PROJECT SUMMARY/ABSTRACT Lower urinary tract symptoms (LUTS) encompass a wide range of symptoms, including urinary incontinence, urinary frequency, urgency, nocturia, bladder pain, urinary tract infections, and voiding symptoms. There is an extensive literature describing the many approaches to treatment of LUTS, but less is known about prevention. The “Prevention of Lower Urinary Tract Symptoms (PLUS) Consortium is a transdisciplinary scientific network established to expand research beyond the treatment of LUTS to promotion of bladder health and prevention of LUTS in adolescents and women across the life course. Despite many epidemiologic studies on risk factors for LUTS, little research has examined factors that promote bladder health. One key gap is in understanding of what defines healthy voiding and toileting behaviors and how these behaviors affect bladder health over time. Our overarching hypothesis is that maladaptive voiding and toileting behaviors contribute to poorer bladder health among adolescent and adult women. The primary aim of this proposal is to continue our participation as a clinical research center in PLUS and collaborate with other centers to design and conduct a longitudinal cohort study that lays the foundation for developing future prevention interventions to promote bladder health and prevent LUTS. The University of Alabama at Birmingham (UAB) team is an interdisciplinary group of investigators with collective expertise in LUTS clinical research, behavioral medicine, geriatric medicine, adolescent medicine, prevention science, public health, epidemiology, biostatistics, health disparities, and medical sociology. Our team is poised to contribute expertise on 1) design and conduct of longitudinal studies, 2) evaluation and treatment of LUTS (including clinical examination and bio-specimen collection), 3) qualitative methods, 4) recruitment and retention of diverse samples of participants with/without LUTS, and 5) community engagement. The second aim is to build on the longitudinal cohort study to examine two additional potential risk/protective factors for bladder health and LUTS that are plausible targets for future intervention studies. In addition to testing a number of other factors in the national cohort, we propose to examine 1) the role of neighborhood disadvantage in relation to voiding and toileting behaviors, using the Area Deprivation Index, and 2) the association of functional ability with voiding and toileting behaviors using gait speed and bio-markers of inflammation. Understanding the role of these factors will support the development of models for identifying at- risk individuals and groups, as well as inform education initiatives. The third aim is to develop and conduct pilot foundational studies related to promoting healthy voiding and toileting behaviors. The first study aims to understand voiding and toileting behaviors across environments among adolescents using a mobile application with geographic i...