Women, new initiates and IDUs recruited via outreach appear to be at increased risk of infection. Results confirm the significance of cocaine injection as a risk factor and provide the first evidence outside North America of the link between shared use of drug preparation equipment and incident HCV infection. Prevention efforts should attempt to raise awareness of the risks associated with drug sharing and, in particular, the role of potentially contaminated syringes in HCV infection.

We compared mortality of 1,999 outdoor staff working as part of an insecticide application program during 1935-1996 with that of 1,984 outdoor workers not occupationally exposed to insecticides, and with the Australian population. Surviving subjects also completed a morbidity questionnaire. Mortality was significantly higher in both exposed and control subjects compared with the Australian population. The major cause was mortality from smoking-related diseases. Mortality was also significantly increased in exposed subjects for a number of conditions that do not appear to be the result of smoking patterns. Compared with the general Australian population, mortality over the total study period was increased for asthma [standardized mortality ratio (SMR) = 3.45; 95% confidence interval (CI), 1.39-7.10] and for diabetes (SMR = 3.57; 95% CI, 1.16-8.32 for subjects working < 5 years). Mortality from pancreatic cancer was more frequent in subjects exposed to 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (SMR = 5.27; 95% CI, 1.09-15.40 for subjects working < 3 years). Compared with the control population, mortality from leukemia was increased in subjects working with more modern chemicals (standardized incidence ratio = 20.90; 95% CI, 1.54-284.41 for myeloid leukemia in the highest exposure group). There was also an increase in self-reported chronic illness and asthma, and lower neuropsychologic functioning scores among surviving exposed subjects when compared with controls. Diabetes was reported more commonly by subjects reporting occupational use of herbicides. These findings lend weight to other studies suggesting an association between adverse health effects and exposure to pesticides.

Dietary intake surveys of rural and urban communities in three Pacific Island countries were conducted using an adjusted 24-hour dietary recall method. Dietary survey samples were drawn from noncommunicable disease surveys of Melanesians and Indians in Fiji, Micronesians in Kiribati and Melanesians in Vanuatu. Comparisons of total energy and macronutrient intakes and of obesity, hypertension, diabetes mellitus, serum cholesterol and physical activity levels revealed similar rural/urban trends. Urban subjects were more obese than rural ones, had higher prevalence rates of diabetes and hypertension, and generally had higher cholesterol levels. Rural subjects were leaner, suffered less from diabetes and hypertension, and had greater total energy intakes than urban dwellers. Rural people ate a greater proportion of carbohydrates, while urban subjects ate proportionally more protein and fat, apart from the outer Kiribati atolls with high coconut intakes. Rural subjects in all three studies had higher levels of physical activity. These studies provide persuasive evidence that exercise as well as diet has a significant effect on rural/urban differentials in obesity and noncommunicable disease, and that energy intake reflects energy expenditure.

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H 10,000 new infections each year.'Transmission is predominantly via blood, with shared drug injection equipment being the major exposure.2 Little is known about the impact of HCV on behaviour or circumstance of infected individuals. Media reports suggest community concern regarding bloodborne viruses (BBVs) such as HCV, compounded by negative stereotyping of injecting drug users (IDUs). We report on the impact of HCV infection on behaviour, treatment choices and lifestyle in people notified with HCV on the NSW North Coast. MethodsStudy methods have been described prev i o~s l y .~ Briefly, all persons notified with HCV over a 21-month period during 1993 and 1994 were asked to complete a questionnaire examining exposures, therapies and behaviours. Subjects were asked specifically how their infection had influenced behaviours such as alcohol and tobacco intake, and personal circumstances such as relationships and working ability. Details of symptoms were requested on a separate questionnaire from attending medical practitioners with patients' written consent. ResultsKnowledge of potential risk factors for HCV infection varied. Of 467 resident cases who responded, 321 (69%) were aware of potential exposures. Of 398 IDUs, 238 (60%) identified this as an exposure. Forty-three IDUs believed they were infected via other means, 34 did not know and 83 did not state how they were infected. Of 30 non-IDU transfusion recipients, 24 identified this as an exposure. Only 9 of 176 tattooed subjects stated this as a potential exposure.The major reported symptom was fatigue affecting some aspect of daily life, e.g. relationship, work, sleep (n=212; 45%). Some 182 (39%) also reported reduced ability to perform daily duties, 50 (1 1%) nausea and 77 (16%) emotional disturbances (e.g. stress, depression). There was no association between symptoms and hepatitis B virus coinfection (x2=0.21, df=l, p=0.65).Symptoms observed by medical practitioners were reported for a sub-sample of 2 19 subjects (1 17 male, 102 female): 78 (36%) reported fatigue, 47 (21 %) nausea, 46 (21 %) abdominal pain, 28 (13%) loss of appetite, 14 (6%) vomiting, and 7 (3%) jaundice. Fifty-nine (27%) were asymptomatic.Many subjects (n=338; 72%) reported no treatment for HCV, many having not so far returned since diagnosis. Twelve (3%) had used interferon, 37 (8%) anti-emetics, 34 (7%) pain relief and 15 (3%) sedatives. A variety of complementary therapies were also trialed (Table 1). Other steps to improve health included stress management, exercise, reduced alcohol/drug intake, yoga, meditation and counselling.Many people reported n o change in circumstance due to their infection. Others reported negative effects on physical and mental health, and social interaction ( Table 2). Reports of isolation and discrimination related to community concern about HCV, stereotyping of people with H C V and adverse media portrayal of the disease. Respondents had concerns about commencing relationships, HCV infection having ended relationships, introduced fear and/or tension, a...