Project Summary/Abstract American Indian (AI) adolescent girls in the United States suffer from significant health disparities as compared to their non-AI White peers. Increased sexual risk behaviors, earlier sexual debut, higher rates of teen pregnancy, and higher rates of sexually transmitted infectious are more prevalent among AI adolescents as compared to their non-AI peers. Poor health outcomes for adolescent AIs in the Great Plains are compounded by high rates of poverty perpetuated by low high school graduation rates. Collectively, these risk factors place AI adolescents at greater risk for negative health and educational outcomes. Previous studies have portrayed the challenges of managing menstruation in low-resource settings and demonstrated poor health and well- being outcomes associated with negative menstruation experiences. The goal of this proposed study is to gain an understanding of the impact of menstruation on health and education for AI adolescent girls. The specific aims are to (1) describe the in-school menstruation-related experiences of AI adolescent girls living in rural, reservation communities and (2) describe the experiences, perceptions, and comfort level of middle and high school teachers in tribal schools in responding to the menstrual experiences of their students. Aim 1 will use community-informed focus group research to understand the following issues for AI adolescent females: (1) learning and talking about menstruation; (2) menstruation education at school; (3) getting their first period; (4) preparing for menstruation; (5) menstruation perceptions; (6) traditional menstruation customs; (7) learning how to use menstrual products; (8) school-based menstruation experiences, including teacher behaviors and perceived attitudes; and (9) menstruation benefits. The purpose of Aim 1a will be to compare/contrast early and late adolescent menstruation experiences. Aim 2 will also use community-informed focus group research to understand the following issues for educators at reservation-based middle or high schools: (1) frequency with which they have assisted a student with a menstruation-related issue; (2) presence of menstrual products within the classroom; (3) perceptions of menstruation experiences for girls at school; (4) comfort with addressing menstruation-related issues with students; (5) actions taken when a girl experiences their period in the classroom; (6) traditional menstruation customs; and (7) the impact of menstruation on student learning. Aim 2a will focus on comparing and contrasting the experiences, perceptions, and comfort levels of teachers by demographic, while Aim 2b will compare and contrast the experiences and perceptions of teachers with those of the adolescents. The findings will be used to identify future intervention foci and methods to address menstruation-related issues for this population. This study's focus is innovative and fills a crucial gap in efforts to further understand and eliminat...