Evidence-based methods for induction of labor (IOL) are underutilized, increasing risk of prolonged induction, complications, and unnecessary costs. To address heterogeneity in response to quality improvement (QI) efforts, an adaptive implementation strategy can “step up” support to hospitals, moving from less to more intensive support to address inadequate hospital improvement. In a statewide network of hospitals, we developed an adaptive implementation strategy (AIS) with three hospital-level components: (1) BASE, delivered virtually, offers provider training, monthly hospital performance reports, technical assistance, and a participation incentive to hospitals (Intensity: Low); (2) LEAD (unit leaders), offers recurring virtual calls to support hospital QI leaders (Intensity: Moderate); and (3) TEAM (maternity clinician team), offers two in-person site visits with bedside maternity clinicians (Intensity: Very High). This study aims to build an optimized AIS that guides sequential decisions about which hospitals should receive BASE, LEAD, and TEAM to increase adherence to evidence-based IOL management at scale in a statewide quality collaborative. A clustered, sequential, multiple-assignment randomized trial design with at least 48 hospitals recruited from the Obstetrics Initiative, a perinatal collaborative quality initiative separately funded by Blue Cross Blue Shield of Michigan and Blue Care Network. Evidence-based induction of labor (EB-IOL) includes (a) dual-agent cervical ripening and (b) early amniotomy. Hospitals will receive BASE for five months (Stage 1; Month 1–5). At Month 6, all hospitals are randomized to augment with LEAD vs. continue BASE only (Stage 2; Month 6–12). Hospitals not achieving Top Performer status (defined as ≥ 80

Current practice guidelines for postpartum pain management lack specific recommendations for opioid prescribing after vaginal births or vaginal births with associated procedures such as operative vaginal birth (ie, forceps, vacuum-assisted birth) and repair of third- or fourth-degree lacerations. This study used adjusted logistic regression models to assess between-hospital variation in opioid prescribing rates and prescription amounts in oral morphine equivalents (OMEs) for vaginal births with associated procedures. We performed a retrospective cohort study across 67 hospitals of 14,690 opioid-naive, nulliparous patients with term births, of whom 7.2% (n=1,053) had operative vaginal births and 4.9% (n=724) had third- or fourth-degree lacerations. In total, 1.8% of patients (n=269) received an opioid prescription, with a median amount of 60 OMEs (IQR 37.5-75). Prescription rate was higher for third- or fourth-degree laceration (11.6%), and prescription amount was highest for operative birth (75 OMEs, IQR 45-90 OMEs). At a hospital level, the largest range of proportion of patients receiving discharge opioid prescriptions was for third- or fourth-degree lacerations (0-66.7%) and the largest amount was for operative birth (25-135 OMEs). Opioid prescribing after vaginal births with associated procedures is higher than for routine vaginal birth and marked by variation among hospitals, highlighting an opportunity for standardization.

INTRODUCTION:Clinical education of midwifery students depends on preceptors to guide students' transition from theoretical knowledge to safe beginning practice. However, there is limited information on the experiences for clinical preceptors working in sites serving rural and medically underserved communities. The purpose of this qualitative study was to understand the experiences of midwives working in lower-resource areas who also act as clinical preceptors for students enrolled in midwifery education programs accredited by the Accreditation Commission for Midwifery Education. METHODS:Semistructured qualitative interviews were conducted along with the collection of preceptor and clinical practice site demographic data. A convenience sample of midwives who have served in a clinical preceptor role within the last 5 years were recruited. Interview questions were developed collaboratively by faculty and grant staff from 10 academic institutions receiving Maternity Care Nursing Workforce Expansion program funding from the Health Resources and Services Administration. Interviews were deidentified and analyzed by faculty and grant staff across 7 programs using qualitative research software and content analysis methodology by Krippendorff and the Standards for Reporting Qualitative Research. RESULTS:Thirty-nine midwife preceptors participated in interviews, representing all US Census regions. Five key themes emerged from the analysis of preceptor-focused information: (1) needs, (2) barriers and (3) facilitators, (4) learning from past experiences, and (5) compensation. DISCUSSION:Findings highlight the need for comprehensive support, clear communication, and meaningful recognition of preceptors' critical role in training the next generation of midwives. Investing in preceptor training and support at the national and policy level could enhance the quality of midwifery education in rural and underserved areas.

