Water Supply Interruptions Are Associated with More Frequent Stressful Behaviors and Emotions but Mitigated by Predictability: A Multisite Study.

Water supply interruptions contribute to household water insecurity. Unpredictable interruptions may particularly exacerbate water insecurity, as uncertainty limits households' ability to optimize water collection and storage or to modify other coping behaviors. This study used regression models of survey data from 2873 households across 10 sites in 9 middle-income countries to assess whether water supply interruptions and the predictability of interruptions were related to composite indicators of stressful behaviors and emotional distress. More frequent water service interruptions were associated with more frequent emotional distress (ß = 0.49, SE = 0.05, P < 0.001) and stressful behaviors (ß = 0.39, SE = 0.06, P < 0.001). Among households that experienced interruptions, predictability mitigated these respective relationships by approximately 25 and 50%. Where the provision of continuous water supplies is challenged by climate change, population growth, and poor management, water service providers may be able to mitigate some psychosocial consequences of intermittency through scheduled intermittency and communication about water supply interruptions. Service providers unable to supply continuous water should optimize intermittent water delivery to reduce negative impacts on users, and global monitoring regimes should account for intermittency and predictability in post-2030 water service metrics to better reflect household water insecurity experiences.

Men's household water fetching in India: Gender inequity is associated with greater responsibility and related risks.

INTRODUCTION: Household water fetching elevates physical and emotional harms, and these are generally assumed to accrue to women due to gendered labor assignments. But even in cases like India where fetching remains a highly feminized task, there are households where the primary responsibility is assumed by men. METHODS: We test the proposition that men's responsibility for water fetching is predicted by greater gender equity, reflected in measures of wives' empowerment. We used an extremely large, nationally representative Demographic and Health Survey dataset from India (2019-2020), narrowed to only households in which spouses co-reside with off-plot water sources (N = 10 616), and applying a multinomial regression approach. RESULTS: In >20% of households, men are the primary fetchers. They are more likely to have primary responsibility when water is more distant, privately purchased, or transported by vehicle. Contrary to predictions, men assume greater responsibility for household water fetching as their wives' empowerment measures decrease and when they want to control their movement. CONCLUSION: Married men in India sometimes assume responsibility for water fetching, but this is not explained by greater household gender equity. The findings also suggest that when men are responsible for fetching they have heightened risk of some forms of physical trauma but less relative psychological harm. Detailing why men fetch water matters for identifying and mitigating the physical and emotion harms of bearing responsibility for water labor, with implications for how gender should be conceptualized in water interventions intending to improve health and well-being.

Beyond WASH: Testing Additional Connections Between Household Water Insecurity and Child Nutrition Outcomes in Multi-Country Contexts.

This study identifies multiple pathways connecting household water insecurity with child nutrition. Using nationally representative samples for 18 countries, we examine the mediating role of child's dietary diversity as a function of household water status, while also accounting for sanitation. We construct a latent household water insecurity score (HWI) and use Structural Equation approach to model underlying pathways. HWI affected child's HAZ score and hemoglobin both directly and indirectly, with a mediation from child feeding alongside effects from sanitation. Broadening the conception of household water insecurity and accommodating the indirect effects of water could improve explanations of child under-nutrition.

Determinants of tap water mistrust among Phoenix, Arizona Latinx adults.

The purpose of this investigation was to characterize factors that predict tap water mistrust among Phoenix, Arizona Latinx adults. Participants (n = 492, 28 ± 7 years, 37.4% female) completed water security experience-based scales and an Adapted Survey of Water Issues in Arizona. Binary logistic regression determined odds ratios (OR) with 95% confidence intervals (95% CI) for the odds of perceiving tap water to be unsafe. Of all participants, 51.2% perceived their tap water to be unsafe. The odds of mistrusting tap water were significantly greater for each additional favorable perception of bottled compared to tap water (e.g., tastes/smells better; OR = 1.94, 95% CI = 1.50, 2.50), negative home tap water experience (e.g., hard water mineral deposits and rusty color; OR = 1.32, 95% CI = 1.12, 1.56), use of alternatives to home tap water (OR = 1.25, 95% CI = 1.04, 1.51), and with decreased water quality and acceptability (OR = 1.21, 95% CI = 1.01, 1.45; P < 0.05). The odds of mistrusting tap water were significantly lower for those whose primary source of drinking water is the public supply (municipal) (OR = 0.07, 95% CI = 0.01, 0.63) and with decreased water access (OR = 0.56, 95% CI = 0.48, 0.66; P < 0.05). Latinx mistrust of tap water appears to be associated with organoleptic perceptions and reliance on alternatives to the home drinking water system.

