TY - JOUR
T1 - Cash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries
AU - the Household Water Insecurity Experiences (HWISE) Research Coordination Network
AU - Stoler, Justin
AU - Pearson, Amber L.
AU - Staddon, Chad
AU - Wutich, Amber
AU - Mack, Elizabeth
AU - Brewis, Alexandra
AU - Rosinger, Asher Y.
AU - Adams, Ellis
AU - Ahmed, Jam Farooq
AU - Alexander, Mallika
AU - Balogun, Mobolanle
AU - Boivin, Michael
AU - Carrillo, Genny
AU - Chapman, Kelly
AU - Cole, Stroma
AU - Collins, Shalean M.
AU - Escobar-Vargas, Jorge
AU - Freeman, Matthew
AU - Asiki, Gershim
AU - Ghattas, Hala
AU - Hagaman, Ashley
AU - Jamaluddine, Zeina
AU - Jepson, Wendy
AU - Maes, Kenneth
AU - Mathad, Jyoti
AU - Mbullo, Patrick
AU - Melgar-Quiñonez, Hugo
AU - Miller, Joshua
AU - Niesluchowski, Monet
AU - Omidvar, Nasrin
AU - Samayoa-Figueroa, Luisa
AU - Sánchez-Rodríguez, E. Cuauhtemoc
AU - Santoso, Marianne V.
AU - Schuster, Roseanne C.
AU - Sullivan, Andrea
AU - Tesfaye, Yihenew
AU - Triviño, Nathaly
AU - Trowell, Alex
AU - Tshala-Katumbay, Desire
AU - Tutu, Raymond A.
AU - Young, Sera L.
AU - Zinab, Hassan
N1 - Funding Information:
The Household Water Insecurity Experiences (HWISE) Research Coordination Network (RCN) is supported by National Science Foundation (NSF) BCS-1759972 . This project was funded by the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA). IMMANA is funded with UK Aid from the UK Government. The project was also supported by the Buffett Institute for Global Studies and the Center for Water Research at Northwestern University ; NIH / NIMH K01 MH098902 and R21 MH108444 ; Arizona State University 's Center for Global Health at the School of Human Evolution and Social Change and Decision Center for a Desert City (NSF SES-1462086 ); the Office of the Vice Provost for Research of the University of Miami ; the National Institutes of Health grant NIEHS/FIC R01ES019841 for the Kahemba; Lloyd's Register Foundation for Labuan Bajo; and College of Health and Human Development and Social Science Research Institute at Pennsylvania State University . AW was supported by NSF SES-1462086 and NSF DEB-1637590 . We are very grateful to the field teams including the many enumerators, translators, survey testers, and data entry staff identified in Young et al., 2019b .
Funding Information:
The Household Water Insecurity Experiences (HWISE) Research Coordination Network (RCN) is supported by National Science Foundation (NSF) BCS-1759972. This project was funded by the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA). IMMANA is funded with UK Aid from the UK Government. The project was also supported by the Buffett Institute for Global Studies and the Center for Water Research at Northwestern University; NIH/NIMH K01 MH098902 and R21 MH108444; Arizona State University's Center for Global Health at the School of Human Evolution and Social Change and Decision Center for a Desert City (NSF SES-1462086); the Office of the Vice Provost for Research of the University of Miami; the National Institutes of Health grant NIEHS/FIC R01ES019841 for the Kahemba; Lloyd's Register Foundation for Labuan Bajo; and College of Health and Human Development and Social Science Research Institute at Pennsylvania State University. AW was supported by NSF SES-1462086 and NSF DEB-1637590. We are very grateful to the field teams including the many enumerators, translators, survey testers, and data entry staff identified in Young et al. 2019b. JS and CS conceived the study and drafted the introduction and discussion. AP led data processing, statistical analyses and drafted the methods and results with JS. AW contributed significantly to the introduction and discussion. All authors contributed to the study design, read and edited the manuscript, and approved the final version.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2020/5/10
Y1 - 2020/5/10
N2 - Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures moderated the relationships between water insecurity and both food insecurity and perceived stress. Using tobit mixed effects regression models, we observed a positive association between multiple measures of water expenditures and a household water insecurity score, controlling for demographic characteristics and accounting for clustering within neighborhoods and study sites. The positive relationships between water expenditures and water insecurity persisted even when adjusted for income, while income was independently negatively associated with water insecurity. Water expenditures were also positively associated with food insecurity and perceived stress. These results underscore the complex relationships between water insecurity, food insecurity, and perceived stress and suggest that water infrastructure interventions that increase water costs to households without anti-poverty and income generation interventions will likely exacerbate experiences of household water insecurity, especially for the lowest-income households.
AB - Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures moderated the relationships between water insecurity and both food insecurity and perceived stress. Using tobit mixed effects regression models, we observed a positive association between multiple measures of water expenditures and a household water insecurity score, controlling for demographic characteristics and accounting for clustering within neighborhoods and study sites. The positive relationships between water expenditures and water insecurity persisted even when adjusted for income, while income was independently negatively associated with water insecurity. Water expenditures were also positively associated with food insecurity and perceived stress. These results underscore the complex relationships between water insecurity, food insecurity, and perceived stress and suggest that water infrastructure interventions that increase water costs to households without anti-poverty and income generation interventions will likely exacerbate experiences of household water insecurity, especially for the lowest-income households.
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U2 - 10.1016/j.scitotenv.2019.135881
DO - 10.1016/j.scitotenv.2019.135881
M3 - Article
C2 - 31874751
AN - SCOPUS:85076857888
VL - 716
JO - Science of the Total Environment
JF - Science of the Total Environment
SN - 0048-9697
M1 - 135881
ER -