Bladder health promotion and LUTS prevention inadolescent and adult women across the life course

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ABSTRACT Lower urinary tract symptoms (LUTS), including storage, voiding, urinary incontinence symptoms and pain, and their associated diagnoses are common, costly, and negatively impact women's quality of life throughout the life course. Despite their common occurrence and high cost, little research to date has focused on identification of risk and protective factors for LUTS and prevention, and even less has focused on promotion and maintenance of bladder health. To address this gap, the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium (of which our site is a founding Clinical Research Center) was established to develop the scientific foundation for future evidence-based bladder health promotion and LUTS prevention interventions in adolescent and adult women. In this application, we propose to build upon foundational work conducted in PLUS 1 to further this scientific foundation. Specifically, we propose to establish a large, longitudinal, national, population-based, observational cohort study (currently under development and co-led by the Washington University School of Medicine site PI) designed to: a) determine the distribution of and changes in bladder health over time in the general female population; and b) identify new risk and protective factors for LUTS and bladder health amenable to intervention. Per the FOA, we have selected one important risk/protective factor research question for incorporation into the population-based cohort study: does chronic delayed voiding, a common behavior among women across the life course that can be addressed by preventive interventions at multiple levels of social ecology, contribute to bladder health deterioration and the development of LUTS? Guided by an intervention mapping approach and community partner insight, we will build the evidence base for this research question by conducting a series of innovative, multi-method, transdiciplinary studies nested within the population-based cohort study, as well as complementary to this study. Together, this comprehensive set of quantitative and qualitative studies will provide: 1) critical new data to address the causal nature of associations between chronic delayed voiding and bladder health/LUTS (i.e., high-quality, prospective epidemiologic data devoid of temporal biases and supportive biologic, mechanistic data); 2) new findings to inform the optimal focus and mode of delivery of future prevention interventions (i.e., multi-method data on the strongest individual-behavioral, interpersonal, institutional, and community/societal determinants of chronic delayed voiding, the most effective mode of delivery of educational interventions [assuming that future interventions will include an educational component], and initial promising educational messages); and 3) new tools to evaluate future interventions. As such, this complementary set of studies holds the promise to greatly expand the foundation of knowledge for future bladder health promotion and LUTS prevention interventions.