Promoting Bladder Health in Elementary Schools: A Community-Engaged Approach - PROJECT SUMMARY/ABSTRACT Lower urinary tract symptoms (LUTS), including daytime incontinence, frequency, urgency, and dysuria, affects up to 1 in 5 children, leading to decreased quality of life, increased parental stress, child embarrassment, urinary tract infections, and persistence of symptoms into adulthood. Regular bladder emptying (every 3 hours) effectively improves symptoms. However, students, parents and teachers report that the school setting is an obstacle to this behavior due to individual factors (e.g., knowledge of bladder health, perceptions of bathrooms) and bathroom environments (e.g., dirty bathrooms). Even though children spend a substantial time of their day in school, school-level factors that influence bathroom use and LUTS have not been studied in a U.S. school setting. Addressing factors that influence bathroom use in schools presents a valuable opportunity for early intervention in the disease lifecycle. My long-term goal is to gain skills and experience to transition to an independently funded investigator and leader who will pioneer impactful behavioral interventions to treat and prevent LUTS, reducing the burden of disease at a population level. The overall objective for this K23 proposal is to investigate environmental and individual factors associated with school bathroom use and use a community- engaged research approach to develop and pilot test the acceptability and feasibility of a behavioral intervention to promote school-day bathroom use to improve LUTS. The central hypothesis is that by identifying and addressing both individual and environmental factors that influence bathroom use in elementary schools, we can improve and prevent LUTS. This central hypothesis will be tested through the following specific aims: 1) the use of an observational tool to determine environmental factors that impact school-day bathroom use in elementary schools, 2) the use of Ecological Momentary Assessment to identify real-time factors that impact elementary student bathroom use during the school-day, and 3) the development and pilot test of the acceptability and feasibility of an elementary school-based behavioral intervention to promote student bathroom use. Completion of these aims will generate preliminary data for a fully-powered clustered randomized control trial that will test the impact of an elementary school-based intervention to promote student bathroom use and reduce LUTS symptoms through a competitive R01 application. This proposal supports my career development and training in mixed methods techniques, developing and sustaining partnerships with schools, clustered randomized control trial design, and advanced statistical analysis, in order to support my growth into an independent investigator.
