Tawnjerae R. Joe

Supplementary Table S1: 16S rRNA sequencing data.

Supplementary Figure S2: BV-associated bacteria positively correlate with each other and negatively correlate with Lactobacillus species, including L. crispatus and L. jensenii.

Supplementary Table S4: Differences in global health and perceived stress measurements between hrHPV-positive and hrHPV-negative participants.

Supplementary Table S3: Differences in global health and perceived stress measurements between participants with Lactobacillus-dominant microbiota and non-Lactobacillus-dominant microbiota.

Supplementary Figure S1: Vaginal microbiota profiles cluster based on Lactobacillus dominance and not clinical or sociodemographic factors.

Supplementary Table S5: Differences in global health and perceived stress measurements between Native and non-Native participants.

Supplementary Figure S3: Associations of Lactobacillus abundance with race, vaginal pH, and HPV status.

Supplementary Table S2: Differences in demographic, socioeconomic and behavioral/life style factors between participants with Lactobacillus-dominant microbiota and non-Lactobacillus-dominant microbiota.

Human papillomavirus (HPV) is the most common sexually transmitted infection. Among Native Americans, HPV-associated cancers can lead health disparities in cervical cancer and increased rates of oral cancer in men. We designed a pilot study using a culturally tailored educational intervention aimed to improve knowledge and attitudes toward HPV and the vaccine among community members and healthcare providers in Northern Arizona. The one-hour intervention included in-person and online presentations, along with pre-and post-electronic surveys that assessed changes in knowledge and attitudes regarding HPV. The surveys featured demographic questions, true/false knowledge questions, and vignettes. Of the 67 participants in the intervention, the majority were females aged 18 to 55 years. About 32% identified as Native American, 47% as non-Hispanic White, and 8% as Hispanic. Students comprised the majority (46%) of participants, while healthcare providers, educators, staff, and social workers accounted for 25%. Attitudes towards HPV and the vaccine indicated that 93% of participants recognized the importance of catching up on vaccinations, though only 64% supported vaccination following a positive Pap test. Vignettes showed generally positive attitudes towards vaccination, with strong agreement on its importance and safety. Knowledge about HPV, the vaccine, and its association with cancer improved following the intervention. The pilot study demonstrates that culturally tailored educational interventions can effectively enhance knowledge and attitudes toward HPV and its vaccine, potentially reducing cancer-related disparities in Native American communities. Ongoing efforts are necessary to address remaining gaps in awareness and vaccine uptake.

Supplementary Table S1: 16S rRNA sequencing data.