Historically, the highest incidence rates of invasive Haemophilus influenzae disease in the world were found in North American and Australian Indigenous children. Although immunization against H. influenzae type b (Hib) led to a marked decrease in invasive Hib disease in countries where it was implemented, this disease has not been eliminated and its rates in Indigenous communities remain higher than in the general North American population. In this literature review, we examined the epidemiology of invasive H. influenzae disease in the pre-Hib vaccine era, effect of carriage on disease epidemiology, immune response to H. influenzae infection and Hib vaccination in Indigenous and Caucasian children, and the changing epidemiology after Hib conjugate vaccine has been in use for more than two decades in North America. We also explored reasons behind the continued high rates of invasive H. influenzae disease in Indigenous populations in North America. H. influenzae type a (Hia) has emerged as a significant cause of severe disease in North American Indigenous communities. More research is needed to define the genotypic diversity of Hia and the disease burden that it causes in order to determine if a Hia vaccine is required to protect the vulnerable populations.

It has been suggested that in addition to genetic factors, fetal and post-natal growth influence cognition in early adulthood. However, most studies have been in developed populations, so it is unclear if the same findings would be seen in other, less developed, settings, and have used testing tools not applicable to an Australia Aboriginal population. This study investigated the relationships between cognitive function in early adulthood and birth weight and contemporary height. Simple reaction time (SRT), choice reaction time (CRT) and working memory (WM) were assessed using the CogState battery. A significant association was seen between birth weight and SRT in early adulthood, but not with the other two cognitive measures. Urban dwellers had significantly shorter SRT and CRT than their remote counterparts. Contemporary body mass index and maternal age were associated with CRT. Only fetal growth restriction was associated with WM, with greater WM in those with restricted growth. No associations were seen with contemporary height. These results suggest that fetal growth may be more important than the factors influencing post-natal growth in terms of cognition in early adulthood in this population, but that the associations may be inconsistent between cognitive outcomes. Further research is required to identify whether similar associations are seen in other, similar, populations and to assess why differences in cognitive outcome measures are seen.

Tobacco smoking perpetuates the disadvantages experienced by Aboriginal and Torres Strait Islander people in Australia. Tobacco smoking is a risk factor for poor maternal and infant outcomes in pregnancy. Over half of Aboriginal and Torres Strait Islander women smoke during pregnancy and few successfully quit. Aboriginal and Torres Strait Islander women face many intrinsic barriers to quitting such as low socioeconomic disadvantage and patterns of use in family networks. There are also several extrinsic hurdles surrounding current practice guidelines and policy that may limit success in reducing smoking rates among Aboriginal and Torres Strait Islander women during pregnancy: the use of the Stages of Change (SOC) model; delay in the use of nicotine replacement therapy (NRT); and the absence of subsidised intermittent NRT. A more proactive approach towards smoking cessation for pregnant Aboriginal and Torres Strait Islander women may be necessary, including moving away from the SOC model approach and subsidised provision of intermittent NRT. Comprehensive programs that take into account the family network and wider social context are also recommended.