Changing Flows: Sociotechnical Tinkering for Adaptive Water Management.

The Western United States is experiencing historic drought, increasing pressure on water management systems. Agricultural production that relies on surface water flows is therefore imperiled, requiring new innovations and partnerships in order to adapt and survive. In Arizona, some agriculture continues to rely on historic, low-tech irrigation infrastructure such as hand-dug open ditches that divert river water to flood fields. These ditch systems are managed through both formal ditch companies and informal associations. To address changing water availability and needs, ditch users regularly "tinker" with water infrastructure, experimenting and making changes beyond the original infrastructure plans. Such changes are informed and driven by local social relationships and realities of the physical infrastructure. These dynamics are critical to understanding the adaptive capacity and flexibility of the water system; however, they are challenging to recognize and record. In this paper, we apply the emerging conceptualization of sociotechnical tinkering to examine the adaptive management of irrigation ditches in the Verde Valley of Arizona. We find evidence that water users frequently tinker with their water delivery and monitoring infrastructure to respond to and anticipate changes in water availability. Viewed through the lens of sociotechnical tinkering, these interactions are understood as the material manifestations of situated practice and actor agency within a water management system. This case study contributes to literature on adaptive environmental management and the hydrosocial cycle.

Water Insecurity, Water Borrowing, and Psychosocial Stress Among Daasanach Pastoralists in Northern Kenya.

This article quantifies Daasanach water insecurity experiences in Northern Kenya, examines how water insecurity is associated with water borrowing and psychosocial stress, and evaluates if water borrowing mitigates the stress from water insecurity. Of 133 households interviewed in 7 communities, 94% were water insecure and 74.4% borrowed water three or more times in the prior month. Regression analyses demonstrate water borrowing frequency moderates the relationship between water insecurity and psychosocial stress. Only those who rarely or never borrowed water reported greater stress with higher water insecurity. The coping mechanism of water borrowing may help blunt water insecurity-related stress.

Health impacts of water and sanitation insecurity in the Global North: a scoping literature review for U.S. colonias on the Mexico border.

U.S. border colonias are peri-urban settlements along the U.S.-Mexico border. Residents often face substandard housing, inadequate septic and sewer systems, and unsafe or inadequate household water. As of 2015, an estimated 30% of over 5 million U.S. colonia residents lacked access to clean drinking water, suggesting health complications. This scoping review identifies a very limited existing set of research on water and sanitation insecurity in U.S.-Mexico border colonias, and suggests value in additional focused research in this specific context to address health challenges. Preliminary health data indicates that due to water insecurity, colonia residents are more likely to contract gastrointestinal diseases, be exposed to carcinogenic compounds from contaminated water, and experience psychosocial distress. These widespread health issues in colonias are exacerbated by historical and ongoing socioenvironmental injustices in the U.S.-Mexico border region and their relation to the poor health outcomes.

Fat Is All My Fault: Globalized Metathemes of Body Self-blame.

Norms valorizing not-fat bodies appear to have spread around the world, combined with a globalizing belief that thinness is the result of individual management of self and hard work. We examine themes of blame and felt responsibility for weight and "fat" in four distinct geographic and cultural locations: peri-urban Georgia, United States; suburban Osaka, Japan; urban Encarnación, Paraguay; and urban Apia, Samoa. Use of a novel metatheme approach that compares and contrasts these four distinct places characterized by different population-level prevalences of obesity and by specific cultural histories relevant to body norms and ideals provides a flexible toolkit for comparative cross-cultural/multi-sited ethnographic research. We show that self-blame, marked by an articulated sense of individual responsibility for weight and a sense of failing in this responsibility, is present in every field site, but to varying degrees and expressed in different ways. [fat, obesity, metatheme, stigma, self-blame].

Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments.