Objective Barriers to toilet access and suboptimal toilet environments in workplaces and schools may contribute to unhealthy toileting behaviors and poorer bladder health in women, but quantitative evidence is limited. We examine associations between workplace toilet access, autonomy, and environment with women’s toileting behaviors and test whether these behaviors mediate relationships with bladder function. Methods Data from 1,772 women (mean age 51 years) in the RISE FOR HEALTH study were analyzed. Participants completed Toilet Environment and Access Scales (TEAS), Toileting Behaviors–Women’s Elimination Behaviors (TB-WEB), and the Bladder Function Index (BFI). Regression and structural equation modeling tested associations among TEAS domains (access/autonomy and toilet environment), TB-WEB subscales, and BFI. Results Mean TEAS scores indicated high access and favorable environments (4.1 and 4.4 on a 0–5 scale). Greater access/autonomy and more favorable environments were associated with less delayed voiding (b=–0.26, –0.15), straining (b=–0.17, –0.15), and premature voiding (b=–0.13, –0.08). All unhealthy behaviors were associated with lower BFI scores, with delayed voiding showing the strongest association (b=–8.0). Higher TEAS scores were associated with higher BFI (b=3.3–3.8 per unit). Mediation analyses indicated that toileting behaviors, particularly delayed voiding, partially mediated associations between TEAS domains and BFI. Conclusions Favorable toilet environments and greater toilet access and autonomy were associated with healthier toileting behaviors and better bladder function. Policies and practices that support toilet access and autonomy in workplaces and schools may promote bladder health by reducing unhealthy toileting behaviors.

IMPORTANCE:An improved understanding of associations of bladder-related knowledge and agentic beliefs with bladder health can be informative for developing strategies to prevent lower urinary tract symptoms (LUTS). OBJECTIVES:The objectives of this study were to evaluate associations of bladder knowledge and agentic beliefs with bladder health status. STUDY DESIGN:We assessed bladder-related knowledge and beliefs in RISE FOR HEALTH participants using the Bladder Health Knowledge, Attitudes and Beliefs instrument (BH-KAB, range 0-100) in a cross-sectional analysis. Bladder health was assessed using the Global scale of the Bladder Health Scales (BHS, 0-100), the Total Bladder Function Index (BFI, 0-100), and the Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10, 0-38). Associations of bladder-related knowledge and agentic beliefs with each bladder health outcome were assessed using linear regression. RESULTS:The mean age of participants was 49.2 years (range=18-101 years). The mean knowledge score was 67.5 and the mean agency score was 56.5. The associations of the knowledge score with Global BHS and BFI were weak (-0.9 and -1.1), while associations of the agency score with Global BHS and BFI were stronger, with a 2.4 and 1.4 higher score (better health), respectively, for every 10-point increase in agency. Increased agency was also associated with fewer LUTS; for every 10-point increase in agency score, there was a 0.5 decrease in the LURN SI-10 score. CONCLUSIONS:Bladder-related knowledge was weakly associated and agentic beliefs were more strongly associated with bladder health and function. Longitudinal prevention intervention studies can help determine whether increases in agentic beliefs promote bladder health and prevent the development and worsening of LUTS.

BackgroundPain management after childbirth is widely variable, increasing risk of untreated pain, opioid harms, and inequitable experiences of care. The Creating Optimal Pain Management FOR Tailoring Care (COMFORT) clinical practice guideline (CPG) seeks to promote evidence-based, equitable acute peripartum pain management in the United States. We aimed to identify contextual conditions (i.e., barriers and facilitators) and discrete implementation strategies (i.e., theory-based actions taken to routinize a clinical practice) likely to influence COMFORT CPG uptake and specify corresponding multi-component implementation interventions at the perinatal quality collaborative- and unit-level.MethodsWe conducted a qualitative study involving virtual individual interviews and focus groups. Interviews included individuals undergoing childbirth from 2018-2023, (recruited through two online registries), and actively practicing maternity clinicians and surgeons, (recruited via snowball sampling with the eDelphi panel creating the COMFORT CPG), caring for pregnant people in the United States. Focus groups included physicians, midwives, nurses, and unit-based quality improvement (QI) staff working at Michigan hospitals within the Obstetrics Initiative, a statewide perinatal quality collaborative funded by Blue Cross Blue Shield of Michigan and Blue Care Network. The Consolidated Framework for Implementation Research, Expert Recommendations for Implementing Change taxonomy, and Replicating Effective Programs framework informed data collection and analysis. Qualitative content analysis characterized influential contextual conditions, which were linked to implementation strategies and tools using principles of implementation mapping. We then specified multi-component implementation interventions for use by quality collaboratives and unit-based teams.ResultsFrom May-September 2023, we completed 57 semi-structured individual interviews (31 patients, 26 clinicians) and six focus groups (44 QI champions). Participants identified 10 key conditions influential for COMFORT CPG adoption. Findings enabled identification of five collaborative-level implementation strategies, 27 unit-level implementation strategies, and 12 associated tools to promote COMFORT CPG adoption including the specification of each strategy's hypothesized mechanism of action and each tool's goal and potential uses.ConclusionsThis work identifies contextual conditions and implementation strategies and tools at the perinatal quality collaborative and unit levels to promote COMFORT CPG adoption on maternity units. These findings may foster more rapid CPG implementation and thereby promote more equitable and evidence-based perinatal pain management care.

