School toileting environment, bullying, and lower urinary tract symptoms (LUTS) in a population of adolescent and young adult girls: Preventing Lower Urinary Tract Symptoms Consortium (PLUS) analysis of Avon Longitudinal Study of Parents and Children (ALS

To examine whether the school toilet environment at age 13, including bullying at toilets, is associated with female LUTS at ages 13 and 19, as little is known about the association among school toilet environment, voiding behaviors, and lower urinary tract symptoms (LUTS) in adolescent girls.

The sample comprised 3962 female participants from the Avon Longitudinal Study of Parents and Children (ALSPAC). At age 13, participants reported on 7 school toilet environment characteristics and a range of LUTS items. At age 19, participants completed the Bristol Female Lower Urinary Tract Symptoms (ICIQ-BFLUTS) questionnaire.

All toilet environmental factors were associated with at least one LUTS outcome at age 13. Holding behavior was associated with all school toilet environmental factors, with odds ratios (ORs) ranging from 1.36 (95% CI: 1.05, 1.76) for dirty toilets to 2.38 (95% CI: 1.60, 3.52) for feeling bullied at toilets. Bullying was associated with all daytime LUTS symptoms and nocturia; ORs ranged from 1.60 (95% CI: 1.04, 2.07) for nocturia to 2.90 (95% CI: 1.77, 4.75) for urgency. Associations between age 13 school toilets and age 19 LUTS were in the same direction as age 13 LUTS.

This is the first examination of associations between school toilets and LUTS. Toileting environments were cross-sectionally associated with LUTS in adolescent girls. While further work is needed to determine whether these associations are causal, school toilet environments are modifiable and thus a promising target for LUTS prevention.

Urology. 2020 Jul 14 [Epub ahead of print]

David A Shoham, Zhenxun Wang, Sarah Lindberg, Haitao Chu, Linda Brubaker, Sonya S Brady, Deepa R Camenga, Tamera Coyne-Beasley, Colleen M Fitzgerald, Sheila Gahagan, Bernard L Harlow, Carol Joinson, Lisa Kane Low, Alayne D Markland, Diane K Newman, Ariana L Smith, Ann Stapleton, Siobhan Sutcliffe, Amanda Berry

Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL. Electronic address: ., Department of Biostatistics, University of Minnesota., Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego., Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN., Department of Pediatrics, Yale School of Medicine, New Haven, CT., Division of Adolescent Medicine, University of Alabama at Birmingham Medical School, Birmingham, AL., Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Chicago, IL., Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, CA., Boston University School of Public Health, Boston, MA., University of Bristol, Bristol, UK., University of Michigan School of Nursing, Women's Studies, Dept. Obstetrics and Gynecology, Ann Arbor, MI., Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL., Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Department of Medicine, University of Washington, Seattle, WA., Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO., Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, University of Minnesota.