Water problems due to scarcity, inaccessibility, or poor quality are a major barrier to household functioning, livelihood, and health globally. Household-to-household water borrowing has been posited as a strategy to alleviate unmet water needs. However, the prevalence and predictors of this practice have not been systematically examined. Therefore, we tested whether water borrowing occurs across diverse global contexts with varying water problems. Second, we tested if household water borrowing is associated with unmet water needs, perceived socio-economic status (SES), and/or water-related system failures, and if water access moderated (or changed) these relationships. Using survey data from the Household Water Insecurity Experiences (HWISE) study from 21 sites in 19 low- and middle-income countries (n = 5495 households), we found that household-to-household water borrowing was practiced in all 21 sites, with 44.7% (11.4-85.4%) of households borrowing water at least once the previous month. Multilevel mixed-effect logistic regression models demonstrate that high unmet water needs (odds ratio [OR] = 2.86], 95% confidence interval [CI] = 2.09-3.91), low perceived SES (OR = 1.09; 95% CI = 1.05-1.13), and water-related system failures (23-258%) were all significantly associated with higher odds of water borrowing. Significant interactions (all p < 0.01) between water access, unmet water needs, and water-related system failures on water borrowing indicate that water access moderates these relationships. These data are the first to demonstrate that borrowing water is commonly used by households around the world to cope with water insecurity. Due to how prevalent water borrowing is, its implications for social dynamics, resource allocation, and health and well-being are likely vast but severely under-recognized.

Corrigendum to "Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments" [Global Environ. Change 64 (2020) 102148].

[This corrects the article PMC7566692.].

Water insecurity: An agenda for research and call to action for human biology.

Water insecurity-the lack of adequate and safe water for a healthy and productive life-is one of the greatest threats facing humans in the coming century. By 2030, half of the world is expected to be living in water-stressed conditions, given current climate change scenarios. A key goal of the UN Water Action Decade and Sustainable Development Goal 6 is to improve water security for the three billion people globally affected, but the future looks grim. For many communities, from Cape Town, South Africa to Flint, United States, the imagined dystopian future of severe water shortages has already arrived-shaped not so much by lack of water, but by aging infrastructure, underfunded utilities, social exclusion, politicized commodification, and environmental racism. Stepping off from my biocultural research in Cochabamba, Bolivia, I discuss how recent research is dramatically advancing our understanding of water insecurity, such as new findings around the biocultural causes and consequences of dehydration, contamination, and water stress. But, much more needs be done to support local communities in creating fair and just water systems. I discuss how human biologists can make crucial contributions toward the advancement of a much-needed science of water insecurity, while highlighting some practical and ethical challenges to advancing a core mission of providing safe, sufficient water to all.

Stigma: A biocultural proposal for integrating evolutionary and political-economic approaches.

OBJECTIVES: Stigma-the process by which people become socially discredited because they hold a characteristic that is classified as unacceptable or undesirable-has barely been considered in biocultural analyses. Yet, it provides an acute point of articulation for evolutionary and political-economic perspectives on human variation, including the biocultural production of health disparities. To explain the theoretical integration of the two perspectives to stigma, we first lay out some operationalizable definitions of stigma, and review feasible methods to capture them in the field. We then test the roles of predictors suggested from evolutionary (respondent's level of disgust, fear of contagion) and political-economic (respondent's perceived social standing and negative social labeling of those who violate hygiene norms) theories of stigma. METHODS: We used survey, interview, and behavioral report data from a study of hygiene behaviors at four local community sites in Guatemala, Fiji, New Zealand, and the United States (N = 300). We applied a hierarchical GLMM design that treats site as a random effect. RESULTS: The independent influences of both variable sets are evident in publicly visible forms of reported hygiene behaviors, specifically the exhibition of clean bodies, clothes, and homes. CONCLUSION: We propose that the study of stigma provides a productive operationalizable space to engage the promise of the biocultural synthesis to integrate evolutionary and political-economic models of health and human variation.

Household water insecurity is strongly associated with food insecurity: Evidence from 27 sites in low- and middle-income countries.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Measuring Human Water Needs.

Water connects the environment, culture, and biology, yet only recently has it emerged as a major focus for research in human biology. To facilitate such research, we describe methods to measure biological, environmental, and perceptual indicators of human water needs. This toolkit provides an overview of methods for assessing different dimensions of human water need, both well-established and newly-developed. These include: (a) markers of hydration (eg, urine specific gravity, doubly labeled water) important for measuring the impacts of water need on human biological functioning; (b) methods for measuring water quality (eg, digital colorimeter, membrane filtration) essential for understanding the health risks associated with exposure to microbiological, organic, metal, inorganic nonmental, and other contaminants; and (c) assessments of household water insecurity status that track aspects of unmet water needs (eg, inadequate water service, unaffordability, and experiences of water insecurity) that are directly relevant to human health and biology. Together, these methods can advance new research about the role of water in human biology and health, including the ways that insufficient, unsafe, or insecure water produces negative biological and health outcomes.