Purpose: Qualitative studies exploring bladder health are rare compared to research focusing on lower urinary tract symptoms (LUTS). Our aim was to explore adolescent and adult women's perceptions about what constitutes a healthy bladder. Methods: We conducted a 7-site focus group study of bladder health with adolescent and adult women across six age categories (11-14 to 65+ years). Transcripts were analyzed using transdisciplinary, directed content analysis and an iterative interpretive consensus building approach to identify key constructs, focusing on "healthy bladder"and "unhealthy bladder"codes. Results: Forty-four focus groups with 360 participants were completed. Three thematic categories were identified: (1) concept of a healthy bladder (conceptual abstraction); (2) experience of a healthy bladder (subjective experience); and (3) lifestyle and life course considerations (bladder health in context). Participants struggled to define the unfamiliar concept of healthy bladder and relied on contextualized experiences and behaviors for characterizing bladder health. They described the concept of a healthy bladder as something that you did not need to think about but did require attention to healthy habits to maintain. Other features of a healthy bladder discussed include having bladder control despite urgency and environmental constraints on voiding, normal voiding frequency, and qualities of urine and urination. Participants struggled with lack of information about healthy bladder habits and noted absence of routine bladder health screening. Discussion: Findings identify need to promote public education and information sharing in health care visits about bladder health. Further they can inform bladder health promotion and clinical research on LUTS prevention.

This scoping review synthesized literature on women’s bladder self-care practices by: 1) describing study characteristics; 2) identifying questionnaires used to assess self-care; and 3) summarizing behaviors relevant to bladder health. Five databases and reference lists were searched through April 2025 for qualitative, quantitative, and mixed-methods studies. Ninety-seven studies were included, identifying 107 behaviors grouped into four domains: Toileting and Bladder Management, Personal Care and Hygiene Practices, Lifestyle and Behavioral Strategies, and Therapeutic Interventions. Most studies focused on women with urinary symptoms, with few population-based samples. No comprehensive, validated questionnaire assessing the full scope of bladder self-care was identified. Women engage in diverse behaviors that may influence bladder health. A validated, multidimensional questionnaire is needed to assess these behaviors, identify risk and protective factors, and guide preventive interventions.

STUDY OBJECTIVE:Lower urinary tract symptoms (LUTS) can have a pronounced impact on adolescent women's overall health and quality of life, both during adolescence and across the life course. Little research has examined adolescent women's knowledge, attitudes, and beliefs (KAB) about bladder health and preventing LUTS. METHODS:This study combines data from two large multi-site focus group studies of individuals born female, who identified as women, conducted by the Prevention of Lower Urinary Tract Symptoms Research Consortium. The first study included data from 8 focus groups conducted in 2018 with 44 adolescents aged 11 through 17 years. The second consisted of data from 20 focus groups conducted in 2020 with 123 adolescents aged 13 through 17 years. We used directed content analysis, including deductive and inductive approaches, to explore textual data and identify emergent insights. We present themes that emerged from analyzing coded data related to KAB. RESULTS:Themes included: (1) lack of information about bladder function, leading to limited knowledge, (2) hydration as a healthy behavior, (3) distinguishing healthy versus unhealthy voiding, (4) social and environmental barriers to voiding, and (5) shame and stigma of bladder related behaviors. CONCLUSION:Our data suggests that adolescent women are aware of healthy and unhealthy behaviors related to bladder health, despite little exposure to formal education about the bladder. Social and environmental factors, including stigma, appear to be primary drivers of adolescents' behaviors around bladder health, suggesting that multi-level socio-ecological prevention interventions are needed to prevent LUTS in this population.

