Water and Food Insecurity Are Differentially Associated With Healthy Diets Among Men and Women in Mexico: Findings From the 2021 National Health and Nutrition Survey

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle‐income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross‐sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI‐HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log‐binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI‐HWI with child outcomes. Moderate‐severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI‐HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI‐HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

The COVID-19 pandemic has increased the risk of global public health and has the potential to cause severe food and water insecurity due to economic recession during lockdown for people living in low-middle income countries like Bangladesh where capital resources are scarce. There is growing evidence that household food and water insecurity has been associated with poor psychological outcomes. The objective of this study was to determine the association between household food and water insecurity with mental health and whether these differed among urban-rural households. A cross-sectional online survey was conducted with 545 participants immediately after the COVID-19 lockdown period in Bangladesh (August 1-September 30, 2020). Household food and water security were determined using a 9-item Household Food Insecurity Access Scale (HFIAS) (score range 0-27) and a 12-item Household Water Insecurity Experiences (HWISE) scale (score range 0-36), respectively. The Perceived Stress Scale (PSS) was used to evaluate mental health. Multivariable logistic regression examined the association between household food and water insecurity with perceived stress, adjusting socioeconomic characteristics. An urban-rural stratified analysis was also performed. About 72.84% (397) respondents reported high stress and more than 70% of households suffered from food and water insecurity during the lockdown period. After adjusting covariates, logistic regression model results show that food insecurity was associated with a 1.07-point increase in high perceived stress (OR=1.07, 95% CI=1.01-1.11, p<0.01) while water insecurity was associated with 1.03 times greater odds of high perceived stress (OR=1.03, 95% CI=0.93-1.23, p<0.05). In stratified analysis, only food insecurity was associated with high perceived stress in the urban household (OR=1.08, 95% CI=1.00-1.11, p<0.05). However, none of the household insecurity was associated with perceived stress in rural households. Interventions that promote equal access to resources for low-income individuals will likely to be more effective to alleviate economic burden of pandemic.

Household Water Insecurity Is Positively Associated With Household Food Insecurity in Low- and Middle-Income Countries

Drinking water access and water and food insecurity have been linked to mental well-being, but few studies have comprehensively assessed potential pathways linking these associations. Understanding these mediation pathways is particularly important among pregnant women, as prenatal stress and poor mental well-being have been shown to negatively impact fetal development. In this study, we address this gap by analyzing the relationships between drinking water source and water and food insecurity with mental well-being amongst pregnant women living in low-income, urban neighborhoods of Beira, Mozambique. Data for this cross-sectional analysis were collected among third-trimester, pregnant women (n=740) from February 2021 through October 2022 as part of a matched cohort study. Validated, cross-cultural measures of mental well-being and household water and food insecurity were administered in the survey. Drinking water source was determined by presence of a household drinking water source on-premises. We used logistic regression to characterize the associations between drinking water source, water and food insecurity, and mental well-being and causal mediation analysis to determine mediation by food and water insecurity along these pathways. We found evidence that water insecurity (OR 1.44; 95%CI 1.02, 2.02) and food insecurity (OR 2.27; 95%CI 1.57, 3.34) were individually associated with adverse mental well-being. Drinking water source was not associated with mental well-being (OR 1.00; 95%CI 0.71, 1.39), water insecurity (OR 0.86; 95%CI 0.60, 1.24), or food insecurity (OR 1.02; 95%CI 0.71, 1.47). Food insecurity may also mediate the relationship between water insecurity and mental well-being (ACME 0.05; 95%CI 0.02, 0.07; ADE 0.04; 95%CI -0.04, 0.13). Our findings support growing literature that water and food insecurity are important to mental well-being, a key aspect of overall health. Further research is needed to confirm causality along these pathways and determine specific mechanisms through which these interactions take place.

Food and water security are essential components for Panama’s advancement toward the Sustainable Development Goals. This study aimed to quantify the prevalence of household food insecurity and water insecurity, and to explore the association between them using standardized measurement tools. A cross-sectional survey was conducted between January and June 2024 using an online questionnaire administered via Google Forms. The survey collected sociodemographic data and applied the Food Insecurity Experience Scale (FIES) and the Household Water Insecurity Experiences (HWISE) scale to assess water and food insecurity, respectively. A total of 222 adult household heads were included (66.2% female), with a median age of 31.4 years. The prevalence of moderate and severe food insecurity was 29.7% (95% CI: 24.8–34.6%) and 6.1% severe food insecurity (95% CI: 3.7–8.4%), while water insecurity affected 27% of households (10.4% high; 16.7% moderate). Multiple linear regression showed that moderate to severe food insecurity was significantly associated with water insecurity (β = 0.19; 95% CI: 0.08–0.31) and lower income levels. Specifically, food insecurity was associated with households reporting no income (β = 0.25; 95% CI: 0.05–0.44) and those with monthly income between 501 and 1000 USD (β = 0.11; 95% CI: 0.01–0.22), compared to households with income above 1000 USD. The results suggest that food insecurity is significantly associated with water insecurity, supporting the need for integrated approaches in public policy to address basic resource access in vulnerable populations.

Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n=716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P<0.001) and 2.92 times greater odds of probable depression (P<0.001). Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.

This study compared the prevalence of concentrated urine (urine specific gravity ≥1.021), an indicator of hypohydration, across Tsimane' hunter-forager-horticulturalists living in hot-humid lowland Bolivia and Daasanach agropastoralists living in hot-arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. This study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane' households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). The prevalence of hypohydration among Tsimane' men (50.0%) and women (54.0%) was substantially higher (P < .001) than for Daasanach men (15.9%) and women (17.5%); the prevalence of hypohydration among Tsimane' (37.0%) and Daasanach (31.4%) children was not significantly different (P = .33). Multiple logistic regression models suggested positive but not statistically significant trends between household water insecurity and odds of hypohydration within populations, yet some significant joint effects of water and food insecurity were observed. Heat index (2°C) was associated with a 23% (95% confidence interval [CI]: 1.09-1.40, P = .001), 34% (95% CI: 1.18-1.53, P < .0005), and 23% (95% CI: 1.04-1.44, P = .01) higher odds of hypohydration among Tsimane' men, women, and children, respectively, and a 48% (95% CI: 1.02-2.15, P = .04) increase in the odds among Daasanach women. Lactation status was also associated with hypohydration among Tsimane' women (odds ratio = 3.35, 95% CI: 1.62-6.95, P = .001). These results suggest that heat stress and reproductive status may have a greater impact on hydration status than water insecurity across diverse ecological contexts.

IntroductionHousehold food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta.Materials and methodsThis cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study.ResultsStatistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water.ConclusionThis study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.

Household food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta. This cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study. Statistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water. This study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.

Water insecurity may exacerbate food insecurity even in water-rich environments: Evidence from the Bolivian Amazon

BackgroundWater and food insecurity often co-occur, and have independently been identified as potential risk factors for poor mental health. Their interlinkages are only just beginning to be explored; even less is known about how the relationships vary by gender. Understanding the independent associations of water and food insecurity with mental health, as well as their joint effects, can help identify which interventions might be most appropriate for improving health. MethodsWe explored how probable depression covaried with water and food insecurity using nationally representative data from the Mexican National Health and Nutrition Survey 2021 (ENSANUT 2021, n = 13,126). Cross-sectional data were collected on household water, food insecurity, and probable depression amongst adults. We used multivariable logistic regression models to examine the association of water insecurity and food insecurity with moderate-to-severe probable depression, and we stratified the models by sex. ResultsHousehold water insecurity was associated with higher odds of probable depression amongst women (1.37 OR, CI: 1.13–1.66) and men (1.30 OR, CI: 0.92–1.83). When controlling for household food insecurity, the association between probable depression and water insecurity was no longer important, however, household food insecurity was associated with higher odds of probable depression. Those experiencing joint water and food insecurity had the highest odds of probable depression (2.70 OR, CI: 2.13–3.40). The associations between water insecurity, food insecurity and mental health did not differ by sex. ConclusionConcurrent water and food insecurity increase the likelihood of probable depression amongst both men and women. Strategies to mitigate both resource insecurities could improve mental health.

Food and water insecurity have both been demonstrated as acute and chronic stressors and undermine human health and development. A basic untested proposition is that they chronically coexist, and that household water insecurity is a fundamental driver of household food insecurity. We provide a preliminary assessment of their association using cross-sectional data from 27 sites with highly diverse forms of water insecurity in 21 low- and middle-income countries across Africa, Asia, the Middle East, and the Americas (N = 6691 households). Household food insecurity and its subdomains (food quantity, food quality, and anxiety around food) were estimated using the Household Food Insecurity Access Scale; water insecurity and subdomains (quantity, quality, and opportunity costs) were estimated based on similar self-reported data. In multilevel generalized linear mixed-effect modeling (GLMM), composite water insecurity scores were associated with higher scores for all subdomains of food insecurity. Rural households were better buffered against water insecurity effects on food quantity and urban ones for food quality. Similarly, higher scores for all subdomains of water insecurity were associated with greater household food insecurity. Considering the diversity of sites included in the modeling, the patterning supports a basic theory: household water insecurity chronically coexists with household food insecurity. Water insecurity is a more plausible driver of food insecurity than the converse. These findings directly challenge development practices in which household food security interventions are often enacted discretely from water security ones.

