3.O. Workshop: Students avoiding school toilets: a universal, unrecognized & rarely discussed public health issue

Based on recent statistics, access to school toilets can be considered no more an issue in the European region (UNICEF, 2020). However, presence is not equivalent to use. Four complementary perspectives will illustrate this universal yet unrecognised and underdiscussed public health issue: the avoidance of school toilets by children and adolescents. The workshop will be introduced by a presentation about WHO initiatives, perspectives and recommendations on sanitation and handwashing facilities in schools. Putting the European specificities in a global context will allow us to understand the difference between access and use that will drive the other presentations. The next presentation, will question Youth popular culture regarding school toilets. For many adolescents, popular culture is the primary way in which they learn about people's experiences, therefore, the way toilets are pictured in popular culture such as books or films may influence adolescents’ use of school toilets, even if they are not aware of that. This presentation will analyse some examples of how school toilets are presented in Young Adults’ fictions and popular films. This will help finding ways to talk about and alleviate concerns about the use of toilets in school by adolescents. The next presentation will give a Dutch insight: in 2023, master students under the supervision of a health sociologist and a paediatrician conducted an online survey on school toilets use by secondary pupils and reasons not to use them. The findings aim at advising schools on how they can adapt so that pupils use school toilets more often, but as well they may serve to advocate the topic to general practitioners, paediatricians, and youth health care physicians about health issues related to this public health problem. The last presentation will be driven by a health promotion and pedagogical perspective, through the example of the training of French school doctors. Since 40 years they have periodically addressed the issue of underuse of school toilets by children and adolescents, with the same negative findings. In 2022, 24 school doctors have worked again on the topic with health promotion's methods. Overall, their health priority stood as: “School toilets, a place of challenges and a reflection of the well-being of each and every pupil”. From there, some have built a tool to assess toilets in schools and the readiness of the staff to act upon the findings in a health promotion perspective. In conclusion, our perspectives, based on findings from different EU countries are rather complementary and coherent: children and adolescents underuse school toilets, despite their presence, leading to medical problems, lower well-being at school with the risk to endanger their learning availability. This confirms, if needed, that this is still a true public health issue. Some of the findings around the issue of safety (environmental as well as psychological) seem to be universal and will be discussed with the audience. KEY MESSAGES: • Underuse of school toilets by pupils is a true yet under-addressed public health issue even in Europe. • Safety (environmental and psychological), could be a lever to improve the use of school toilets by pupils.