Research exists exploring prevalence of lower urinary tract symptoms (LUTS) in cisgender heterosexual women yet validated instruments have not been used to survey sexual and gender minority (SGM) people. Alongside LUTS measures, recently validated bladder health instruments were used in the RISE FOR HEALTH Study that included expanded demographic information of sexual orientation, gender identity, and sex assigned at birth questions. The RISE FOR HEALTH study is a population-based prospective cohort survey study of adults born female, recruited from a commercial marketing database. Participants who responded to questions identifying them as SGM people were compared with age-matched non-SGM participants. Chi-square and t tests were used for comparison between groups in general, and in the age-matched sample paired t tests, McNemar, and McNemar-Bowker tests were used. Among 98% of participants who answered sexual and gender identity questions (3364 of 3424), 260 (8%) met sexual and gender subset criteria with a selected group of 260 non-SGM people participants for the age-matched comparison. The SGM participants had significantly lower bladder health scores and bladder function indices yet there were no significant differences in lower urinary symptoms between the SGM participants and the age matched non-SGM participants. In this study, SGM populations had bladder health and bladder function outcomes suggesting poorer bladder health and higher risk for LUTS compared with cisgender populations.

Introduction: Toileting behaviors are recognized as potential contributors to lower urinary tract symptoms (LUTS) in women. This study examines the association between toileting behaviors and LUTS among community-dwelling women and whether age modifies these associations. Methods: Cross-sectional analyses were conducted using baseline data from a population-based cohort study, RISE FOR HEALTH (RISE). Women completed validated questionnaires assessing toileting behaviors (Toileting Behaviors-Women's Elimination Behaviors scale) and LUTS (10-item Lower Urinary Tract Dysfunction Research Network-Symptom Index [LURN SI-10]). Toileting behaviors included place preference for voiding, premature voiding, delayed voiding, straining to void, and toileting position. LUTS items included urine storage, emptying, and postmicturition symptoms. Associations were analyzed by proportional odds logistic regression. Analyses were stratified by seven age groupings. Results: Data from 2,327 women (mean age 51.1 years, standard deviation = 18.2) were analyzed. Delayed voiding was most strongly associated with the LURN SI-10 composite score (odds ratio [OR] 1.89; 95% confidence interval [CI]: 1.72, 2.09) and urgency incontinence (OR 1.87; 95% CI: 1.66, 2.10). Premature voiding showed the strongest association with urgency (OR 1.82; 95% CI: 1.68, 2.04). Straining was strongly associated with emptying symptoms, including delay before urine starts (OR 2.28; 95% CI: 2.05, 2.54) and slow stream (OR 2.28; 95% CI: 2.05, 2.53). Age modified associations between delayed voiding and LUTS, with strongest associations among 18- to 25 year-old women. Conclusions: Premature voiding, delayed voiding, and straining showed the strongest associations with LUTS in this cross-sectional analysis. Longitudinal studies are needed to clarify the directionality of these associations. Educating young women on healthy toileting habits may mitigate potential effects of unhealthy toileting behaviors on bladder health.

IMPORTANCE:Although parturients report few postpartum symptoms, birth is clearly associated with future symptom development. The ability to identify asymptomatic at-risk women would facilitate prevention. OBJECTIVE:The aim of the study was to develop a model predicting abnormal recovery in women at risk for childbirth-associated pelvic floor injury. STUDY DESIGN:Women undergoing first vaginal birth at high risk of pelvic floor injury underwent examinations and ultrasound imaging and completed 6-week and 6-month postpartum questionnaires. We defined "abnormal" recovery as having ≥1 of the following 3 findings: (1) levator ani injury, (2) decreased objective pelvic floor strength, and (3) Pelvic Organ Prolapse Quantification point Bp ≥0. Descriptive statistics and bivariate analyses compared "normal" and "abnormal" recovery. Birth characteristics, 6-week examinations, and questionnaires potentially predicted abnormal recovery at 6 months. Significant variables were included as candidates in the multivariable logistic regression predicting "abnormal" recovery after birth. RESULTS:Fifty-four women (63.5%) had normal and 31 (36.5%) had abnormal recovery at 6 months. At 6 weeks, women with abnormal recovery had decreased pelvic floor strength by Oxford scores (3 [2-5], 6 [2-8]; P  = 0.002), lower point Bp (-1 [-3 to 0], -2 [-3 to -1]; P  = 0.02), larger genital hiatus (4 [3 to 4], 3 [3 to 3.5]; P  = 0.02), and higher levator ani injury rate (76.7%, 22.4%; P  < 0.001). Between-group questionnaire differences were not clinically significant. Our final model included postpartum examination findings or birth characteristics: Oxford Scale, 6-week Pelvic Organ Prolapse Quantification GH strain, infant head circumference, and second stage ≥120 minutes. The area under the curve for predicting abnormal recovery at 6 months was 0.84, indicating a good sensitivity and specificity balance. CONCLUSION:The model identifies women at risk for an abnormal recovery trajectory.

