbing yielded 13.6% of subjects positive for beta-haemolytic streptococcus group A. Boys had a higher rate than girls, and girls aged 14 and over had a lower rate than younger girls. Discriminant analysis failed to identify ethnic, social or geographic factors as contributing to positivity. Sibling concordance was not significant. ASO titres were high in comparison with another New Zealand study (Rotorua Lakes). There was an association between high ASO titre and throat swab positive for group A and group C streptococci. The prevalence of definite rheumatic fever and rheumatic heart disease was established as 11/715 (1.5%). A wide range of residential geographic, climatic and socioeconomic factors failed to discriminate between cases and noncases. Ethnicity alone was a significant discriminator, the cases being more Maori than noncases.

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Serum levels of immunoglobulins A, G and M are described in a group of New Zealand (NZ) children of European descent. These findings are used as reference standards for three groups of Tokelauan children, atoll residents, migrants in NZ, and NZ-born Tokelauan children. All three Tokelauan groups had high levels of IgA, IgG, and IgM. Breast feeding was diminished and morbidity was higher in the NZ-born group. The IgG level was negatively correlated with duration of breast feeding in this group. In the atoll group IgG was related to present illness but no other consistent relationships were found between present illness status and the immunoglobulin levels. It remains unclear whether the high Tokelauan immunoglobulin levels are genetically or environmentally determined.

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