"If there is no water, we cannot feed our children": The far-reaching consequences of water insecurity on infant feeding practices and infant health across 16 low- and middle-income countries.

OBJECTIVES: Infant feeding plays a critical role in child health and development. Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study. METHODS: We interviewed respondents from 19 sites in 16 low- and middle-income countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively. RESULTS: Water was perceived to directly affect breastfeeding and non-breastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality. CONCLUSIONS: These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating biocultural pathways by which water impacts infant and young child feeding, it will be possible to understand if, and how, water security can be leveraged to improve child nutrition and health.

Sub-optimal household water access is associated with greater risk of intimate partner violence against women: evidence from Nepal.

Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health.

Water insecurity potentially undermines dietary diversity of children aged 6-23 months: Evidence from India.

Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015-2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6-23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender-related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition-independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water-based strategies can be leveraged in multiple ways.

Low water access as a gendered physiological stressor: Blood pressure evidence from Nepal.

OBJECTIVES: The study aims to test novel proposed biocultural pathways linking the stressful lived experience of water insecurity to elevated blood pressure, a risk factor for chronic disease. Using the case of Nepal, where women have primary responsibility for managing household water, allows testing for potentially gendered mechanisms that exacerbate negative physiological consequences of water insecurity for women relative to men. METHODS: Data are from the nationally representative 2016 Nepal Demographic and Health Survey (DHS), N = 8633 women and 6209 men. Multiple regression models tested effects of low household water access on systolic and diastolic blood pressure, as stress biomarkers, comparing women to men. Key covariates included HFIAS food insecurity scores, household wealth class (high, medium, low), and body mass index. RESULTS: In this cross-sectional study, low water access was consistently associated with higher women's systolic and diastolic blood pressure across all wealth levels. The strongest results were for the lowest wealth households, where low water access is concentrated. Higher food insecurity was also associated with higher systolic blood pressure values in women in these households. Men showed no such effects. CONCLUSIONS: This is the first study, to our knowledge, to demonstrate a consistent and direct association between living with water insecurity and elevated blood pressure measures. Findings support the proposition that the stress of living with water insecurity could manifest as chronic disease risk. In the Nepali case, the proposed mechanism appears highly gendered, reflecting the culturally prescribed responsibilities women particularly face for managing household water. Living with food insecurity compounds further the apparent effects.

Qualitative Data Sharing: Data Repositories and Academic Libraries as Key Partners in Addressing Challenges.

Data sharing is increasingly perceived to be beneficial to knowledge production, and is therefore increasingly required by federal funding agencies, private funders, and journals. As qualitative researchers are faced with new expectations to share their data, data repositories and academic libraries are working to address the specific challenges of qualitative research data. This paper describes how data repositories and academic libraries can partner with researchers to support three challenges associated with qualitative data sharing: (1) obtaining informed consent from participants for data sharing and scholarly reuse; (2) ensuring that qualitative data are legally and ethically shared; and (3) sharing data that cannot be deidentified. This paper also describes three continuing challenges of qualitative data sharing that data repositories and academic libraries cannot specifically address-research using qualitative big data, copyright concerns, and risk of decontextualization. While data repositories and academic libraries can't provide easy solutions to these three continuing challenges, they can partner with researchers and connect them with other relevant specialists to examine these challenges. Ultimately, this paper suggests that data repositories and academic libraries can help researchers address some of the challenges associated with ethical and lawful qualitative data sharing.

Obesity stigma as a globalizing health challenge.

BACKGROUND: Based on studies conducted in the global north, it is well documented that those who feel stigmatized by overweight/obesity can suffer extreme emotional distress, be subject to (often legal and socially-acceptable) discrimination, and adjust diet and exercise behaviors. These lead to significant negative health impacts, including depression and further weight gain. To date, weight-related stigma has been conceptualized as a problem particular to the highest income, industrialized, historically thin-valorizing societies like the US, Australasia, and Western Europe. MAIN BODY: There is limited but highly suggestive evidence that obesity stigma is an emergent phenomenon that affects populations across the global south. Emergent evidence includes: implicit and explicit measures showing very high levels of weight stigma in middle and low-income countries, complex ethnographic evidence of widespread anti-fat beliefs even where fat-positivity endures, the globalization of new forms of "fat talk," and evidence of the emotional and material damage of weight-related rejection or mistreatment even where severe undernutrition is still a major challenge. CONCLUSION: Recognizing weight stigma as a global health problem has significant implications for how public health conceives and implements appropriate responses to the growing "obesity epidemic" in middle and lower income settings.