Project Summary Lower urinary tract symptoms (LUTS) are common in women and negatively impact activities of daily living and quality of life, resulting in medical and psychological morbidity and enormous economic burden. Because of the deleterious consequences of LUTS on women, understanding optimal bladder health is essential. Given the complexity and heterogeneity of women with urinary symptoms, transdisciplinary research is needed to screen for risk factors for the development of bladder symptoms, protective factors that facilitate optimized bladder health, and mechanisms to target for prevention programs to disrupt causal pathways to bladder symptoms To date, the literature on LUTS has mostly focused on non-Hispanic White women with health insurance who present with symptoms and are already engaged with the healthcare system. Thus, extant prevention and treatment approaches are not generalizable to vulnerable populations like minority and underserved women. Significant gaps remain in understanding bladder health for minority and underserved women, where significant health disparities exist. Well-designed longitudinal cohort studies of urinary symptoms in diverse samples in which racial/ethnic minorities are well represented are severely lacking. Consistent with the PLUS Research Consortium, our objective is to move beyond the absence of symptoms and optimize bladder health as “a complete state of physical, mental, and social well-being related to bladder function.” Therefore, the primary goal of this project is to assess the influence of biological, psychosocial (mind/behavior), interpersonal, institutional, environmental, and societal factors on bladder health among diverse women using qualitative and quantitative approaches within the PLUS framework. The mixed- methods approach of this project includes: Specific Aim 1. Conduct a longitudinal, observational study of bladder health in a diverse cohort of adolescent and adult women with respect to race/ethnicity, age, income, education, health literacy, insurance status, sexual orientation, and employment, Specific Aim 2. Determine factors and behaviors that influence bladder health in diverse women, and Specific Aim 3. Create a screening tool for bladder health that is reliable and valid across diverse women. We hypothesize that social determinants of health, implicit bias, and discrimination will be significantly related to the trajectory of bladder health and engagement with the healthcare system over time for LUTS. We also hypothesize that the screener we develop will assess bladder health in all women (including diverse populations in which disparities exist) and will identify women at risk for future bladder symptoms with high reliability, validity, accuracy, sensitivity, and specificity and minimal burden to the respondent. The impact of this U01 will be the curation of a novel knowledge base on risk and protective factors in diverse populations of women.