The United States has persistent and growing rates of severe maternal morbidity and maternal mortality. Yet, the majority of pregnancy-related complications and deaths are preventable. Social, cultural, political, and system barriers, structural racism, and the uneven distributions of points of access to care all contribute to the disparities in maternal outcomes. Populations that experience disproportionately poor maternal health outcomes due to unequal access to perinatal care include racial and ethnic groups, sexual and gender minorities, people with disabilities, and persons who are incarcerated. Using a health equity perspective, the interacting factors that lead to avoidable pregnancy-related illness and death are discussed. Recommendations to improve access, care, and outcomes for childbearing persons are presented.

Using scientific evidence to guide medical practice seems self-evident but, in certain specialties, it has proven difficult to realize. Use of continuous electronic fetal monitoring (cEFM) during labor is a case in point: research has shown that when compared to intermittent auscultation (IA), use of cEFM in uncomplicated labors of healthy women offers no clinical benefit and may result in unneeded interventions, and yet it remains common practice in obstetric care. In this study, we used observations on a labor and delivery unit and interviews with key informants to investigate the factors that drive the use of cEFM in the face of contrary evidence. Our observations of clinician behaviors regarding the use of cEFM and documentation of the effect of unit workflow on decisions about monitoring allowed us to identify several factors that drive the non-evidence-based use of cEFM. These include fear of liability, training, hospital unit policies, perceptions of patient desires, and workflow on the unit. What we learned about the continued use of cEFM offers insight into other instances where evidence fails to be implemented in practice. Our recommendations for how to align fetal assessment during labor with research evidence include more and better education about modes of fetal assessment for expectant parents and clinicians, hospital policies that encourage reflection on research evidence when making clinical decisions, attention to the way policies and protocols discourage use of IA, and making visible the clinical and economic benefits of evidence-based practice.

Background: Little is known about women's decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app "Where I Go" captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with "Where I Go", variation in novel parameters collected, and readiness for the data collection tool's use in population-based studies. Methods: "Where I Go" has three components: (1) real-time data, (2) short look-back periods (3-4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant's self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86%, on day 1 and 40/44, 91%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61%, on day 1 and 129/171, 75%, on day 2) due to a need to go (114/140, 66%, on day 1 and 153/171, 74%, on day 2). The most common reasons for delaying toileting were "work duties" (33/140, 21%, on day 1 and 21/171, 11%, on day 2) and "errands or traveling" (19/140, 12%, on day 1 and 19/171, 10%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93%, on day 1 and 42/44, 95%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95% CI 3.0-3.5; mean on day 2=4.3, 95% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in "Where I Go" showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: "Where I Go" has potential to increase the understanding of factors that affect women's toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies.