Addressing the growing burden of noncommunicable disease (NCD) across Latin America requires identifying modifiable risk factors that can be targeted through policy and programmatic action. While water insecurity – the inability to reliably access sufficient water for domestic uses – has been found to be associated with diet-related NCD risk factors, few studies have quantified its association with NCDs. We therefore estimated the association between household water insecurity and six self-reported NCDs and NCD risk factors among adults in Mexico. Data are from 24, 920 adults (≥ 20 y) who participated in the 2021 or 2022 round of the nationally representative Mexican National Health and Nutrition Survey and provided information about NCDs diagnosed by a medical doctor. Household water insecurity in the prior month (no-to-marginal, low, moderate, or high) was measured using the Household Water Insecurity Experiences (HWISE) Scale. Survey-weighted multivariable log-Poisson regression models were used to estimate prevalence ratios (PR) between household water insecurity and NCDs, adjusting for confounders. Nationally, 16.9% of adults experienced moderate-to-high household water insecurity in the prior month. On average, participants in households with greater water insecurity were younger, less educated, and of lower socioeconomic status compared to participants in households with lower water insecurity. Relative to no-to-marginal water insecurity, moderate water insecurity was associated with higher prevalence of self-reported high cholesterol (PR: 1.15; 95% CI: 1.01, 1.30) and self-reported cardiovascular events (PR: 1.37; 95% CI: 1.02, 1.84), while high household water insecurity was associated with higher prevalence of self-reported diabetes (PR: 1.23; 95% CI: 1.01, 1.50) and hypertension (PR: 1.28; 95% CI: 1.10, 1.48). Greater household water insecurity was associated with a higher prevalence of self-reported NCDs and NCD risk factors among Mexican adults. Improving water access and sufficiency may therefore represent an under-recognized strategy to reduce NCD burden, but further research is needed to identify causal mechanisms and guide effective policy responses.

Evidence from diverse global populations suggests that household food insecurity (HFI) is associated with adult disability, but the association between household water insecurity (HWI) and disability remains understudied. Examinations of the joint association of dual HFI and HWI with disability are lacking. To explore independent and joint associations of HFI and HWI with functional disability in Ecuadorian adults. This cross-sectional study used data from the 2018 Ecuadorian National Health and Nutrition Survey, a nationally representative, population-based survey conducted in Ecuador. The study included adults (aged 18-99 years) with information on sociodemographic characteristics, household food and water security, and functional disability status. Data were collected in 2 waves of the survey, from November 2018 to January 2019 and June to July 2019. Statistical analysis was performed from May to December 2024. HFI, WFI, or both. The primary outcome was self-reported functional disability, assessed using the Washington Group Short Set on Functioning, a tool that uses a set of 6 questions to measure activity limitations. Among 42 071 participants (mean [SE] age, 48.0 [0.1] years; 31 683 male [75.3%]; 1840 African descendant [4.4%], 5184 Indigenous [12.3%], and 35 047 Mestizo ethnic majority group [83.3%]), most lived in urban areas (26 164 participants [62.2%]). Exposure to HFI only was associated with an increased risk for any functional disability (adjusted relative risk [aRR], 1.44; 95% CI, 1.37-1.52), as well as sensory (aRR, 1.43; 95% CI, 1.35-1.52), physical (aRR, 1.56, 95% CI, 1.42-1.72), and cognitive (aRR, 1.78; 95% CI, 1.61-1.98) disabilities. HWI exposure only was associated with increased risk for any functional disability (aRR, 1.12; 95% CI, 1.06-1.20), as well as sensory (aRR, 1.17; 95% CI, 1.09-1.25), physical (aRR, 1.15; 95% CI, 1.05-1.26), and cognitive (aRR, 1.17; 95% CI, 1.03-1.34) disabilities. Exposure to dual HFI and HWI was associated with a greater increase in risk than HFI or HWI alone of any functional disability (aRR, 1.61; 95% CI, 1.50-1.72), as well as sensory (aRR, 1.65; 95% CI, 1.52-1.79), physical (aRR, 1.72; 95% CI, 1.59-1.87), and cognitive (aRR, 2.01; 95% CI, 1.76-2.29) disabilities. In this study, dual exposure to HFI and HWI was associated with a greater increase in risk of any and specific functional disabilities compared with independent contributions of HFI and HWI alone. These findings highlight the importance of addressing HFI and HWI jointly rather than independently when conducting research on disability and other health outcomes and in designing policies and programs to protect at-risk adults and their households.

Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. Northern Kenya, June-July 2019. Daasanach pastoralist households (n 136) from seven communities. In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.