BACKGROUND:Bladder health encompasses total bladder well-being and not merely the absence of urinary symptoms. While much is known about the prevalence of urinary symptoms in women, little is known about the distribution of bladder health (eg, optimal to poor). OBJECTIVE:We report the distributions of multiple dimensions of bladder health and function in a population-based sample of community-dwelling women, overall and separately in women without urinary symptoms to begin to explore bladder health dimensions that may precede the onset of symptoms. STUDY DESIGN:RISE FOR HEALTH is a regionally-representative cohort study of US women aged 18 and older. Baseline surveys included the validated Bladder Health Scales/Bladder Function Indices, the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and additional study items. Bladder well-being was assessed across 10 scales and bladder function across 6 indices. Bladder Health Scale scores were adjusted for adaptive/coping behaviors (eg, using/carrying pads, staying close to a toilet) to account for the perceived impact of urinary symptoms on well-being. Scores for scales and indices ranged from 0 (poor well-being/function) to 100 (optimal well-being/function). We calculated summary statistics for each scale (with and without adaptive behavior adjustment) and each index in the full study population and subset of women without urinary symptoms. RESULTS:The mean age of 3027 eligible participants was 49.8 years (standard deviation 17.9). The median global Bladder Health Scale score was 72 (interquartile range: 56, 84) before adjustment for adaptive/coping behaviors and 55 (interquartile range: 34, 78) after adjustment. Median scores for the other scales ranged from 75 to 100 before and 61 to 72 after adjustment. Sixty-nine percent of participants reported using adaptive/coping behaviors, including using pads (40%), toilet mapping (58%), and staying close to a toilet (3%). The median overall Bladder Function Index score was 77 (interquartile range: 63, 89); individual median scores ranged from 63 to 68 for frequency, sensation, continence, and emptying indices to 100 for biosis/urinary tract infection and comfort indices. Among participants without reported urinary symptoms (n=700), scores were higher across all scales (unadjusted medians=88-100 and adjusted medians=82-100) and indices (medians=93-100), indicating better, but not optimal health; however, 38% of asymptomatic women reported using adaptive/coping behaviors: 11% using pads, 30% toilet mapping, and 2% staying close to a toilet. CONCLUSION:We observed a wide range of bladder well-being and function in RISE participants and high utilization of adaptive/coping behaviors. Bladder health variability and utilization of adaptive/coping behaviors was also observed in women without urinary symptoms, highlighting bladder health dimensions not captured by traditional urinary symptom tools and potentially identifying a group of women with "subclinical" symptoms who may be at greater risk of developing urinary symptoms. Future prospective analyses should investigate this novel group of women further.

BACKGROUND:Poorer performance on standardized tests of cognitive function is associated with urinary incontinence (UI), overactive bladder, and poorer bladder health among people aged 40 and older. OBJECTIVE:To examine whether self-rated deficits in executive function domains (organization/problem solving, inhibitory control/self-restraint, self-regulation of emotions) are associated with lower urinary tract symptoms (LUTS), perceived bladder health and function, and adaptive behaviors to prevent or manage UI among adult women across the life course. METHODS:Surveys were administered as part of the RISE FOR HEALTH population-based study of women (19-100 years, mean = 50 years) in the United States. In this cross-sectional analysis, LUTS, perceived bladder health and function, and adaptive behaviors were regressed on individual executive function subscales and a composite measure (analytic sample n = 1,551). RESULTS:Self-rated deficits in all evaluated domains of executive function were significantly associated with greater numbers and frequency of LUTS, including urgency and urgency UI; poorer perceived bladder health and function; and a greater tendency to locate bathrooms when entering new places. Associations were of similar magnitude across age categories ranging from emerging to older adulthood. CONCLUSIONS:Findings demonstrate an association between self-rated executive function deficits and bladder function. Further research should test brain-bladder communication as a potential mechanism linking deficits in executive function to greater numbers and frequency of LUTS, poorer perceived bladder health and function, and greater engagement in adaptive behaviors to prevent or manage UI. Research is also needed to further evaluate whether associations between executive function and LUTS differ by life course stage.

Background: To determine the need for an instrument to measure knowledge, attitudes, and beliefs (KAB) regarding bladder health for use in a population-based study of community-dwelling women, we performed a scoping review of the extant literature focusing on studies utilizing survey methodology to characterize bladder health KAB.Objectives: To synthesize quantitative studies on women's KAB regarding bladder health and characterize their survey instruments.Methods: A systematic search in Ovid Medline was conducted for articles published from January 1990 through April 2024. We included quantitative studies that used questionnaires to assess adolescent and adult women's bladder health KAB. Titles, abstracts, and full-text articles were screened, followed by data extraction of key study elements, questionnaire items, and quality.Results: We identified 83 articles across seven topic areas. Studies were conducted in 26 countries in clinically (52%) and community-based (47%) settings. The majority (74%) used cross-sectional designs. Most studies used investigator-designed instruments (n = 36), the Prolapse and Incontinence Knowledge Questionnaire (n = 20), Urinary Incontinence Quiz (n = 6), Knowledge, Attitudes, and Practice (n = 5), and the Urinary Incontinence Knowledge Scale (n = 4). The 33,444 respondents generally had limited knowledge of urinary incontinence. Although awareness of pelvic floor muscle exercises was high, respondents often could not articulate performance or indications. Few studies assessed bladder health and function, and there were limited data on attitudes and beliefs.Conclusions: There is some evidence regarding women's knowledge of bladder and pelvic floor dysfunctions, particularly urinary incontinence, but less is known about women's knowledge of other bladder health topics. Even fewer data exist on bladder health attitudes and beliefs. Survey instruments that comprehensively assess bladder health are needed.